Mike Ryan, WHO Health Emergencies Programme Executive Director, says the recent sexual exploitation and sexual abuse scandals has forced the WHO to do some introspection.

A special strategic meeting at the 74th World Health Assembly on Friday discussed how the World Health Organization (WHO) is scaling up powers to investigate sexual exploitation, abuse and harassment in emergency situations. WHO officials said this effort involves a “mass of inspectors” to prioritise investigations in at least eight countries.

The intervention comes in the wake of a sex-for-jobs scandal in the Democratic Republic of Congo (DRC), where dozens of workers alleged abuse by WHO employees during the 2018-2020 Ebola outbreak. One nursing assistant had charged that a WHO doctor offered her a double salary in exchange for sex, one of multiple misconduct cases WHO allegedly knew about but failed to act on.

The scandal spurred at least 53 countries to voice concern about how the agency handles sexual abuse and exploitation. Although the World Health Assembly, WHO’s highest decision-making body, hasn’t devoted a specific agenda item to the alleged DRC misconduct, Friday’s roundtable session discussed how to prevent sexual abuse.

Senior WHO management, including WHO Health Emergencies Programme Executive Director, Mike Ryan,  Assistant Director-General for Emergency Response,  Ibrahima Soce Fall, and Gaya Gamhewage, Head of Learning and Capacity Development, admitted some failures in the organisation’s efforts against sexual exploitation and abuse.

Ryan said the sex scandals had forced WHO to do a self-assessment: “You sometimes see something in the mirror you don’t want to see. It’s being able to look in that mirror, and accept that what you see is not really up to scratch… and then promising to get better.”

Addressing donors and member states, he said that “In many ways, we’re all to blame for what happens in these situations, and we all need to commit to making it better.”

Dr Ibrahima Soce Fall, WHO assistant director-general emergency response, says a lot of work needs be undertaken in the fight against sexual exploitation and sexual abuse.

Fall said, “We are looking at what has to be done [dealing with sexual exploitation and abuse]. This is a colossal job which requires a lot of work on our part, but also on the part of our partners.”

The DRC, Ethiopia, Afghanistan, Somalia, South Sudan, Sudan, Venezuela and Yemen are the first target countries where inspectors will be deployed. Fall said this service eventually will cover all 30 countries with ongoing WHO operations: “The objective is to protect vulnerable populations and save lives. We obviously cannot tolerate in any way whatsoever, ever, any kind of abuse, including sexual abuse.”

In addition to the inspectorate, WHO also set up a working group to identify priority policies, including strengthening training modules for staff, “people on the ground” and management. The new module will contain an entire section on sexual abuse and exploitation, Fall said.

Ryan said the alleged DRC scandal “deeply impacted” staff, though the investigation has not been finalised. He said WHO, its member states and partners should “commit ever more fiercely” to the Latin injunction to Primum non nocere (do no harm).  

Following the strategic lunchtime meeting, WHO Director-General Tedros Adhanom Ghebreyesus later told delegates at the main session of the WHA  that an independent commission was set up in Goma in March and that WHO had hired an investigative firm that began field investigations in early May. The independent investigation should issue findings by the end of August.

Dr Tedros said abusive behaviour was “totally incompatible with WHO’s mission” and  “undermine trust in WHO and threaten the critical work we are doing”.

During the WHA session, Leslie Norton, Canada’s ambassador to the United Nations. in Geneva, read out a statement on behalf of 53 countries, including the United States, Japan and European Union members, urging the WHO to speed up the investigation and provide an update in June.

Prevent  and Respond to Sexual Abuse Cases

Dr Gaya Gamhewage, WHO Head of Learning and Capacity Development, says WHO staff are “outraged” at the latest sex scandal to rock the organisation.

Senior WHO management addressing the lunchtime briefing agreed on the need to “prevent things going wrong in the first place”.

“Prevention must be the foundation on which we build any decent protective system. Prevention  means abuse avoided, trust and dignity maintained and lives improved through better health, said Catharina Boehme, WHO’s Chef De Cabinet.

Gamhewage said WHO staff were “outraged” by the latest allegations, so the session was held to focus on practical actions being taken to address the complex issue.

Stella Chungong, WHO health emergencies country preparedness director, said WHO was working on an holistic approach to achieve a transformed gender agenda by working on inequities that contribute to abuse. “But we’re also looking inwards, identifying ways in which our internal culture and systems can promote gender equality, respect, and an environment where abuse in any form is not tolerated.”

WHO also identified potential barriers to equal female leadership and decision-making positions within programmes, she said. “All of this in the medium and longer term will help make WHO more accountable for implementing concrete and evidence-based actions for prevention of sexual abuse and exploitation.” 

Hotlines and Training Help Raise Awareness

Dr Israel Gestoso says economic desperation and consequences of conflict situations increase sexual exploitation risks in Ukraine.

WHO frontline workers from Ukraine, Guinea, Bangladesh and Libya shared various measures to prevent and deal with sexual exploitation and abuse in their work.

 In Ukraine, of 3.4 million people needing humanitarian assistance, 1.8 million are women in highly vulnerable situations. Israel Gestoso, who works as a WHO sexual exploitation and abuse focal point there, said economic desperation and consequences of conflict situations increase sexual exploitation risks.

