A new report calls out the animal health industry for fuelling superbug resistance as a result of uncontrolled use of antibiotics and other drugs in intensively farmed livestock.

Antimicrobial resistance (AMR), fostered by the wanton use of antibiotic-laced feed and growth-boosting supplements for livestock and poultry, could lead to the “next pandemic”, warns the first-of-its-kind report on AMR that focuses on the long-ignored global animal health sector. 

The new report, Feeding Resistance, on the growing threat of superbug risks associated with animal health products, was issued last week by a group of forward-looking investors ahead of the opening of this week’s major UN pre-summit on food systems in Rome. 

Globally, some 70% of antibiotics and other antimicrobial drugs are fed to livestock and poultry, accelerating the risk of widespread antimicrobial resistance, warns the report, released by an investor network called the FAIRR Initiative last week.

(A) Largest five consumers of antimicrobials in livestock in 2010. (B) Largest five consumers of antimicrobials in livestock in 2030 (projected). (C) Largest Increase in antimicrobial consumption between 2010 and 2030. (D) Largest relative increase in antimicrobial consumption between 2010 and 2030. CHN, China; USA, United States; BRA, Brazil; DEU, Germany; IND, India; MEX, Mexico; IDN, Indonesia; MMR, Myanmar; NGA, Nigeria; PER, Peru; PHL, Philippines. (PNAS, 2015)

Critical drugs are still being marketed by the industry, worth some US$ 47 billion annually, as growth promoters and preventative medications, leading to their misuse and overuse in the world’s 70 billion animals raised in industrial livestock complexes, charges the report.

The report analysed publicly-available data from 10 of the largest publicly-listed animal health companies that manufacture and sell antimicrobials for use among livestock, poultry and also in fish farms, and which comprise about 40% of the sector overall.  

Intensive, industrial-style livestock and poultry production comprises the majority of those animals today that eventually end up as meat in supermarkets and on restaurant menus in developed countries – and increasingly in emerging economies as well. 

“For animal health companies, antibiotics and other antimicrobials are a volume business. The overuse and misuse of these products in animal agriculture is a significant contributor to the global risk of AMR, catalysed by manufacturing, marketing and sales practices,” the report states.

“The animal health sector is failing to live up to its responsibilities to manage the risks we all face from antibiotic resistance,” said Jeremy Coller, the British philanthropist who is the chair of FAIRR. “It’s absolutely necessary for animal pharma to improve its antibiotics stewardship.”

Industry labelling of antibiotics as animal growth products contributes to AMR

Livestock applications of antibiotics in metric tons/year, among the few dozen countries reporting use. (The Antibiotic Footprint)

In particular, the FAIRR report calls out 10 of the world’s leading animal health companies, which represent roughly 40% of the sector, for failing to adequately address and reduce AMR risks. 

These include Dechra Pharmaceuticals PLC (UK), Elanco Animal Health Inc (USA), Jinhe Biotechnology Co. Ltd. (China), Merck / MSD (USA), Orion Oyj (Finland), Phibro Animal Health Corporation (USA), Vetoquinol (France), Virbac (France), Zoetis Inc. (USA) and  Zydus Cadila / Cadila Healthcare (India).

“By labelling products for growth promotion and prophylaxis, animal health companies are directly influencing how farmers administer antibiotics to their animals,” said Jo Raven, senior manager at FAIRR and co-author of the report.

Sales of antibiotics represent approximately 24% of the total animal health market, and between 7-43% of individual companies’ total revenue, with figures likely to be higher if expanded to include all antimicrobials, the report found. 

The impacts can be immediate on the farmworkers themselves – even before drug-resistant bacteria or viruses spread more widely into the population, he warned.

Assessment of industry exposures to AMR risks

Antibiotic ‘severely restricted by WHO for human use – promoted by industry for everyday, non-medicinal use in humans

Ugandan dairy farmer Tony Kidega has taken a keen interest in turning the tide of antimicrobial resistance (AMR) in his country. -as part of a pilot project under way there

Raven cited a German study that found that up to 86% of humans who work with pigs directly – mainly veterinarians and farmers – carry livestock-associated MRSA, which can be a dangerous bacterial infection in the chronically and ill, resistant to many leading antibiotics.

Data from China and Viet Nam, collected as recently as 2018, illustrates the scale of the problem. In Viet Nam’s heavily agricultural Mekong Delta region, the use of antibiotics as prophylaxis can account for as much as 84% of total antibiotic use in animal agriculture.  In China, the use of such antibiotics for growth promotion accounts for an estimated 53% of total antibiotic use in livestock.

The report found that none of the10 largest publicly-listed animal health companies have a comprehensive strategy to mitigate the impact of AMR, nor do they have responsible marketing policies for use of antimicrobials in agriculture. It suggests that this is a particular problem in emerging markets where product labels can be a farmers’ only guide around when to use drugs and what doses.

In emerging markets, in particular,  “sales, marketing and package sizing practices contribute to growing AMR… ” the report states, and companies operating in such markets “do little to change the ingrained behaviour of their routine use for growth promotion or prophylaxis.”

For instance, the report cites the example of a product called Winmyco – sold by the Indian firm Zydus Cadila in 25kg bags and described as a “growth promoter” – which contains the antibiotic tylosin, categorised by the WHO in a 2016 report as a high-priority drug “critically important” for human health.

“This antibiotic is severely restricted for use in humans, yet is being promoted for everyday use for non-medical purposes in animals,” the report warns.

WHO, FAO and OIE have failed to address industry practices – despite long-term risks to humans and agricultural production

AMR risks across the animal agriculture value chain.

 WHO cites AMR as one of the top 10 global public health threats facing humanity.  A 2019 UN report estimated that drug-resistant bacteria kills roughly 700,000 people a year –  with a prediction that it would hit 10 million by 2050 if AMR continues at its current rate.

But the World Health Organization (WHO) and the global health community have largely focused on the injudicious use, or overuse, of antibiotics in human populations. Global health policymakers have largely sidestepped the potentially bigger challenges posed by uncontrolled administration of such drugs to animals.

Many antimicrobials such as tylosin, which are used both in human and animal health, are not even mentioned in the new WHO AWaRe classifications of antibiotics that guides global health policymakers and professionals about drugs that should be reserved or restricted for only the most urgent medical uses.  So despite being noted by WHO as “critically important” to human health in its comprehensive 2016 report, there is in fact no clear, up-to-date guidance from the the global health agency about the extent that such drugs could or should be used in animal health as well.

Despite signals of change – such as the formation of a “One Health” initiative with the World Organization for Animal Health (OIE) and the Food and Agriculture Organization (FAO), none of the UN agencies are tracking data or aggressively promoting the problems associaed with unfettered antimicrobials use in animal husbandry.

The World Bank has meanwhile warned that AMR could lead to an 11% decline in livestock production in low-income countries by 2050.

A pig pokes his head out of a barn in Oosterhout, Netherlands – where air pollution produced by livestock in rural areas has been linked to higher rates air pollution – and during the pandemic, more COVID-19 deaths.

Along with being a major contributor to AMR, intensive livestock production is also a major driver of climate change – with livestock consuming some two-thirds of the world’s grain and cereals production, which in turn drives deforestation and ground water pollution.  Ruminant livestock also are major emitters of methane, a powerful climate changing gas, and residues from livestock excrement mixes with other air pollutants to form airborne particulate matter that contributes significantly to air pollution in regions such as Europe.  

“AMR cannot be solved without stewardship and cooperation from this industry which manufactures, markets and sells antimicrobial products to protein producers to treat the animals we eat,” said Coller, warning that: “An AMR crisis threatens to make even routine operations such as a hip or knee replacement life-threatening because we may no longer have effective antibiotics available to treat patients in recovery.”

Vaccines and probiotics can replace medicines – and reduce reckless antibiotic use

Inspecting a pig’s health in Busia, western Kenya.

The report calls for increasing farmer/consumer, public and policymaker awareness of the risks associated with the overuse and abuse of antimicrobials in animal health products – so as to exert pressure on industry to reduce their use. 

It also calls on companies to increase their marketing to farmers of practical alternatives and measures that can reduce the need for antimicrobial products – which include antiviral and antiparasitic medicines along with antibiotics. 

Those can include: the better use of diagnostic tools; more use of vaccines; and more use of novel preventative and curative medicines. Proven treatments include: probiotics, prebiotics, immunotherapeutics, and in-feed enzymes, as well as bacteriophages (the deployment of harmless viruses that can infect and kill harmful bacteria). 