“The most vulnerable groups are women and children,” Gestoso said. “Families whose family members died or were injured in the tragic events, in particular with women who now became the only providers for the family.”

Gestoso detailed training and awareness programmes for staff and consultants that include online training before employment, one-on-one induction sessions and monthly meetings. “There is a very shallow perception of sexual exploitation and abuse, and we have achieved to break that translucent glass, and be open to discuss, share, and understand the complexity of sexual exploitation and abuse,” he said.

WHO representative Marius Jones said Guinea has trained 326 staff how to prevent sexual exploitation and abuse and how to manage clinical cases. Other activities include setting up a hotline to report abuse, distributing multilingual education materials and engaging with communities through organisations and platforms.

Dr Elizabeth Hall said Libya is also setting up a dedicated hotline and community-based systems to report sexual abuse.

UK: “Very Good Chance That Victims Will Be Listened To”

A delegate from the United Kingdom called for transparent monitoring and case-number reporting of allegations and investigations. This will demonstrate to survivors that if they are courageous enough to report incidents, there is a “very good chance that they will be listened to and action will be taken”.

In response to allegations of slow WHO response to the DRC scandal, the delegate said: “[This] is why it’s so important that the WHO and member states are crystal clear that we have zero tolerance for PSCA, that we listen to survivors, and that we act promptly and transparently to respond to their allegations.”

The US reaffirmed its support for COVID-19 vaccine intellectual property waivers Friday as World Health Assembly delegates and experts discussed how to promote local production of medicines in low- and middle-income countries (LMIC).

US delegate A Lipstein Fristedt,

An Ethiopia-led resolution to stimulate local production of medicines and health technologies has the support of WHO’s African Region, the European Union, the United States, China, Brazil and other nations.

“The United States believes strongly in intellectual property protections, but in service of ending this pandemic supports the waiver of those protections for COVID-19 vaccines,” said US delegate A Lipstein Fristedt, US FDA deputy commissioner for policy, legislation and international affairs.

The Trade-Related Aspects of Intellectual Property Rights (TRIPS) Council set an informal meeting Monday (31 May) to discuss an Indian and South African proposal for an IP waiver on COVID-19 products. 

The council’s power balance shifted in the weeks since the US voiced support for a vaccine-related waiver, although the European Union is trying to broker a “third way” rather than a waiver.

Price Transparency

Ethiopia’s Alegnta Gebreyesus Guntie

The resolution urges member states to take into account “the rights and obligations” listed in the TRIPS Agreement, including those affirmed by the Doha Declaration: “to promote access to medicines and other health technologies for all”.

The resolution calls for “transparency of prices and economic data along the value chain of medicines, including locally produced medicines, and other health technologies” to address the non-disclosure agreements between countries and pharmaceutical companies that contribute to higher prices. 

“The COVID-19 pandemic has revealed the vulnerabilities of many low- and middle-income countries, most of them African countries with no or low local production capacities, exacerbating their challenges of inadequate access to the most-needed vaccines, medicines, diagnostics and other health technologies,” Alegnta Gebreyesus Guntie, Ethiopia’s representative, said on behalf of 47 WHO Africa Region countries.

She explained: “The draft resolution strengthens local production and know-how, promotes technology transfer and innovation, considers the TRIPS agreements and intellectual property rights in the context of local production, and strengthens the mandate for the WHO to work with continental bodies such as Africa Union, to provide member states with support to build capacity for local production.”.

Meanwhile, Kenya’s Dr W Kariuki said acute shortage of COVID-19 vaccines “is contrary to public health goals, as it erodes public trust, breeds vaccine hesitancy and prolongs the acute phase of the pandemic”. 

The resolution, which has the support of over 100 countries, is likely to be adopted by this year’s WHA.

Meanwhile, WHO’s Africa Region revealed this week that the continent only has enough vaccines to cover 1% of the population. African countries that received AstraZeneca vaccines from COVAX now urgently need 20 million additional doses to give those who have had one dose their second vaccination, but India’s Serum Institute has stopped supplying COVAX with vaccines.

 

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Washing hands with water and soap can help prevent the spread of AMR and protect people.

A Friday session of the 74th World Health Assembly discussed a report on antimicrobial resistance (AMR) and multi-sectoral approaches to address it. Speakers generally supported a One Health approach involving multiple agencies concerned with communicable diseases, environment, water and food. 

This approach recognises the interconnectedness of people with environments and other animals. The World Health Organization is encouraging national action plans to combat AMR, and so far 144 countries have such a plan in place. 

Summing up discussion on the report,  Björn Kümmel, Vice Chair, WHO Executive Board member, said countries “called for sustained action and investment, stressed the need for a multi-sectoral collaboration to prevent the emergence and spread of antimicrobial resistance, recommended to promote research on strengthening control through a One Health approach, collect comprehensive data, standardise data collection methodology and develop a global platform for sharing best practices.”