“Many of these alternatives show positive outcomes or have promise but require further development and widening of use in order to be cost-effective. Some animal health companies are recognising the commercial opportunities associated with alternatives to antibiotics,” states the report. 

New alternatives could be “extremely valuable” and could become the preferred option for farmers worldwide, it concludes.

Other sales and marketing measures, such as reducing package sizes to reduce the risk of unused or expired medicines being released into the environment, are also important, the report recommends. Labelling also should be clearer to prevent misuse of drugs.

Currently, animal health companies take an inconsistent approach to these measures.  For example, where farmers lack access to veterinarians, particularly in emerging markets, often the product label is their only guide to uses, dosage, method of application, and expiry date.

Addressing antibiotic residues in wastewater

Current manufacturing practices, including the WHO’s Good Manufacturing Practice (GMP) certification, which is the global standard for manufacture of pharmaceuticals – also fail to address antibiotics discharge in wastewater generated by factories producing animal drugs.  

“This means untreated wastewater releases antibiotic residues into the environment around factories increasing the risk of resistance,” Raven pointed out.

Encouraging meaningful industry commitments

On the more positive side, some of the large animal health companies have publicly committed to invest $US 10 billion collectively in alternatives by 2025, with the aim to develop 100 new vaccines, 20 new diagnostic tools, 20 nutritional enhancement tools, and 30 other products that will help to reduce the need for antimicrobials.

They include Boehringer Ingelheim, Ceva Sante Animale, Elanco Animal Health, IDEXX Laboratories,  Merck & Co., Phibro Animal Health Corporation, Vetoquinol, Virbac, Zenoaq and Zoetis.

Those commitments need to be fulfilled – and more, FAIRR asserts – for the well-being of industries themselves as well as the health of people the world over at risk from AMR.

“Animal health companies that do not increase their exposure to alternatives are likely to face increased financial pressures in the medium to long-term as the animal protein sector looks beyond antibiotics and towards preventive care and alternative treatment options as its first line of defence for protecting welfare and animal health,” states the report. 

“This report is a vital contribution to building the momentum needed to ensure the protection of the animal health sector from damaging practices and increasing regulatory risk,” says Coller.

Image Credits: pxfuel, Charyse Reinfelder, Global trends in antimicrobial use in food animals, PNAS 2015 , antibioticfootprint.net, Tony Kidega, Flickr: Dutchairplaneshooter, ILRI / Charlie Pye-Smith.

More affordable second-line ARVs will soon be available following an innovative pricing agreement.

People living with HIV in low-and middle-income countries will soon have access to generic second-line antiretroviral drugs at a much cheaper price following an innovative agreement between Unitaid and the Clinton Health Access Initiative Inc (CHAI).

The new pricing agreement announced on Monday will see pharmaceutical company Hetero Labs manufacture a generic combination of darunavir boosted with ritonavir (DRV/r) for $210 per patient, per year, much cheaper than the well-established but suboptimal alternative option, lopinavir/ritonavir (LPV/r).

 “It is vital that all those living with HIV who cannot stay on first-line treatment have access to a quality second-line product, and we are proud of our work with CHAI to make this happen,” said Unitaid Executive Director Dr Philippe Duneton.

Less toxic than other protease inhibitors, Darunavir is also easier to take

Darunavir (DRV) in combination with ritonavir is a best-in-class protease inhibitor. DRV has proven to be effective in patients who have never been treated for HIV and those who have experienced multi-drug resistance. Less toxic than existing protease inhibitors used in second-line treatment,  DRV is also easier to take.

Despite being available in the United States and other high-income countries for over a decade, low- and middle-income countries still lack access to an affordable, quality generic version of the drug.  Second- and third-line therapies are however critical for people living with HIV where first-line treatment may not be an option, due to medication resistance or intolerance.

Until the announcement by Unitaid and CHAI, DRV/r was too expensive for national treatment programmes in low- and middle-income countries to afford.

Best-in-class second-line HIV treatment is long overdue

Kenly Sikwese, HIV advocate and head of the African Community Advisory Board (AfroCAB), which advocates for better, more affordable HIV medicine, welcomed the announcement saying the board had been advocating for the use of DRV in second-line since 2011, and that the new agreement was a critical step in addressing the “longstanding inequity in access to this optimal HIV treatment in low- and middle-income countries”.

“We look forward to seeing policymakers across the globe move expeditiously forward to accelerate access to this very important drug for communities.”

Joy Phumaphi, CHAI Interim Co-CEO, said access to this second-line HIV treatment is long overdue and people living with HIV in low- and middle-income countries will now be able to access the same high-quality second-line medication as those in high-income countries, “enabling more patients to remain on treatment and save lives”. 

Image Credits: Commons Wikimedia.

How to support African women farmers is a key issue for the continent

As the COVID-19 pandemic and climate change exacerbate global food insecurity, African countries are committed to giving more support to small farmers – particularly women.

This emerged at the United Nations Food Systems Pre-Summit in Italy, which opened on Monday as a precursor to a formal UN summit planned for September.

Rwandan President Paul Kagame told the pre-summit that there was consensus among Africa nations that the continent’s food agenda needed to be based on five pillars: nutrition-centred food policies including school feeding programmes; local markets and local food supply chains; increasing agricultural financing (20% of expenditure); encouraging farmer cooperatives and ensuring women’s access to productive inputs and finally, expanding social safety nets and investing in climate advance warning systems.

Both UN Secretary-General Antonio Guterres and Pope Francis appealed for the world’s food system to be transformed in the face of hunger, poverty, climate change and inequality.

Guterres said the world was “seriously off track” in achieving the sustainable development goals by 2030, thanks to “poverty, inequality and high cost of food”.

About 811 million people face hunger in 2020, about 161 million more than in 2019, he added.

“The pandemic, which still assails us, has highlighted the links between inequality, poverty, food, disease and our planet,” said Guterres.

Meanwhile, Pope Francis urged the world to create food systems that “guarantee sufficient food at the global level and promote decent work at the local level; and that nourish the world today, without compromising the future.”

Women farmers lack land and support

UN Food System Summit gender champion Dr Jemimah Njuki

“There are 1.7 billion rural women and girls in the world – more than one-fifth of all humanity. It is unacceptable that they make up almost half the agricultural labour force, yet they are more likely than men to live in poverty and hunger,” said Sabrina Dhowre Elba, the UN Goodwill Ambassador for the International Fund for Agricultural Development (IFAD).

“In Ethiopia, as in many African countries, women are vital food system actors, but they face many challenges. Women, particularly in rural areas have multiple responsibilities in cooking, farming, fetching water for the household, finding firewood, childcare, food preparation while simultaneously engaging in trading of the food they produce or buy,” said Dr Lia Tadesse, Ethiopia’s health minister, addressing a session on micronutrient deficiencies.

While women performed up to 75% of farm labour, only 18,7% of agricultural land in Ethiopia was owned by women farmers, she added.

“Poverty, inequality and cultural and traditional practices limit woman’s ability to provide better plates for their families,” said Tadesse. “Malnutrition is the inevitable outcome of food systems that do not work for women. And this is also evident by women and children being the most affected in undernutrition and in micronutrient deficiencies.”

High rate of anaemia in women and children

Anaemia is as high as 24% for women of reproductive age and as high as 57% for children under five, she added.

UN Food System Summit gender champion Dr Jemimah Njuki, said that “how to support women smallholder farmers, how to make sure they actually have the productive resources that they need to transform food systems, how to ensure they actually have right to the land that they cultivate,” was one of the key issues in transforming food systems.

Elizabeth Nsimadala, President of the Pan-African Farmers Organization (PAFO) hailed the pre-summit: “It’s the first time that I’m seeing a UN process that is inclusive, diverse and open to all stakeholders.”

UN food systems pre-summit

Low productivity of small-scale farmers 

Lobin Lowe, Malawi’s Minister of Agriculture, lamented the “low production and yields” in his country “due to predominance of smallholder farmers”.

“Productivity levels remain lower than actual potential because of the smallholding land size and labour intensive production… and climate shocks such as droughts and floods,” Lowe told a summit side event on Tuesday.

Prof Amos Laar from Ghana said that a diagnostic analysis of his country, alongside community dialogues, had exposed five key weaknesses in the country’s food system.