Emphasis on One Health, Community Approaches 

Globally, the UK Review on AMR puts the human toll from drug-resistant infections at 700,000 deaths per year. However, up to 5.7 million people die annually from treatable infections, mostly in low- and middle-income countries, and many because they lack access to antibiotics. 

Antibiotics were the most common drug class in WHO’s 2017 Essential Medicines List, but their indiscriminate use increases AMR risks. 

The World Bank reported that AMR containment investment will provide “substantial economic payoffs” to low-income countries, but that the greatest absolute and per-capita gains from such spending would “flow to upper-middle-income and high-income countries.” 

Given that the current pandemic has been linked to non-human origins, several speakers mentioned the One Health approach. Country representatives called for multi-sectoral data sharing and collaboration across regions, and approximately 105 countries have enrolled in a global surveillance system.

 “The current dynamic has resulted in increasing misuse of antimicrobials, including in COVID-19 patients … highlighting the need for strengthening antimicrobial stewardship involving health workers, and incentivising research and development on an equitable access to new microbials,” Portugal’s representative said. 

Africa, Bangladesh Speak for Low-Income Countries 

 Those from middle- and low-income countries warned that widespread AMR presents serious economic ramifications. 

“Antimicrobial resistance has become a serious threat to public health,” Burkina Faso said, speaking on behalf of WHO’s Africa Region. “Up to 10 million human lives will be lost, 60% percent of which are in Africa, by 2050 — and this will be an economic disaster as well.”

Noting that 144 countries have national action plans, Bangladesh said, “We’re concerned that many countries, particularly the low- and middle-income ones, are facing many challenges in the implementation of the action plans.” 

Bangladesh said pandemic tools can strengthen AMR surveillance capacities by improving infection control and preventive efforts to address both issues, but that this depends on sustainable financing.  

“The COVID-19 pandemic has exacerbated the problem of antimicrobial resistance, thanks to the overuse of antibiotics and a weakening of the health system,” said Ashley Arabasadi, Management Sciences for Health senior external affairs manager. “We need to move now to contain AMR while we still have the capacity to do so.”

Image Credits: Wikimedia Commons.

Health experts have called on global leaders to tackle environmental issues affecting health and health systems.

A paradigm shift towards health systems and societies that emphasize health promotion, disease prevention and environmental protection could prevent and reduce 50% of the global disease burden worldwide, experts at an informal session on the margins of the 74th World Health Assembly  said on Thursday.

The COVID-19 pandemic has highlighted the inextricable relationships between environments and health while revealing health systems’ weaknesses, according to WHO director-general  Dr Tedros Adhanom Ghebreyesus at the event, Safe Societies and Environments for Health: The Path to Build Forward Better, Healthier and Greener.   

World leaders should hold a “Nature Summit” that would focus heads of state more squarely on delicate relationships between health, climaste and environment – and the “planetary” crisis facing ecosystems, said Inger Andersen, executive director of the United Nations Environment Programme (UNEP), in an apperance at the WHO forum. 

“There’s evidence that the more we fragment nature, the more we encroach into nature, the more we push biodiversity stress, by encroaching and destroying, then the greater likelihood of human pathogens developing out of contact with wildlife and wild diseases,“ said Andersen. 

Maria Neira, WHO director, Environment, Climate Change and Health shared Andersen’s sentiments: “We need to stop this war we are having with nature. We need to recover our relationship as it is the only way towards a safer world that is green and healthy.”

Maria Neira, WHO director, Environment, Climate Change and Health

The events coincided with a landmark decision by a court in the Netherlands, against the multinational fossil fuel giant Royal Dutch Shell – which was cheered by WHO climate and health advocates such as Neira.

The court in The Hague ordered Shell to reduce it’s CO2 emissions by 45% within the next 10 years in its response to a legal suit by Friends of the Earth Netherlands (Milieudefensie) together with 17,000 co-plaintiffs and six other organizations.  The ruling has far-reaching consequences for the rest of the fossil fuel industry worldwide – opening up the possibility of liability claims and suits in other countries against fossil fuel companies for the damage that they are wreaking on the health of the planet and its people.

WHO’s Green Manifesto

In May 2019, the 72nd WHA adopted a Global Strategy on Health, Environment and Climate Change. The WHO strategy aims to “provide a vision and way forward on how the world and its health community need to respond to environmental health risks and challenges up to 2030, and to ensure safe, enabling and equitable environments for health by transforming our way of living, working, producing, consuming and governing.”

The pandemic provides a unique opportunity to rebuild health systems while also tackling environmental issues affecting health, said Tedros at the session, while also lamenting the lack of sufficient investment today. . 

For instance, global health budgets allocate only 3% to addressing preventable causes of disease and to promoting and enabling healthier environments and lifestyle choices. Increased investment could reduce global disease burdens by half, Tedros said, and this would greatly benefit individuals, families, communities and nations.

That is despite the fact that  “preparation is not just better than cure — it’s cheaper”, he said. 

In fact, an investment of $US 1 per person per year in more disease prevention and health promotion could save 8.2 million lives and US$ 350 billion by 2023, Tedros said in his opening WHA remarks on Monday.