“Number one, is consumption of unhealthy food,” said Laar. “Ghana is urbanising at a very fast pace. Currently, we have nearly 60% of our people living in urban areas in Ghana, and in these areas the food environment is not healthy.”

The second issue, said Laar, was reliance on energy-dense, unhealthy staple foods.

“Ghana must instigate a shift from actions that lead to feeding the population to actions that lead to nourishing them,” said Laar.

Sub-national disparities between different regions affected food production – as did poor infrastructure including a lack of processing and cold-chain capacity that lead to about 20% of food loss, said Laar. 

The final impediment, said Laar, was Ghana’s vulnerability to climate change, which has been exacerbated by environmental degradation – “land pollution, soil pollution, water pollution” – caused by illegal mining.

Beginning more than a year ago, the summit process has included more than 1,000 dialogues in 145 countries involving tens of thousands of people around the world. 

“The results of these dialogues have provided national governments with the most comprehensive picture to date of existing interconnected challenges – from hunger and poverty to rural livelihoods, health and youth unemployment – as well as opportunities to address these,” according to the UN.

 

Image Credits: UN.

World Trade Organization’s General Council meets in Geneva for first in-person session since COVID pandemic began – but fails to reach agreement on proposed IP waiver for COVID health products

World Trade Organization Director General Ngozi Okonjo-Iweala has ” high hopes” that the WTO Ministerial Conference (MC12) that convenes at the end of November can deliver decisions that curb harmful fisheries subsidies as well as improving access of low- and middle-income countries to COVID medicines and vaccines.  But WTO members must overcome a series of hurdles to show results by the end of a year – and demonstrate the continued relevancy of the global trade organization, officials warned Tuesday, following the opening of a two-day General Council meeting.

Two weeks ago, Iweala declared that members were “on the cusp of forging a WTO agreement to curb harmful fisheries subsidies”  – which undermine the environmental sustainability of ocean ecosystems, upon which billions of people worldwide depend for nutrition and food security.

However, as WTO General Council members huddled face-to-face for the first time in months, big decisions on both the fisheries issue as well as the thorny question of a proposed waiver on intellectual property rules for COVID-19 medicines and vaccines, were being still punted down the field to the autumn.

WTO TRIPS Council members will resume informal talks in early September in an effort to break the deadlock over the controversial proposal by India and South Africa to waive all forms of IP on COVID related health products for at least three years, said WTO spokesperson Keith Rockwell, at a press briefing. 

WTO members will also be going “line by line” over a draft text on fisheries subsidies, beginning in early September, in an effort to reach final agreement over another politically charged issue, he said.

WTO talks on the subsidies have dragged on for two decades – while unsustainable, industrial fishing operations continued apace to drain ocean fish stocks, fueled by lucrative government subsidies to powerful industrial fishing fleets and interests.

To add insult to injury, deep water industrial fishing boats often operate thousands of miles away from their own home countries – and offshore of the coasts of poor nations, depriving subsistance fishermen working shallower coastal waters of catches critical to their food security. Some three billion people worldwide depend on fish stocks as their primary source of protein, according to the WWF.

The emerging WTO agreement would ban subsidies that “contribute to unreported and unregulated fishing”. It would also prohibit subsidies for fishing overfished stocks, unless those subsidies help restore such stocks.  And thirdly, the draft text would prohibit subsidies that contribute to overcapacity and overfishing – with a detailed reference of those subsidies.

The net result  is that “non-harmful subsidies would not be prohibited – but subsidiers would have to prove that they have robust measures in place to avoid causing harm,” said Colombia’s Trade Ambassador Santiago Wills, who has been leading the negotiations. “In addition, this prohibition is complemented by other rules, limiting subsidies to distant water fishing.”

For TRIPS waiver agreement – all eyes now set to November’s Ministerial Council meeting

Reaching an agreement on fisheries as well as pandemic response is seen by Iweala as critical steps that also would demonstrate WTO’s relevance to the most pressing issues the world faces.

“A credible outcome here is critically important for the credibility of the organization,” declared Rockwell, of the various COVID initiatives now being debated at WTO.

Talks between rich and poor countries over the waiver initiative stalemated, however, in July’s round of meetings in the WTO TRIPS Council, leading only to an interim report detailing the issues over the deadlock at the two-day WTO General Council session. 

With an eye to producing results for the big November, Norwegian Trade Ambassador and TRIPS Council Chair, Dagfinn Sørli, said that he will reconvene WTO member delegations for an open-ended, informal session in early September – ahead of the next formal TRIPS Council meeting, set for October 13-14. 

Despite the current impasse between rich and poor countries over the proposal for a blanket waiver under WTO’s agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), everyone agrees on the ultimate objectives, Rockwell stressed.

That objective is to expand the supply of medicines and vaccines as fast as possible.  

‘No way they’re going to stop discussing this’

(Left-right) WTO Director General Ngozi Okonjo-Iweala and Chairperson Ambassador Davio Castillo, presiding over the General Council meeting 27-28 July.

“There’s no way they’re going to stop discussing this. It’s too important. It’s a very emotional issue, and it’s not going to stop,” Rockwell affirmed. 

“Let me  make it clear that on the broadest objective,  ramping up production, having trade in these essential products flowing smoothly.  … everyone agrees on this.” 

Key sticking points on the waiver initiative include the proposed duration of a waiver, it’s scope in terms of products that would be covered, as well as the technical TRIPS provisions that would be overridden by any waiver agreement, Rockwell said.

Under the latest formula put forward by South Africa, India and 13 other countries as well as the African Group and the Least Developed Countries group,  the waiver would cover all COVID health products and override all existing  TRIPS restrictions on the use and sharing of IP. It would remain in force for “at least 3 years from the date of decision,” subject to reassessment after that time.   

European delegations and their allies, however, continue to maintain that their proposal to streamline current TRIPS rules would achieve the same overall goal.  That proposal would ease the existing WTO IP rules, making it easier for countries to override commercial patents for urgently needed health products, by issuing their own “compulsory” licenses, including products for export. 

In mid-July, Australia, Brazil and China, as well as Canada, the European Union, and nearly two dozen other high-income and upper middle-income countries also tabled a WTO  “COVID-19 and Beyond: Trade and Health” proposal before the General Council to address critical supply chain bottlenecks related to national export restrictions, customs rules, tariffs and other technical issues – which in turn combine to limit the international movement of hundreds of inputs needed for vaccine and medicines production. 

And at Tuesday’s meeting, EU member states also pointed to their new initiative to set up biomedical innovation hubs in Senegal, South Africa and Rwanda as an example of the kinds of practical steps that need to be taken to actually implement technology transfer – so that available manufacturing capacity could be better harnessed in low- and middle-income countries – and more capacity built.  

Iweala so far sidestepped a position on the TRIPS waiver    

 

WTO Director General Ngozi Okonjo-Iweala, at the body’s General Council session, 27-28 July.

WTO Director Ngozi Okonjo-Iweala continues to seek some third way between the IP waiver initiative – backed by some 100 low- and middle-income countries – and the alternative proposal by the European Union and its allies.  

“It don’t have to be binary option” Rockwell, quoting the WTO DG.

He added that Iweala, as WTO DG, has so far “deliberately”  avoided taking a position on the TRIPS waiver issue – in light of the deep divisions between WTO members themselves. 

“But what she has said is that TRIPS alone is not enough…. We need to find a pragmatic and practical approach.

“And if you listen to the manufacturers, what they say is most important is the transfer of technology and know-how.  You need to have the equipment, the proper regulatory environment and so you need to have some technical assistance to ramp that up.”

“She has also been quite clear to [trade] ministers, that finance ministers, health ministers and development ministers will all be producing outcomes between now and the end of the year, and it would really not be a good look, i the trade ministers didn’t do the same.”

However, he suggested that despite the current impasse, sparks of progress are now apparent – and that is encouraging. 

“”She is very pleased that negotiations are underway.  I think she gets frustrated when you have a situation where people just read papers and talk past each other, and we’re beyond that now.”

Image Credits: WTO .

The tobacco industry is using deceptive advertising to promote its products, according to WHO.

While there has been significant global progress in curbing conventional tobacco products, newer tobacco and nicotine products such as e-cigarettes are evading regulation, according to the World Health Organization (WHO) 2021 report on the tobacco epidemic.

Some 5.3 billion people are now covered by at least one of the six tobacco ‘MPower’ control measures recommended by the WHO, including high taxes, bans on promotion, pack warnings and helping people to quit.