On Thursday he again emphasised the need for more investment. “For every dollar invested in basic sanitation, there is a return of $5.50 in terms of reduced waterborne disease … which is still one of the largest killers of children.”

“Safer air, food and roads, better nutrition, and reduced injuries and violence will save lives. But we’ll also save money by preventing health care costs and [by] contributing to employment, productivity, and inclusive economic growth. Healthy populations are also more resilient populations.”

WHO Director-General  Dr Tedros Adhanom Ghebreyesus

In May 2020, after the COVID pandemic laid bare the underlying vulnerabilities of global health, social and environmental systems, WHO issued a Green Manifesto for healthy and green recovery with several 80 action points for so-called “building back better.”

The manifesto also lists opportunities for actions to enhance the WHO global strategy, which is likewise embedded in WHO’s 2019-2023 workplan – encouraging more cross-sectoral actions on unhealthy urban environments, lifestyles, poor diets and unsustainable food systems – areas where the worst risks often hit hardest on the poor – exacerbating existing social inequalities. 

A Healthy Planet Makes Healthier People

That has been all the more vividly illustrated during the COVID pandemic, in which access to clean water and sanitation, clean air, and decent urban housing conditions have all been understood as critical to reducing disease risks and disease transmission. 

UNEP Director Andersen said the argument for climate action is at an “historic crossroads” due to the COVID-19 pandemic.

Pandemic-related policies thus need to also address climate, biodiversity, nature and pollution, because otherwise “We would just be in a systematic loop … We have been taking nature for granted.”

Although the world has for far too long assumed that climates and environments would remain stable, she said, “A healthy planet is a precondition for healthy lives.”

Referring to research pointing to vast potential losses of genetically diverse animal and plant species over the coming years, Andersen also called for more research into food systems. “Why does this affect us? Because nature is a finely-tuned ecosystem where each relies on the other. And that is what produces the food, the water, the air” that humankind relies upon for life and livelihoods.

Education to Promote Environmental Awareness

Along with high-level efforts like a summit, education also is a critical tool to raise environmental awareness and contribute to improved health, according to  Desmond Appiah, resilience and sustainability advisor in the city of Accra, Ghana. 

Appiah said there is a need to work across sectors and with communities from the ground up to address water, waste, sanitation and air pollution issues critical in developing and building healthy cities. For example, he said the city government and its partners in a WHO and UNEP co-sponsored “Urban Health Initiative,” visits local churches, faith-based organisations to educate them on  air pollution’s health impacts as well as contributing factors, from waste-burning to motor traffic and the dearth of walkable green spaces.  In line with those efforts, Accra in 2018 was also the first city in Africa to join the BreatheLife initiative, dedicated to building awareness and more local action around linked, health, environment and climate.   

In two decades of work on World Bank digital health initiatives, global health policy specialist Akiko Maeda found many fell short of their promises. She suggested these underperforming digital health initiatives focused too much on delivering hardware — but they failed to provide means to ensure stable electricity supplies, and similarly failed to provide adequate human resources to manage data, or to design initiatives that the most vulnerable groups could benefit from.

Akiko Maeda, health economist with over 30 years of experience in international development in over 40 countries

“It’s not just the infrastructure and the hardware, but how we design the software that goes with it,” Maeda said Thursday. She spoke at a World Health Assembly side event co-hosted by the Geneva Graduate Institute’s Global Health Centre, the Lancet & Financial Times Commission, and Digital Square, which is supported by USAID and the Bill and Melinda Gates Foundation. 

“Digital infrastructure is more than just a bunch of cables and devices,” said data literacy consultant Gulsen Guler, who is also co-chair of My Data Global, a civil advocacy group promoting equitable digital societies – adding that the stakes are high:

“Digital technologies can determine what the future of a child will look like…or even more, they can determine between life and death.”

Digital Health Saves Resources to Reach Universal Health Coverage 

Roger Kamba, Special Advisor to the Democratic Republic of the Congo (DRC), called digital technologies crucial in low-income countries. He said these tools can help countries reach universal health coverage and that digital health can help to meet Sustainable Development Goals. 

“Digital health is not an option, but rather a necessary step towards universal health coverage,” Kamba said. “I remain personally convinced that there can be no universal health coverage without a substantial contribution from digital health.”

However, he said that for that to happen, governments must prioritize digital transformation through a multi-sectoral approach that goes beyond the health ministry. 

In 2019, the DRC adopted its digital technology strategic plan, Kamba said. Implemented by a newly-created ministry, the plan engages all sectors, including health. “All governments need to take a systems approach to digital transformation. It’s not just the health ministry that needs to be working on health care anymore.”

An Epidemiological Nerve Centre – The Emergency Operations Centre

Kamba said existing digital health initiatives, notably the nation’s Emergency Operations Centre (EOC), have proven useful in quickly containing infectious disease outbreaks like Ebola. Set up two years ago by PATH, USAID, and the Bill and Melinda Gates Foundation in collaboration with the DRC Centers for Disease Control, the EOC acts as the country’s epidemiological nerve centre to coordinate efforts to prevent, detect, and rapidly respond to public health emergencies. 