But electronic nicotine delivery systems (ENDS) such as ‘e-cigarettes’ are often marketed to children  – and escape regulation, according to the report, which was launched on Tuesday.

The tobacco industry also uses “thousands of appealing flavours and misleading claims about the products” to market these to children and teens, according to the WHO, adding that children who use these products are “up to three times more likely to use tobacco products in the future”. 

“These products are hugely diverse and are evolving rapidly,” said Dr Rüdiger Krech, WHO’s Director of Health Promotion Department. 

“Some are modifiable by the user so that nicotine concentration and risk levels are difficult to regulate. Others are marketed as ‘nicotine-free’ but, when tested, are often found to contain the addictive ingredient. 

“Distinguishing the nicotine-containing products from the non-nicotine, or even from some tobacco-containing products, can be almost impossible. This is just one way the industry subverts and undermines tobacco control measures.”

Youth are targets of the tobacco and nicotine industry

Caleb Mintz: Targetted in Ninth Grade.

Caleb Mintz, a young anti-tobacco advocate from the US told the launch that an official from a vaping company had given a ‘mental health’ talk at his high school where he cast doubt on the dangers of e-cigarettes and vaping.

“When I was in ninth grade, a speaker came to my high school under the guise of a mental health seminar. That speaker turned out to be a representative of Juul Corporation, which is one of the largest vaping conglomerates, and the speaker proceeded to send mixed messages about the safety of the [vaping] devices, saying ‘It is the safest product on the market’,” Mintz said

“As a result of the presentation, many of my peers began to question whether the product  once seen as dangerous was even harmful at all, with some of my closest friends now believing their habits are justified, due to a trusted adult telling them that.”

US anti-tobacco advocate Jasmine Hicks, told the launch that the majority of young people that her organisation, Truth Initiative, reached out to had no idea that e-cigarettes even contained nicotine.

ENDS are ‘highly addictive’

WHO Director-General Dr Tedros Adhanom Ghebreyesus, called for better regulation of ENDS, describing nicotine as “highly addictive”.

“Where they are not banned, governments should adopt appropriate policies to protect their populations from the harms of electronic nicotine delivery systems, and to prevent their uptake by children, adolescents and other vulnerable groups,” said Tedros.

Eighty-four countries don’t restrict or regulate ENDS in any way, although 32 countries have banned their sale and 79 have adopted at least one partial measure to prohibit their use in public places, prohibit their advertising, promotion and sponsorship or require the display of health warnings on packaging. 

“More than one billion people around the world still smoke. And as cigarette sales have fallen, tobacco companies have been aggressively marketing new products – like e-cigarettes and heated-tobacco products (HTP) – and lobbied governments to limit their regulation,” said Michael Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Injuries, who funds much of the global anti-tobacco work.

“Their goal is simple: to hook another generation on nicotine. We can’t let that happen.”

There are an estimated one billion smokers globally, 80% of whom live in low- and middle-income countries (LMICs), and tobacco is responsible for the death of eight million people a year, including one million from second-hand smoke, according to the  WHO.

Almost 80% of high-income countries (HICs) (78%) regulate ENDS while three-quarters of LICs do not.

“The tobacco industry’s ramped up marketing of ENDS and HTPs, especially to young people, is a real threat,” said Rebecca Perl, Vice President of Partnerships and Initiatives at Vital Strategies.

“With its intent on hooking a new generation of tobacco users, the industry is snatching young people’s opportunities, experiences and future potential by shortening their lives. Young people who use new products such as ENDS and HTPs are more likely to regularly use conventional cigarettes, as cited in the report. Yet remarkably 84 countries still have no regulations and restrictions at all on these products.”

Marathon runner Paula Radcliffe

Renowned marathon runner and clean air advocate Paula Radcliffe joined the launch to appeal for public health warnings about tobacco and e-cigarettes to be carried on social media to reach young people.

“Our bodies enable us to do so much and to achieve so much, but we have to look after them and look at the fuel that we put into them,” said Radcliffe. “There are enough stresses around in this world which are unavoidable. I think tobacco is really one that is avoidable. Respect your body and the world by what you put into it and how you live your life.”

 

Image Credits: WHO.

New WTO Director General Ngozi Okonjo-Iweala, has urged WTO members to find a way to compromise, but rich and poor countries remain an at impasse.

Vaccine access advocates issued increasingly desperate, last minute calls upon the World Trade Organization to take action over a stalled initiative to impose a temporary waiver on intellectual property for COVID medicines, tests and vaccines – even as the initiative appeared doomed to a stalemate for the rest of the summer. 

Ahead of the opening of Tuesday’s two-day meeting of the WTO General Council, Médecins Sans Frontières urged the European Union (EU), Norway, the UK, and Switzerland “to stop stalling the landmark proposal to waive intellectual property (IP) on lifesaving COVID-19 medical tools at the WTO, and join forces with more than 100 countries supporting it by openly engaging in formal negotiations to expedite the consensus. 

“Since the proposal was first tabled nearly 10 months ago, the pandemic has worsened and increasingly hit many countries across Africa, Latin America and Asia, with the disease having killed officially more than 4 million people globally,” MSF noted, referring to a proposal by India and South Africa for a blanket waiver on WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), for COVID-related IP, which supporters say would lower prices faster and stimulate local vaccine and medicines production. 

African COVID surge due to lack of access to medicines and vaccines 

Health workers in Cape Town, getting vaccinated against COVID-19 in March 2021. On a continent beset with supply shortages, South Africa is one of the few African countries to have been able to continue mass COVID vaccinations at scale over the past weeks and months.

 African MSF pointed to the worrisome rise in COVID-related deaths in Africa – linked to the low levels of vaccine access which have seen only about 1.5% of the population vaccinated – in comparison to some 50-60% in many high-income countries. 

“As many countries in Africa right now are reporting a high number of deaths due to the spread of new and existing variants of COVID-19, these governments are in dire need of vaccines, diagnostics, oxygen and other treatments to help save lives of critically ill patients,” said Dr Tom Ellman, director of MSF’s Southern Africa Medical Unit. “While the World Health Organization recommends two newer therapeutics for patients with severe COVID-19, medical practitioners and their patients in many low- and middle-income countries cannot access them due to monopolies, limited supply and high prices. It is outrageous to see countries blocking the TRIPS Waiver that is desperately needed as an important tool to remove legal barriers and allow production to be scaled up by multiple manufacturers for critical COVID-19 drugs, diagnostics and vaccines.”

European countries & industry backed voluntary measures 

Ursula von der Leyen, President of the European Commission, at a Global Health Summit event in late May. The EU has supported broader vaccine access, in prinicple, but critics say it falls down on practices that would more rapidly open the doors to production in low- and middle-income countries.

European countries have touted increased pharma collaborations – including a recently announced mRNA vaccine production hub in South Africa, as examples of how voluntary measures will be more effective than a blanket waiver.   Pharma voices have also warned that a wide-open WTO IP waiver on complex and sensitive biological vaccine manufacturing processes would open the floodgates to shadowy producers that could suck up critical, but scarce, inputs – without reliably expanding supplies.  And, they point to the fact that global production will scale up rapidly – so that the real solution is for rich countries to stop hoarding current supplies until that can happen. 

But MSF said donations and other voluntary measures have failed to work, pointing out that so far Pfizer and Moderna, the manufacturers of the two most efficacious, mRNA vaccines, have so far allocated only 11% and 0.3% of their production to low- and middle-income countries (LMICs).  And the problem is not only with respect to vaccines, MSF points out, citing the recently WHO-approved COVID antibody cocktail treatments, tocilizumab and sarilumab, as examples.

Sarilumab, known by its brand name Regeneron, costs as much as US $1830 per dose, MSF noted. Roche, the Swiss company that produces tocilizumab, has said it will not enforce its patents in some countries. But that does not go far enough to really reduce prices and expand supplies, MSF charged. 

“Two new potential COVID-19 therapeutics, casivirimab and imdevimab, are also patented by Regeneron and are being sold as a cocktail at a dose price of $US 820 in India, $US 2,000 in Germany and $US 2,100 in the US. These high medicine prices and monopolistic actions are barriers to global access,” said the MSF statement.