“The center uses tools such as digital mapping, Geographic Information System (GIS) mapping, and mobile health technologies to produce layers of information that help reveal  patterns that enabled more effective interventions during the Ebola epidemic,” he said.

“Actionable surveillance data and digital epidemic maps made the response faster and more focused, and was the first time that response data was digitized and centralized”. Recently the EOC expanded its scope to investigate regional and local malaria trends; it also facilitates disease control strategies using advanced data analyses. 

Kamba warned that digital health initiatives depend on reliable and affordable electricity, which can be a challenge in low-income countries: “We’re talking here about the potential of digital solutions to help us overcome long standing infrastructure challenges in sub-Saharan Africa … Investments in digital health in DRC must be coupled with energy solutions at the national level.”

“These [digital] infrastructures are also faced with a fundamental financing gap,” said Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. “To really have sustainable financing that’s also reflected in the budgets of countries is a truly, truly big challenge.” 

Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030.

Digital Health in Burkina Faso Improves Care Quality

Meanwhile in Burkina Faso, Swiss NGO Terre des Hommes (Tdh) has worked for over a decade with the Ministry of Health to develop Ieda – a digital job aid tool that enhances the clinical diagnosis of childhood diseases and improves health workers’ performance using artificial intelligence (AI) algorithms.

Ieda already is available in 80% of health-care facilities in the country and has helped with a whopping 10 million digital consultations. This generates savings of US$1.6 million every year, Tdh health programmes research head Riccardo Lampariello said. “Digital health solutions at scale bring financial savings for the authorities, of course after the initial national investment, of $1.6 million every year. Hence the importance of investing in digital health.”

Lampariello stressed that the bulk of digital health expenditure is not on infrastructure but on human resources required to build necessary technical and regulatory capacity. He noted that governments need to run local data centers, extract and analyze data, update software and fix data platforms when they crash.

Riccardo Lampariello, head of Tdh’s health programmes

“Digital health is human resource-intensive, and we should equally invest in infrastructure — which is not only tablets and solar power panels, it is also data centers, for example — and in human resources, including local authorities, including the government, the MOH, in technical skills … and also look to teach them the governance skills to regulate labor use.”

Thanks to this already-existing digital health infrastructure, when the coronavirus hit it took only a few weeks for Burkina Faso’s Ministry of Health to deploy digital tools to support training, awareness-raising and triage, and to reach vulnerable groups in remote and unsafe areas, Lampariello said.

But he warned that the digital health landscape is still fragmented in low-income countries, challenged by duplication, a lack of interoperability and waste of precious devices and electricity.

“Even before COVID, it wasn’t rare to pay a visit to a health-care facility in a very poor country, open a cupboard and find two or three tablets or smartphones [for] dealing with different platforms and databases. In a context of limited resources, this represents a lot of wasted tools,” Lampariello said. “And not to mention, for example, the additional unnecessary e-waste and energy consumption related to that.”

Speakers Ask For Well-Designed & Equitable Digital Health Initiatives

Digital health initiatives are likely to be more impactful if they designed to be equitable, added panelists on Thursday. In Japan, for example, vaccine uptake in older age groups was hampered by the country’s response plan failing to consider that booking vaccine appointments online can be a struggle for older people. “It’s a design issue, and it’s not a complex issue, but it was not adequately designed for the elderly, so there’s a huge problem going on right now in Japan,” said Maeda.

Ann Aerts, Head, Novartis Foundation

“Every solution, digital- or AI-driven, has to be human-centered,” said Novartis Foundation head Ann Aerts. “And that’s quite obvious, although it’s not always the case. The best way is to use a human-centered design with input from the people who will have to use a solution, and by thinking up-front how the solution will be integrated in the processes of the health workforce, or the workflow.”

According to a World Bank study, successful digital health initiatives tend to share characteristics like strong leadership and regulatory systems, substantial financial commitments to digitize health systems, and national frameworks to facilitate data flows between systems, added Aerts. 

White House Deputy Press Secretary Karine Jean-Pierre discusses President Joe Biden’s order to the US intelligence community to take a fresh look at the origins of SARS-CoV2 with answers in 90 days.

Amidst fresh calls from US President Joe Biden ordering the science and intelligence community to come up with a more detailed account of how the SARS-CoV2 virus emerged – it’s unclear how much action the World Health Assembly will really see on the issue.

Language in the the final-agreed draft of a WHA resolution, Strengthening WHO preparedness and response to health emergencies, appears to have been muted to assuage objections by China and other allies- with the removal of any explicit reference to an “investigation” of the virus origins from the text.

The reference to “investigation” of the virus origins had been included in an earlier, 20 April version of the text seen by Health Policy Watch,  although it was presented there as a phrase that was still up for debate.

Countries’ Adherence to ‘National’ as well as ‘International laws’

The  resolution, set to be debated on Saturday, also has watered-down language about countries’ obligations to adhere to provisions of the WHO’s international health regulations that mandate transparency and rapid action on emerging pathogens – adding the term, “taking into account national”…  as well as international, laws. That loophole, which can checkmate international mandates, has been another big concern for critics of the investigation so far. That, in light of the fact that China has alerady held back on providing valuable data from national blood banks that could have revealed when the virus really began to spread  – saying that it would violate national privacy laws.