“At a moment when we are in race against time to save lives and control the spread of unchecked transmission and development of new dangerous variants, pharmaceutical corporation’s business-as-usual approach is intolerable. With potentially promising treatments in the pipeline, opposing countries must stop filibustering the waiver proposal and support it to cover not just vaccines, but also treatments, diagnostics and other health technologies,” said Ellman. 

WHO Director General Dr Tedros Adhanom Ghebreyesus last week issued similar pleas and warnings, saying that the world simply lacks the “political will” to end the pandemic – even though it has the means.

But on the eve of the WTO General Council meeting of trade ministers, chances for any sort of breakthrough appeared increasingly slim.  While waiver proponents say that they have over 100 backers for their proposal, most WTO decisions are taken by consensus, and so opposition by even one of the WTOs 164 members would perpetuate the impasse.  Once the General Council breaks, negotiations would not likely resume until mid-September at the earliest – although WTO Director General Ngozi Okonjo-Iweala last week urged WTO members to shorten their holidays in order to come to some sort of agreement, in light of the urgency of the pandemic.

COVAX facility announces new World Bank loan arrangement for vaccine purchases  

COVAX-led vaccine deliveries, launched in February and then nearly halted in April, after India experienced a COVID surge, leading to the diversion of supplies from the Serum Institute of India domestic needs.

Meanwhile, the beleaguered COVAX global vaccine facility, whose ambitious COVID vaccine distribution plan to low-income countries faltered over vaccine hoarding and supply shortages this spring, has made a new deal with the World Bank to finance its advance vaccine purchases. 

The new finance mechanism, announced jointly by Gavi, The Vaccine Alliance and The World Bank, should help ease constraints faced by COVAX in competing for the future purchase of available vaccine doses on the open market – making it less dependent on rich country donations to seal deals for large vaccine pre-purchases. 

That reliance upon rich country largesse and donations, which were not always provided in a timely manner proved to be a key stumbling block in the COVAX facility’s ability to compete and secure large quantities of vaccine doses from multiple suppliers in the initial phases of COVID vaccine rollout, critics told Health Policy Watch in a recent story on COVAX’s shortcomings. 

Gavi announcement thin on details of new arrangements

Gavi CEO Seth Berkley

But Monday’s announcement was thin on details of who would, in fact, be taking out the loans for the vaccine purchases – COVAX or the countries themselves – as well as timeframe and terms for repayment. 

The new arrangement will “accelerate COVID-19 vaccine supply for developing countries through a new financing mechanism that builds on Gavi’s newly designed AMC (advanced marketing commitment) cost-sharing arrangement,” said the Gavi/World Bank press release. “This allows AMC countries to purchase doses beyond the fully donor-subsidized doses they are already receiving from COVAX.”

Asked by Health Policy Watch for further details on the new financing mechanism, GAVI did not immediately reply. 

Some 92 low- and middle-income countries participate in Gavi’s longstanding AMC scheme, which offers  a wide range of vaccines for childhood diseases at free or concessionary prices – and more recently COVID vaccines. 

Bolstered by the new finance, COVAX says it will be able to make available up to 430 million additional COVID vaccine doses, or enough to fully vaccinate 250 million people, for delivery between late 2021 and mid-2022. 

Adjusted 2021 COVAX supply forecast remains highly ambitious – even after setbacks 

In light of the supply problems already seen, COVAX delivery goals for 2021 have been dialed back significantly – from the 1.8 billion doses that COVAX had initially aimed to provide.  

The global supply forecast of the COVAX Facility for 2021 and 2022, as of 6 July.

The latest forecasts, issued on 23 June, and 6 July suggest that the facility still aims by the end of December to have some 1.8 milion vaccine doses available, and deliver some 1.1 to 1.5 billion.  

However, even that remains a highly ambitious goal – insofar as only 138 million COVID vaccine doses had been delivered globally by the COVAX facility, as of 23 July.  

According to the new Gavi-World Bank finance arrangements, countries with “approved World Bank vaccine projects” can then confirm the purchase of additional doses through COVAX and the Gavi AMC facility, benefitting from a wider choice of vaccines as well as delivery windows. 

“On receiving a request from the country, the World Bank will provide COVAX a payment confirmation, allowing COVAX to make advance purchases of large amounts of vaccine doses with manufacturers at competitive prices.

“There will be several supply offerings where countries will have the opportunity to select and commit to procuring specific vaccines that align with their preferences,” said the press statement by Gavi and The World Bank. 

“Accessing vaccines remains the single greatest challenge that developing countries face in protecting their people from the health, social, and economic impacts of the COVID-19 pandemic,” said World Bank Group President David Malpass. “This mechanism will enable new supplies and allow countries to speed up the purchase of vaccines. It will also provide transparency about vaccine availability, prices, and delivery schedules. This is crucial information as governments implement their vaccination plans.”

Supporters of the COVAX facility have long affirmed that the model is solid – but more predictable finance is needed to allow the facility to compete for vaccines more aggressively in the marketplace. 

Civil society advocates have charged that the more fundamental problem with COVAX remains the charity-based model that it represents – anchored in donations of money or vaccines by rich countries – rather than support for the wider production of vaccines in LMICs themselves. 

COVAX is co-led by Gavi, the World Health Organization (WHO) and the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) – all working in partnership with UNICEF and the PAHO Revolving Fund to distribute vaccines and support vaccine campaigns on the ground in countries.  

Image Credits: Felix Dlangamandla, DGTresor , Western Cape government, European Commission, Gavi , WHO.

A major global ‘pre-summit’ on food systems took place in Rome on Monday.

The world needs an investment of US$40 billion per year by 2030 to eradicate hunger. And these investments must be accompanied by major reforms in food systems to make them more efficient, resilient, and sustainable, said experts at a major global “pre-summit” on food systems, Monday.

Transformations to food systems should focus on providing seed security to smallholder farmers, training on improved planting techniques, and ensuring production of more nutritious, biodiverse and climate-resilient crop varieties.

The UN Pre-Summit taking place in Rome from 26-28 July, is a stage-setter for the full-fledged UN Food Systems Summit, scheduled for September in New York. 

“We are here in Rome to bake the cake that will be iced in September. And as we harvest from the rich and diverse outcomes of this process, I am hopeful we will agree on the key ingredients needed to support our countries,” said Amina J. Mohammed, Deputy Secretary-General of the United Nations, at the pre-summit opening Monday.

Amina J. Mohammed, Deputy Secretary-General of the United Nations, at the UN Food Systems pre-summit opening on Monday.

The series of pre-summit sessions aims to foster dialogue between farmers, indigenous peoples, civil society, researchers, private sector, ministers of agriculture, environment, and health, and policy leaders. Meanwhile, UN agency officials and government ministers called for greater and more innovative investment from high-income countries and the private sector. 

“We’ve got the expertise in this room and around the world to end hunger,” said David Beasley, Executive Director of the World Food Programme (WFP). 

“Now it is time to act. We do not necessarily need more meetings, we need more monvey and more investment to eradicate hunger,” said Gerd Müller, Germany’s Federal Minister for Economic Cooperation and Development.

“Increased investment in sustainable transformation, in agriculture, renewable energy, education, and…fair value chains between developing and industrialized countries” is needed from industrialized nations, said Müller, calling on the G20 and G7 to adopt a smarter and more targeted agenda on food systems.

“We need to look at ways where we can create innovative financing to make sure that we can bridge the gap of US$40 billion a year. And not only resources coming from our traditional donors, but also resources coming from the private sector and from domestic resources,” said Gilbert Houngbo, President of the International Fund for Agricultural Development (IFAD).

Gilbert Houngbo, President of the International Fund for Agricultural Development.

Failures of the current food system – obesity, undernutrition & starvation 

Global food systems are currently in dire need of reform, experts stressed at the pre-summit, co-hosted by the Food and Agriculture Organization (FAO),the  International Fund for Agricultural Development (IFAD), the World Food Programme (WFP), and the Italian government.

“The dominant global food systems…are wasteful, inequitable, undemocratic, and unsustainable,” said Anne Nuorgam, Chair of the Permanent Forum on Indigenous Issues. 

Sufficient food is produced to feed the world’s population, but one third of it, almost 1.3 billion tonnes, is lost or wasted every year throughout the supply chain from initial agricultural production to household consumption. Along with lost nutritional opportunities, that food-waste also contributes to climate change, in terms of the climate footprint of wasted energy, water resources, fertilizers, and other production inputs. 

Increased industrialization of the food production chain, including greater reliance on monocultures, production of cheap starches and processed foods, is exacerbating, rather than easing, the twin crises of obesity and malnutrition  –  with the number of food insecure people growing in recent years. 

Over the past five years, the world has regressed on progress towards tackling hunger. In 2015, there were 80 million people on the brink of starvation and today there are 270 million. 

During COVID-19, there was an increase of 165 million people dealing with chronic food insecurity and 135 million people with acute food insecurity. 

“In 2020, the increase [in food insecurity] was equal to the sum of the increase over the last five years,” said Professor Sheryl L. Hendriks, Director of the Institute for Food, Nutrition and Well-being at the University of Pretoria in South Africa. She was speaking at ‘Achieving Zero Hunger: Nutritiously and Sustainably,’ a parallel session organized by the Global Alliance for Improved Nutrition (GAIN). 

Food systems on the whole also fail to provide adequate calories and nutrition to approximately 760 million people. 

“The world needs a wake up call. We are in serious trouble,” said Beasley.

Industrialized food systems driving deforestation, biodiversity loss & climate change

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

In addition, industrialized food systems are the number one cause of deforestation and they are among the main drivers of climate change, biodiversity loss, and erosion of topsoil. 

Food systems, overall, generate massive amounts of pollution and produce close to one third of global greenhouse gas emissions. Even in Europe, for instance, agricultural chemicals and fertilizers used on crops and for livestock production are a major, neglected cause of air pollution – due to the particulate emissions that they generate. 

Land grabs from indigenous peoples are instigated by food systems, forcibly displacing indigenous communities, destroying livelihoods, and violating human rights.

“The system is not fit for purpose,” said Mari Pangestu, World Bank’s Managing Director of Development Policy.

Despite the large divergence in perspectives between actors in food systems, “there is consensus on one thing: the status quo is not acceptable,” said Houngbo.

“We have to recognize that we do have failures, not only market failures, but failures around the whole chain,” he added. 

Reforms to food systems should focus on small farmers

Farmers should be central to transformations in food systems, said the experts on Monday. 

There are some 500 million smallholder farms worldwide that over 2 billion people depend on for their livelihoods. These small farms produce 35% of the world’s food supply and 80% of the food consumed in Asia and sub-Saharan Africa.

Smallholder farmers typically produce small volumes on relatively small plots of land and are vulnerable in supply chains. 

“This is where we must invest,” said Beasley. 

David Beasley, Executive Director of the World Food Programme.

Fostering seed security, secure land tenure & crop diversity  

Ensuring seed security to smallholder farmers is defined as providing farmers and farming communities with access to adequate quantities of quality seed and planting materials, adapted to their agro-ecological conditions and socioeconomic needs. 

Seed security is particularly important to farmers in areas that experience frequent droughts or other natural disasters. 

“We need to put farmers and indigenous peoples first, both in access to crop diversity and in seed policy and practice,” said Aksel Jakobsen, State Secretary of International Development for the Norwegian Ministry of Foreign Affairs. 

“Policy and regulation must provide farmers with the legal space to save, use, sell and exchange seeds from their harvests,” said Jakobsen. “By providing legal space and empowering local communities by strengthening farmers seed systems, we are investing in a true path towards ending hunger.”

Smallholder farmers would also benefit from access to high quality and affordable farming equipment and training on basic planting techniques.

Providing smallholder farmers with tools and technologies they need 

“We must give smallholder farmers the tools and technologies that will help them boost their deals and manage the impact of growing climate shocks as we race to meet the goals of the Paris Climate Agreement,” Samantha Power, Administrator of USAID, said at the GAIN event on Monday.

Samantha Power, Administrator of USAID.

“The poorest farmers in the world deserve the same access to the innovative new tools and services that wealthier farmers benefit from,” said Andrew Youn, Co-founder of One Acre Fund, at the GAIN session.

Crops developed with biotechnology are able to withstand harsh weather conditions and reduce hunger in the face of climate change. Drought tolerant crops can help maintain farm productivity and yield. 

Farmers should also be empowered to invest in farming techniques that benefit the environment by ensuring the health and sustainability of the soil and land. Agroforestry, which involves the integration of trees and shrubs into crop and animal farming systems, is a technique to reduce erosion.

Transition to ‘agroecology’ and ecosystem restoration 

Scientific innovation is a critical part of reforming food systems and reducing hunger worldwide. Innovations, such as bio science plant breeding, solar irrigation, carbon capturing soil, and digitized blockchain technology to assure land rights, could be important to benefit smallholder farmers and the environment. 

Advocates from farmers’ associations called for policies that respect the rights of family farmers and indigenous peoples to natural resources, especially land, water, forestry, and seeds. 

They also advocated for the transition to agroecology and ecosystem restoration, including promoting local traditional crops, which are often neglected and underutilized.

In addition, adequate financing should be directed to farmers through national committees and cooperatives with family farmers. 

“To be bold, for us, is to transform our food system into something that is sustainable, resilient, regenerative, healthy, nutritious, just, and empowering to people, including family farmers, which improves production in crops, livestock, fisheries, forestry, herding and pastoralism,” said Estrella Penunia, Secretary-General of the Asian Farmers’ Association for Sustainable Rural Development. 

Estrella Penunia, Secretary-General of the Asian Farmers’ Association for Sustainable Rural Development.

“We need to move beyond incremental change,” said Peter Bakker, President and CEO of the World Business Council for Sustainable Development. “Transformational change is what we need and it is urgent.”

Private sector has important role to play in reforms 

“Solving food insecurity is not only a government problem. The private sector has to play an equally important part,” said Sunny Verghese, Executive Director of Olam International, speaking at the GAIN event.

The World Business Council for Sustainable Development announced the launch of the Business Declaration for Food Systems Transformation on Monday.

“Business commits to help lead the food system transformations by implementing actions in their companies, their sectors and their value chains,” said Bakker. 

“We must not exclude the private sector. They must be part of the solution,” said Beasley. “As I talk to the private sector, I know you need a return on your investment, but be willing to make a little bit less to empower the smallholder farmers and to change systems in developing nations so that we all share this success.”

Big timber, cattle, palm, and pulp and paper cause significant damage to the environment, but “[we should] never make these sectors the enemy,” said Dr. Inger Andersen, Executive Director of the United Nations Environmental Programme (UNEP). 

“Those sectors have a responsibility to lean in and to drive sustainability. That is what we need to see them do,” she added. “And governments need to set policies that do not subsidize, that do not cause further destruction. [They should] subsidize the smallholder, and big agriculture, if that is what is needed, but not with those negative consequences.”

Image Credits: FAO, FAO.

Drones hovering above Tokyo’s Olympic Stadium form the shape of planet earth at the opening ceremony Friday, 23 July

The long-delayed 2020 edition of the Tokyo summer Olympics opened Friday against the sober backdrop of soaring COVID infection rates, but with plenty of pomp and ceremony nonetheless –  including a massive fireworks display and an aerial show of drones resembling planet earth hovering above Olympic Stadium, while John Lennon’s “Imagine” echoed across the night sky.   

Only about 950 VIPS, including United States First Lady Jill Biden and French President Emmanuel Macron, attended the gala opening ceremony – leaving the 68,000 seat Olympic Stadium virtually empty – but still booming with chords of characteristically Japanese video game sounds, followed by classical music, as well as  amplified recordings of cheering crowds – while protestors against the games marched outside. 

With mostly – but not always – masked Olympic athletes parading around the nearly-empty stadium, the games are being widely perceived as a global test case for how “normalization” might look against the persistent pandemic risks – now being fueled by the highly infectious Delta variant spreading across Japan.  

Despite weeks of  speculation over whether the games might be canceled at the last minute due to growing public health risks, critics said that the decision of the International Olympic Committee (IOC) organizers to go ahead irregardless, was not a surprise – in light of the billions of dollars in TV broadcast revenues at stake.  

Japan Takes Very Stringent Measures – Global test case if they are sufficient  

But the measures being taken by Japan and the IOC to cope with the obvious risks, were also strict – and unprecedented. They contrasted sharply with the risky in-person crowds of spectators that marked the recent European football cup matches.  

Some 11,000 Olympic athletes were being carefully sequestered in Japan’s Olympic village – consigned to live, eat and work out under strict supervision at the village – and with their personal contacts limited to their immediate trainers and team. 

That, after undergoing a rigorous regime of pre- and post- travel testing, as well as quarantine upon arrival. Although vaccination was not a mandatory condition for participating, some 80% of participating athletes have been vaccinated, the IOC reported. 