So far, the earliest cases that China acknowledges formally date from December 2019 – although a series of US intelligence leaks, as well as scientific and surveillance reports of increased hospital occupancy, flu cases and even mask purchases earlier that fall or winter, suggest that cases were occurring well before that in China.  Earlier circulation of the virus in Wuhan and Hubei province, a major center of trade and business with Europe, would also explain why surveillance reports from Italy and elsewhere in Europe have also found evidence of SARS-CoV2 antibodies in populations dating as early as August or September.

Horseshoe bats found in southwestern China’s Yunnan province carry the viruses most similar to SARS-CoV2 – they also were the subject of intense study at the Wuhan Instiute of Virology.

“It is absolutely critical that the World Health Assembly mandate a comprehensive investigation into pandemic origins before the 2021 session closes on Monday,” Jamie Metzl, a senior fellow of the US Atlantic Council, told Health Policy Watch on Thursday. “If China should block that process, the only way forward will be for interested countries to work together to set up a parallel investigation process. We must not let China have a verto over whether or not we investigate the worst pandemic in a century which has unnecessarily killed so many millions of people.

Metzl was one of the co-authors of a detailed open letter penned by an international group of scientists to the World Health Assembly in late April, urging WHO member states to seize the moment of the upcoming World Health Assembly to adopt a much tougher mandate, with more rigorous scientific measures, to get to the truth of whether the SARS-CoV2 virus first infected humans from a natural source, a wild animal market, or in a laboratory.

US Mandates Major Investigation

Perhaps out of frustration with Geneva’s inaction, Biden’s administration only this week ordered a major investigation of its own –  ordering scientists and intelligence experts to explore with equal vigour the two main pathways by which the virus may have escaped – from a laboratory or via a more natural route.

“”Today the president 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 him in 90 days,” said Principal Deputy Press Secretary Karine Jean-Pierre, speaking at a White House briefing on Wednesday.

“Back in early 2020, the President [then Donald Trump] called for the CDC to get access to China to learn about the virus, so we could fight it more effectively-  getting to the bottom of the origin in this this pandemic will help us understand how to prepare for the next pandemic,” she added.

“As we have done throughout our COVID response, we have been committed to a whole of government effort to ensure we’re doing everything to both understand and end this pandemic and to prevent future pandemics.

“This is why the President is asking the US intelligence community, in cooperation with other elements of our government, to redouble efforts to collect and analyze information that can bring the world closer to a definitive conclusion on the origin of the virus and deliver a report to him again in 90 days. It will be another hole of government of effort, as I mentioned, including work by our national labs and other agencies.”

With regards to the WHO-led investigation, which even WHO Director General Dr Tedros Adhanom Ghebreyesus had admitted was flawed, Jean-Pierre said:

“Importantly, we will continue to pushing for a stronger, multilateral investigation into the origins of the virus in China, and we will continue to press China to participate in a full transparent, evidence based, international investigation with the needed access to get to the bottom of a virus that’s taken more than 3 million lives across the globe. And critically, to share information and lessons that will help us all prevent future pandemics.

The White House statement marked the first time since Biden’s election that Washington has taken a direct lead on the thorny and geopolitically charged origins issue.  Although Trump’s administration had also launched an investigation into the same questions – that earlier quest was laced, from the start, by the hyperbole and politics around Trump’s overall approach to China and the WHO, leading many to dismiss the lab escape hypothesis a conspiracy theory.

However, in the intervening months, as the WHO investigation fumbled, while more shards of evidence emerged elsewhere about the problematic conditions in the Wuhan Virology Institute, its research into horseshoe bats that carry the same coronaviruses most similar to SARS-CoV2, and, most recently, reports that scientists in the virology lab may have fallen ill shortly before the COVID outbreak visibly began in Wuhan.  That has led to concerns among more and more mainstream scientists about the holes and omissions around the narrative about the virus emergence – emerging from both China and the WHO-led investigative team.

In addition, the speed and ease at which the virus became transmissible in humans, once it emerged, suggested to many that it may not have emerged from a natural, animal-borne route.

Said former US Centers for Disease Control Director Robert Redfield, a respected virologist, in a recent CNN interview,  I do not believe this somehow came from a bat to a human.  Normally when a pathogen goes from a zoonotic source to a human, it takes a while for it to figure out how to become more and more efficient in humans, in human transmission. … so I just don’t think this makes biological sense. ”

 

 

 

 

Image Credits: NIH/David Veesler, University of Washington.

Disability services should be incorporated into primary health care programmes at the community level, states a resolution adopted at the 74th WHA.

A new resolution adopted on Thursday by the 74th World Health Assembly aims to scale up access to services and treatment for people living with disabilities – using a more “gender-sensitive and inclusive” approach.

The resolution co-sponsored by Israel and Australia,  calls upon member states to ensure that disability services are incorporated into primary health care programmes at the community level – and that conversely disabled people also have full access to health services.

It also calls for special attention to be paid to the “unique vulnerabilities of those who may be living in care and congregated living settings in times of public health emergencies such as COVID-19, and for special protection against infections in particular for at-risk groups,” including more education for health care workers. 

And, the resolution calls upon WHO to etch out a global research agenda on disabilities, as well as to develop, by the end of 2022, a global report on disabilities, updating estimates on the numbers of disabled people worldwide, from a decade old World Report on Disability (2011).

Countries Said Community-based Interventions Are Key 

Israeli diplomat Nitzan Arny speaks about the resolution on persons with disability led by Israel.

One in seven persons worldwide experience some form of disability. The numbers are increasing due to factors such as ageing populations and widespread chronic health conditions. 

Many countries highlighted the roles community-based interventions can play in improving access – in reactions that warmly supported the initiative overall. 

The resolution broadly calls for collection of reliable data that allow for disaggregation by disability. It also advocates equal access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. 

Persons with disabilities face inequality in social, economic, health and political spheres and are more likely to live in poverty than those without disabilities. They are also more likely to have risk factors for noncommunicable diseases and less likely to have access to essential health services.  

“Nothing about us without us’ is not just a catchphrase. Meaningfully involving persons with disabilities in decision-making processes is a precondition for ensuring disability inclusion,” said Israel’s delegate to the WHA,  Nitzan Arny, in presenting the initiative. 

Australia, the resolution’s co-sponsor said: “We recognize the importance of promoting disability inclusion in the health sector to ensure persons with a disability enjoy the highest sustainable highest attainable standard of health, including access to quality disability inclusive health services, information and education across their lifetimes.”

Israel, Australia, the United States, European Union, Kenya, Botswana, the United Kingdom, Japan, Mexico and a dozen other countries co-sponsored the resolution.

Meanwhile, the resolution gives new impetus for action, particularly in light of the fact that WHO’s current Global Disability Action Plan 2014–2021 is set to expire this year. 

New Zealand, however, said it supports extending the Global Disability Action Plan because “This would demonstrate continued international commitment to this goal, and provide guidance for how this can be achieved.” 

 

COVID’s Impacts on Persons With Disabilities 

The pandemic has harmed people with disabilities in various ways, yet few member states collect data that are disaggregated by disability.  

Women and girls living with disabilities face particular challenges. “Women, young women and girls who are disabled have a high risk of being marginalized and seriously discriminated against. That reduces their economic and social status, it increases the risk of sexual violence and sexist attitudes against and towards them and [of] limited access to justice,” Canada said. “These challenges have only increased during the COVID-19 pandemic, and disabled women and girls continue to fight for their rights for equality and for changes to the system.” 

The resolution highlighted the role of community health workers in advancing equitable access of persons with disabilities to safe, quality, accessible and inclusive health services.

Stress on Community-Based Rehabilitation

Among the stakeholders invited to collaborate under the resolution are organisations of persons with disabilities, private sector companies, scholars and teachers. 

“Community-based rehabilitation is a strategy to improve access to the services to persons living disabilities in middle-and low-income countries through the optimal use of local resources,” said Colombia. 

 Civil society organisations have welcomed the resolution. “We welcome that the resolution calls on governments to actively involve people living with disabilities in decision-making and programme design. This will ensure that health systems and responses to health emergencies can better deliver on the needs of the people most affected,” said Nina Renshaw of the NCD Alliance. “As we’ve seen in other fields of global health, such as HIV and TB, meaningful inclusion of lived experience is absolutely fundamental to catalyse overdue progress.”

Image Credits: PicPedia.

A Nigerian health workers receives his COVID-19 vaccine.

With vaccine deliveries delayed by India’s decision to prioritise local vaccination over export requests, Africa’s leading disease control agency suggested COVID-19 could become endemic.

John Nkengasong, director of Africa’s CDC, told reporters on Thursday that Africa needs to immunise population majorities quickly, but the vaccine delays make this unlikely. 

“With the rate of immunisation in Africa, we are lagging behind in the battle against the pandemic,” Nkengasong said. He asked the global community to consider vaccine access a collective security issue that needs to be addressed everywhere.

“If we keep vaccinating at this pace, we are not going to achieve our target. And that will delay our ability to eliminate the virus from our population — and my greatest concern is that we may actually begin to move towards the endemicity of this virus,” he said.

WHO Regional Director Echoes Concerns About Eradication

At a separate briefing, Matshidiso Moeti, WHO Africa Regional Office director, also said Africa faces challenges that make it unlikely to eradicate the disease anytime soon. She said vaccine delays disproportionately affect African countries, and these point to further poor outcomes for the continent.

Dr Matshidiso Moeti, WHO Africa Regional Office director, warned of slow pandemic progress.

Moeti discussed WHO research saying Africa needs at least 20 million doses of the Oxford-AstraZeneca vaccine in the next six weeks in order to get second doses to all who received a first dose within the 8-12 week recommended interval between doses.

Compared with 1.5 billion vaccine doses already administered globally, Africa has to date administered 28 million doses, or fewer than two per 100 people. “As supplies dry up, dose-sharing is an urgent, critical and short-term solution to ensuring that Africans at the greatest risk of COVID-19 get the much-needed protection,” said Moeti. “Africa needs vaccines now. Any pause in our vaccination campaigns will lead to lost lives and lost hope.”