With the 68,000 seat stadium closed to the public, Tokyo residents were being urged to stay home and watch the games on TV. 

Tokyo infections hit new peak – 200 Olympic athletes test positive 

Masked protesters cordoned off by police outside of Olympic Stadium as the 2020 Olympic games hold opening ceremony.

Even so, as of opening night, some 200 of the 11,000 athletes competing had already tested positive for COVID. That included athletes from: Australia, Chile, Czech Republic, Mexico, Netherlands, Russia, South Africa, United Kingdom and the United States. 

Among the Czech delegation, where six athletes all fell ill, an unvaccinated team doctor Vlastimil Voráček, who had previously claimed that gargling and sucking lozenges can prevent COVID was the first to test positive. All travelled together on a charter flight.

With case counts inside the village growing, Guinea’s government initially announced that its national team would pull out of the Tokyo Olympics, but later reversed the decision.

“Due to the resurgence of COVID variants, the government, concerned with preserving the health of Guinean athletes, has decided with regret to cancel Guinea’s participation in the 32nd Olympics scheduled for Tokyo,” said the initial Guinean statement, which was retracted after the government said that it had received more guarantees from Japanese health authorities. 

Individual top athletes from other countries opted to sit out the games at home – rather than risk traveling only to become infected. 

Tokyo reporting peak in new cases

Olympics cauldron lit signaling the start of the year-delayed 2020 games .

On 22 July, the eve of the games, the megacity of Tokyo was also reporting almost 2,000 new cases a day, the megacity’s highest peak since 7 January, when 2520 new cases a day were reported. 

Although Japan’s overall infection levels remain well below those of European countries such as the United Kingdom and France, or even the United States – those latter nations all have greater levels of COVID variant protection, with some 40-50% or more of their population fully vaccinated.  

While only 23% of Japanese are fully vaccinated so far, vaccines are now becoming more available, and the government is urging people to turn out en masse to get the jabs.  Large-scale vaccination venues were set up by the Tokyo metropolitan government to speed up the pace of the immunizations.  

But until rates rise further, the overriding concern remains the risk of a dangerous spike in serious cases. 

Protests on streets and social media

The public opposition to the staging of the games – despite the measures put in place – was plainly evident on opening night. 

Hundreds of masked protestors gathered outside of the Olympic stadium venu with placards bearing slogans such as “Olympics killing the poor” – only to be met and cordoned off by even more masked police.  

On social media, too, opponents of the games were making themselves heard.  

“It’s On!  Let the games begin,” tweeted the IOC as the “Olympic cauldron” was set afire by the Olympic torch that had been kept alight throughout the dark pandemic year – marking the formal start of the games at the end of the ceremony.  

“No” one Japanese protestor  tweeted back  

“There’s no beds in hospitals that are vacant anymore in Tokyo.  The infection cases are increasing rapidly. People are going to die in their own home, without any medical care.”

Those competing themes of sobriety and excitement will accompany the games throughout the coming two weeks – and only at the end will it become clear which message will remain as the legacy of the OIympics 2020-2021.

Image Credits: @Olympics, @NYPost , IInternational Olympics Committee .

Zeng Yixin, Vice Minister of the National Health Commission, rejecting the WHO strategy at the latest Chinese government press conference on the SARS-CoV2 origins on Thursday, 21 July.

Chinese officials have rejected WHO’s proposal for a more rigorous Phase II investigation of the origins of the SARS-CoV2 virus, including renewed consideration that the virus may have escaped from a laboratory, describing the new plan as “impossible” at a press conference.   

“We will not accept such an origin-tracing plan as it, in some aspects, disregards common sense and defies science,” said Zeng Yixin, Vice Minister of the National Health Commission, at the press conference organized by the Chinese State Council Information Office on Thursday, rejecting the WHO plan out of hand. 

“We hope the WHO would seriously review the considerations and suggestions made by Chinese experts and truly treat the origin tracing of the COVID-19 virus as a scientific matter, and get rid of political interference,” Zeng said.  

 New WHO plan would address omissions of first virus origins mission to Wuhan

WHO Director General Dr Tedros Adhanom Ghebreyesus calls for a new approach to the SARS-CoV2 quest and more Chinese “transparency.”

The plan for a revamped second phase of investigations was presented by WHO Director General Dr Tedros Adhanom Ghebreyesus to member states at a closed-door meeting last week. 

WHO’s new and tougher strategy, includes the creation of an international Scientific Advisory Group on Origins of Novel Pathogens (SAGO) to replace the international group that led the first mission to Wuhan in January 2021. 

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

In response to those concerns, WHO now wants to obtain and review more data on Wuhan’s sensitive coronavirus research laboratories, as well as data on wild animal species on sale in 2019 at the city’s live animal markets, to assess the likelihood that the virus may have escaped from a laboratory – as compared to infecting humans via a food-borne source. 

WHO also is requesting more raw data from China on the first COVID patients, and on population-level serology screening in Wuhan, which could lend insight into where and when in 2019 the first COVID cases really began to appear. China had previously refused to provide the data, saying that it violated privacy laws. 

WHO applying more pressure on China

In his remarks last week to member states, Tedros explicitly described the new plan of attack, as including:

  • “First, integrated studies of humans, wildlife, captive and farmed animals, and environment, as part of a One Health approach.
  • “Second, studies prioritizing geographic areas with the earliest indication of circulation of SARS-CoV-2, and neighbouring areas where other SARS-related coronaviruses have been found in non-human reservoirs;
  • “Third, studies of animal markets in and around Wuhan, including continuing studies on animals sold at the Huanan wholesale market;
  • “Fourth, studies related to animal trace-back activities, with additional epidemiology and molecular epidemiology work, including early sequences of the virus;
  • “And fifth, audits of relevant laboratories and research institutions operating in the area of the initial human cases identified in December 2019.”

“We expect China to support this next phase of the scientific process by sharing all relevant data in a spirit of transparency. Equally, we expect all Member States to support the scientific process by refraining from politicising it,” Tedros told member states at the closed-door meeting.

In a subsequent media briefing on Thursday, the WHO DG also publicly called upon China to share data more transparently, while acknowledging in the strongest terms to date, the plausibility that the virus may have escaped from a laboratory. 

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team in early February, 2021.

“There was a premature push to reduce one of the [origins] options, the laboratory theory,” the WHO DG said, referring to the report on the virus origins that came out of the WHO-led mission to Wuhan in January. “I was a lab technician myself, an immunologist, and have worked in the lab and lab accidents happen.”

While WHO’s new move has been criticized by China, it has been applauded by former critics of the global health agency.

“Last week, Tedros showed tremendous courage when he called on the Chinese government to be more transparent in the sharing of raw data,” Jamie Metzl, a senior fellow at the Atlantic Council and one of the co-authors of a series of open scientific letters that criticized the WHO-led investigation for inadequately exploring the possibility that the SARS-CoV2 could have “escaped” from the WIV, said in an op-ed published on CNN.

“Given the leadership and moral courage Tedros has shown by calling for a full examination into the pandemic origins, the United States and its partners around the world must come together in support of the integrity of the WHO and his leadership,” said Metzl. 

China supports conclusions of the first origins report 

The report by the first SARS-CoV2 origins team concluded that of the four possible hypotheses about where the virus originated, the possibility of a laboratory biosafety incident was “extremely unlikely.”

The report generated widespread criticism from member states as well as an ad-hoc group of scientists, who published a series of open letters to WHO detailing how the investigation was limited by China and lacked the data and access necessary to carry out an unrestricted inquiry. 

China, on the other hand, has said that it continues to support the conclusions made by the report. Officials insist that SARS-CoV2 has natural origins, most likely the result of a natural spillover event involving zoonotic transmission.

At a press briefing on 16 July, Zhao Lijian, Spokesperson of China’s Ministry of Foreign Affairs, called on countries to “respect the opinions of scientists and scientific conclusion, instead of politicizing the issue.” 

Zhao Lijian, Spokesperson for China’s Foreign Ministry, at a press conference on 16 July.

In addition, the WIV has not reported any leaks or staff infections since it first opened in 2018, said Chinese officials. 

“We believe a lab leak is extremely unlikely and it is not necessary to invest more energy and efforts in this regard,” said Liang Wannian, the Chinese team leader of the joint WHO-China mission in January, speaking at the State Council Information Office press conference on Thursday. 

Chinese officials express disappointment

Senior Chinese health officials have expressed keen disappointment with the new WHO approach. 

“I was surprised when I saw WHO’s origin-tracing plan for the second phase,” said Zeng, at the Thursday media event. “The plan has set the assumption of China leaking the virus due to violating research instructions as one of the research priorities. We can’t possibly accept such a plan for investigating the origins.” 

At yesterday’s conference, the Chinese panelists proposed an alternative approach to the second phase of the investigation, focusing on zoonotic transmission and investigating early cases in other countries.

A panel of senior Chinese health officials discussed the COVID-19 origin investigation at a press conference on Thursday organized by the State Council Information Office.

“In the next step, I think animal tracing should be the priority direction,” said Liang. “It is the most valuable field for our efforts.”

“The second phase of origin-tracing should be extended on the basis of the first phase, guided by the relevant WHO resolutions, and carried out after full discussion and consultation among member states,” said Zhao, in a separate press briefing yesterday organized by the Chinese Foreign Ministry.

“The work that has already been done in the first phase should not be repeated, especially when a clear conclusion has been reached,” Zhao added. “Instead, we should promote origin-tracing on the basis of full and extensive consultations among member states, including search of early cases in various places and countries around the world.”

Chinese officials call for investigation into US military lab

In an attempt to deflect attention and blame, Chinese authorities also have tried to suggest that the virus could also have escaped from a laboratory in the Untied States, pointing in particular to the US Army Medical Research Institute of Infectious Diseases at Fort Detrick in Maryland.

Chinese officials have suggested that the US should invite an international team of scientists to conduct an independent investigation into Fort Detrick.

Conspiracies, largely peddled by Chinese officials, continue to swarm around Fort Detrick, with reports of some five million people in China signing a petition calling on WHO to investigate the bio-lab.

“What dark secrets are hidden out of sight at Fort Detrick?” asked Zhao at a press briefing on Wednesday. 

“Facing the 630,000 American lives lost to the coronavirus, the US should be transparent, take concrete measures to thoroughly investigate the origins of the virus at home, thoroughly investigate the reason of its botched response and who should be held accountable, thoroughly investigate the mysteries over Fort Detrick and its over 200 overseas bio labs,” said Zhao. 

The prominent military germ lab was temporarily shut down in 2019 by the US Centers for Disease Control and Prevention (CDC) because it didn’t have “sufficient systems in place to decontaminate wastewater” from its highest-security labs.

The lab reopened in March 2020 and was accompanied by an announcement from officials that no dangerous pathogens had escaped the lab.

US ‘deeply disappointed’ with China’s response

“[China’s] position is irresponsible and frankly dangerous,” said Jen Psaki, the White House Press Secretary on Thursday at a press briefing. “We are deeply disappointed.”

“Alongside other member states around the world we continue to call for China to provide the needed access to data and samples, and this is critical so we can understand and prevent the next pandemic,” Psaki said.

Jen Psaki, White House Press Secretary, at a press briefing on Thursday.

Relations between the US and China have suffered as a result of the probe, increasing tensions between the nations. 

“This is about saving lives in the future and it’s not a time to be stonewalling,” said Psaki.

In late May, US President, Joe Biden, instructed the country’s scientific and intelligence communities to investigate and publish a report on the pandemic’s origins by late August. One of the theories being examined is the possibility that the novel coronavirus emerged from a lab accident. 

“I have now asked the Intelligence Community to redouble their efforts to collect and analyze information that could bring us closer to a definitive conclusion, and to report back to me in 90 days,” said Biden. 

The US has expressed its dissatisfaction with the joint origins investigation, describing the report as “insufficient and inconclusive” in late May. The Biden Administration even appears to be positioning itself to take independent action if the WHO investigative process doesn’t succeed. 

“Unfortunately, phase one…did not yield the data and access from China that we think is necessary,” said Psaki. “But [the US] support[s]…the phase two plan…because it’s rigorous and science-based.”

Experts express concern over the future of the origins investigation

China’s refusal to participate in WHO’s next phase of the origin probe is “outrageous & absolutely unacceptable,” tweeted Metzl. 

According to Metzel, the “process has been compromised from the very beginning,” he told CNN.

The joint study by the international committee and their Chinese counterparts was agreed upon at the World Health Assembly last year, which gave the Chinese government a certain degree of control over the process.

“It’s been clear from day one that the Chinese have no interest in a full investigation into the pandemic origins and…they’ve been doing everything possible to block that,” Metzl said. 

“Given the critical importance of fully investigating the origin of Covid-19 and preventing future pandemics, China’s rejection of a full investigation poses a threat to the world that cannot be tolerated,” said Metzel in an op-ed on CNN. 

An alternative strategy is needed to conduct the SARS-CoV2 investigation without China’s cooperation. This will require the US and its partners both to support the WHO-organized process and set up a separate mechanism for an in-depth probe, said Metzl. 

The US should involve the Group of 7 (G7), an intergovernmental political forum for the world’s seven largest advanced economies, Quadrilateral Security Dialogue (Quad) countries, or the Organisation for Economic Co-operation and Development (OECD), a group of 37 member countries that develop economic and social policy.

“Although not having full access to all of the relevant resources in China would hamper this investigation, a great deal of progress can be made by pooling efforts, accessing materials available outside of China, and creating secure whistleblower provisions empowering Chinese experts to share information,” said Metzl.

“The international community must proceed with a forensic investigation, with or without China’s cooperation,” Dr Richard H. Ebright, a professor of chemical biology at Rutgers University, told Health Policy Watch.

“Many threads of forensic investigation are available outside China. In particular, information relevant to the origin of SARS-CoV-2 may exist at the US-based research partner of the Wuhan Institute of Virology (EcoHealth Alliance), at the US-government research funders of the Wuhan Institute of Virology and EcoHealth Alliance (USAID, DTRA, DARPA, DHS, and NIH), and at the US- and UK-based scientific publishers that handled publications of the Wuhan Institute of Virology and EcoHealth Alliance (Springer-Nature, Lancet, and PLoS),” Ebright added.

Creation of new body and expert group to investigate disease origins

In the meeting with WHO member states last week, Dr Tedros announced the establishment of a new body to investigate the origins of SARS-CoV2 and future pandemics.

The permanent International Scientific Advisory Group for Origins of Novel Pathogens (SAGO), which will be composed of experts nominated by member states, will “play a vital role in the next phase of studies into the origins of SARS-CoV2,” said Tedros. 

“The world needs a more stable and predictable framework for studying origins of new pathogens with epidemic or pandemic potential,” said Tedros.

“Finding where this virus came from is essential not just for understanding how the pandemic started and preventing future outbreaks, but it’s also important as an obligation to the families of the 4 million people who have lost someone they love, and the millions who have suffered,” said Tedros.

WHO will launch an open call for nominations for “highly qualified” members of the new advisory group from member states.

Image Credits: China Daily, WHO, CNN, Ministry of Foreign Affairs of the People's Republic of China, C-Span.

Cambodia, Iran and Bangladesh are the first lower-income countries to receive delivery of a donation from Japan of over 11 million doses of the AstraZeneca COVID-19 vaccines, beginning this weekend.

Cambodia and Iran received 332,000 and 1,087,570 doses respectively on Friday, while Bangladesh is scheduled to receive 2,45,200 doses on Saturday, Gavi, the Vaccine Alliance said in a statement.

The Japanese vaccine donations are being distributed via Gavi’s COVAX Advance Market Commitment scheme – that provides vaccines free of charge to some 92 low-income countries in Southeast Asia, the Eastern Mediterranean region, Western Pacific, Latin America, and elsewhere.

Announcing the donations, the government of Japan said: that “In order to overcome COVID-19, it is important to promote equitable access to vaccines not only in Japan but also throughout the world. Japan will continue to work towards securing equitable access to safe, effective and quality-assured vaccines through various support, responding to the needs of developing countries and the world, in cooperation with relevant countries and international organizations.”

Japan itself has lagged in its own vaccination campaign, despite being a high-income country – creating added risks of a spike in serious COVID cases as the 2020 Olympics get underway – a year late.

Seth Berkley, Gavi CEO said in the statement: “ In operationalising its dose donation, the Government of Japan has further grown its commitment to global equitable access. We look forward to seeing Japanese doses flowing to a number of countries in the coming weeks.”

Read more here…

Image Credits: Gavi .