“We are expecting, not only in Africa, but globally, that this is a virus that we are going to live with in the future,” Moeti said in response to a question from Health Policy Watch. “ So instead of talking about quickly eradicating COVID-19, the main objective is to minimise severe illness and deaths from the virus”. She said Africa should continue to develop needed vaccines and therapeutics, and that African health systems must not be overwhelmed by the pandemic waves.

She stressed the need for more vaccine access on the continent going into 2021 to “reach that level of vaccination that’s needed to enable African countries to open up and return to a more normal life”.

While the threat of endemicity remains, Moeti said, public health stakeholders on the continent are anticipating and hoping very much that COVID-19 will not become endemic in Africa. 

France, Europe Pledge Support for Africa Vaccine Quest

The French government meanwhile, announced a new, and larger, phase of vaccine dose sharing with African countries. Speaking at the WHO briefing briefing, Stéphanie Seydoux, French Ambassador for Global Health, Seydoux said that France would now share half a million doses with six African countries within weeks. 

France was the first developed country to volunteer to share COVID-19 vaccines from domestic supplies, donating over 31,000 doses to Mauritania, with another 74,400 set for imminent delivery.

Stéphanie Seydoux, French Ambassador for Global Health Issues, said Africa should benefit from tools established to fight the pandemic.

 Seydoux noted that while Africa has largely been spared from the full brunt of the pandemic, the continent and all regions should benefit from tools established to fight COVID-19. She also noted France’s commitment to Africa’s vaccine manufacturing capacity. 

France also is committed to a European Union plan to provide 100 million COVID-19 vaccine doses for low-income countries by year’s end. The United States has similarly pledged to share 80 million doses with lower-income countries.

Lesotho Explains How to Share “Half a Loaf” 

Lesotho was hoping to receive more than 130,000 COVID-19 vaccine doses through the COVAX facility. Instead, it received about 36,000 doses of Oxford-AstraZeneca vaccine on 3 March. Health Minister Semano Henry Sekatle said the country takes a “half loaf is better than none” approach in vaccination planning.

Lesotho Health Minister Semano Henry Sekatle: “Those who have surplus should be kind enough to return the doses”.

This approach allowed vaccination of 95% of health workers, he said. He then appealed to vaccine-rich countries to share with those in need: “Those who have surplus should be kind enough to return the doses. It is also quite important that all these countries that are producing these vaccines should seriously consider the liberalisation of the patents,” Sekatle said.

Added Nkengasong,“Now [it is] critically urgent for countries sitting on excess doses to redistribute — and redistribute quickly, so that we can put vaccines in the arms of the people. And the people of Africa should understand that these vaccines are safe. 

He cautioned, however, that as Africa cannot expect to receive very large quantities of vaccines anytime soon, the continent needs to continue focusing on key preventive measures such as masks and social distancing, as well as careful surveillance of hot spots in new cases and improved treatment, including sufficient oxygen supplies to treat seriously ill patients. All of those measures can help prevent health systems from getting overwhelmed.

At the same time, he noted that the public needs to do its part too: “By having safe vaccines, you’re ensuring that your neighbour is safe, your loved ones are safe. So I urge everyone that has access to getting vaccinated to quickly do so, so that we can continue to protect ourselves, and protect our loved ones.”

WHO member states are lagging behing in achieving Universal Health Coverage by 2030, as outlined in the Sustainable Development Goals.

While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring  Universal Health Coverage (UHC).

Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed.

WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030.  WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work.  There, too, countries fall far short of the mark. 

Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports.

“But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.”

Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF.

UHC is a Right, Not a Privilege

US Health and Human Services Secretary Xavier Becerra said UHC is “a right and not a privilege”.

US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010  – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. 

Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization.

Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said.

“Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra.

To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits.

“We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.”

UHC 2030 steering committee co-chair Justin Koonin

UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”.

For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers.

“If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said.

Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.”

Somalia Calls for UHC ‘Roadmap’

Somalian Health and Human Services Minister Fawziya Abikar Nur

While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”.

She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians.

Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said.

COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame 

WHO DG Dr Tedros Ghebreyesus called on all member states to strengthen primary health care.

Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. 

The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months.

“Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said.

Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”.

UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. 

Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” 

Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness.

Image Credits: UNICEF.

Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session

China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. 

WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing.  COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge.  

But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. 

“China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna.  

 

The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. 

However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. 

In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. 

“The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. 

Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. 

“However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. 

Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms.  

vaccine
Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.”

Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs).

“While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.”

Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center.

COVID – One Among Many Outbreaks Africa Faces 

Dr Matshidiso Moeti, WHO Regional Director for Africa.

WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases.

Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.”

The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.”

‘Last Pandemic’ Report Approved

The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats.

See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response 

Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind.

Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.”

“We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said.

The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”.

Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics.

‘Two-tiered World’ of Vaccinated and Unvaccinated

Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand.

As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. 

“Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states.  

“At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. 

She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. 

Said Clark: “The return on investment would be enormous – both for people’s health and for economies.”

Image Credits: Paul Adepoju , Paul Adepoju.