Voting on the UN High-Level Declaration on AIDS

Russia stunned the United Nations High Level Meeting on AIDS on Tuesday when it proposed a series of last-minute oral amendments to the meeting’s final political declaration – removing references to “rights”; the decriminalisation of sex work; and harm reduction in the context of the battle against HIV/AIDS.

The text of the final declaration had been negotiated over the past two months under the leadership of Australia’s Mich Fifield and Namibia’s Neville Gertze, and Gertze told the meeting that 73 changes had already been made to accommodate Russia’s concerns.

The declaration text was finally adopted, not by consensus but by a vote, after the vast majority of delegates rejected further last-minute amendments proposed by Russia at the meeting. The declaration was approved by 162 countries voting in favour and four against, with Belarus, Nicaragua and Syria siding with Russia.

However, after the vote, a number of countries that supported the declaration also made it clear that their support was qualified.  Countries including Bahrain, Egypt and Libya disassociated themselves in particular from references to “key populations” – those groups considered particularly vulnerable to HIV, including sex workers, men who have sex with men and injecting drug users.

They described such groups as being against their culture, while Russia described them as an affront to “family values”.

Meanwhile, a number of African countries including South Africa, Rwanda and Cameroon expressed disappointment that the declaration, which is meant to guide the next stages of the global campaign against HIV, had not been adopted by consensus at the High Level meeting.

Declaration ‘Does Not Measure Up’

However, the US was the most direct in its condemnation of Russia’s “new and hostile amendments” – as well as the compromises that had been made to get to the current declaration.

“The political declaration before us, put simply, does not measure up,” said the US delegate.

What started as a “strong, ambitious declaration” that was evidence- and science-based, has become a text that “lacks the ambition needed to meet the stated goals of this High-Level Meeting: ending inequalities and ending AIDS”, she said.

The main issue the US had with the declaration was how “national sovereignty” had been given prominence, enabling countries an escape from implementing various clauses because of “national context”.

“Comprehensive sexuality education, and the recognition of sexual orientation and gender identity are central to an effective HIV/ AIDS response,” stressed the US delegate.

“HIV prevention and treatment programmes that do not recognise the diversity of populations and their unique needs will not successfully stop HIV infection or ensure that all persons living with HIV AIDS have access to treatment.”

Delegates from the US, Canada and Portugal (on behalf of the European Union) also condemned Russia’s approach which scuppered weeks of sensitive negotiations.

Research findings, such as a study published just this week also underline the importance of sensitivity to sexual orientation and gender identity in the battle against HIV/AIDS. The study, led by Matthew Kavanagh, of the Global Health Policy and Politics Initiative at Georgetown University, found that countries that criminalise same-sex relationships, illicit drug use, and sex work have worse outcomes against HIV.

Kavanagh’s research found that “in countries with criminalised legal environments, a smaller portion of people living with HIV knew their HIV status and had suppressed virus compared to countries with less criminalising laws”.

Russia Opposed to Harm Reduction, ‘Key Populations’ and ‘Rights’

Russia opposed a number of clauses including harm reduction measures.

The clauses that particularly offended Russia included those related to “key populations”, harm reduction; and reference to a “rights-based” approach in combatting HIV/AIDS.

In particular, Russia had wanted to drop a clause that committed the global community to “urgent and transformative action to end the social, economic, racial and gender inequalities, restrictive and discriminatory laws, policies and practices, stigma and multiple and intersecting forms of discrimination, including based on HIV status, and human rights violations that perpetuate the global AIDS epidemic”.

In addition, Clause 28, was also viewed as unacceptable by Moscow. This expresses “deep concern about stigma, discrimination, violence, and restrictive and discriminatory laws and practices that target people living with, at risk of and affected by HIV”.

Clause 37 on countries’ lack of progress on “expanding harm reduction programmes” was also earmarked for deletion. 

Overall, Russia accused UNAIDS of abandoning it’s science-based approach in favour of a “rights-based approach” and asked that all such references to “rights-based” be removed. 

In addition, Russia sought to delete language committing countries to “eliminating HIV-related stigma and discrimination, and to respecting, protecting and fulfilling the human rights of people living with, at risk of and affected by HIV” and “reviewing and reforming restrictive legal and policy framework” that create barriers or reinforce stigma and discrimination was also unacceptable (Clause 65 A and B).

These clauses are in line with the Joint UN Programme on AIDS (UNAIDS) 2025 “10-10-10 targets”: Less than 10% of countries with punitive legal and policy environments; less than 10% of people living with HIV and key populations experiencing stigma and discrimination, and less than 10% of women, girls, people living with HIV and key populations experience gender inequality and violence.

AIDS is Not Over, Says UNAIDS Head

UNAIDS Executive Director Winnie Byanyima

UNAIDS Executive Director Winnie Byanyima, told the opening plenary: “AIDS is not over. It is one of the deadliest pandemics of modern times. Since the start of the pandemic, 77 and a half million people have been infected with HIV globally and we have lost nearly 35 million people to AIDS. An AIDS death every minute is an emergency.”

A number of countries have made good progress to eliminate new cases by 2030 – a goal set at the last UN High Level Meeting in 2016 – but the COVID-19 pandemic had undermined progress, she added.

“The evidence shows that when laws are strengthened to support gender equality, the rights of key populations and confront stigmatisation, countries have made greater progress in treatment and prevention programmes benefiting everyone,” added Byanyima. “We need to keep moving forward in our common journey away from harmful punitive, outdated, often colonial laws and from all forms of discrimination.”

Yana Panfilova, a 23-year-old woman who was born with HIV and is a member of GNP+ Global Network of People Living with HIV, also addressed the plenary.

“The AIDS response is still leaving millions behind: LGBTQ people, sex workers, people who use drugs, migrants and prisoners, teenagers, young people, women and children who also deserve an ordinary life with the same rights and dignity enjoyed the most people in this room,” said Panfilova.

“If we’re going to make a real change, these four things must become a reality. First one, comprehensive sexuality education in all schools in all countries. Second, psychological support, and peer support for every adolescent living with HIV and young key populations.

Third, the community needs HIV services to become the reality, not the exception. And the last one, finally, get an HIV vaccine.”

Food safety is closely bound to nutrition and food security. Traditional markets, as a central component of the supply chain, have the potential to provide affordable, accessible, and safe food to consumers globally.

While the COVID pandemic has highlighted the pathogen risks that can emerge from unsafe animal and food handling in traditional markets – those same markets are also sources of healthy, fresh food for billions of people around the world – healthier and fresher, in many cases, than what may be found on a supermarket shelf. 

Post-pandemic, traditional food markets need to be modernized and strengthened – so that they can fulfill their real potential in future food systems, said panellists at the event “Talking Food Safety” coinciding with World Food Safety Day. 

The event was hosted by EatSafe, a program funded by USAID, and led by the Global Alliance for Improved Nutrition (GAIN).

“Food safety, nutrition and food security are inextricably linked,” said Bonnie McClafferty, Director of Food Safety at GAIN and Chief of Party for USAID’s EatSafe. “Unsafe food creates a vicious cycle of disease and malnutrition.”

McClafferty was the moderator of a panel of experts on India, Nigeria and West Africa who explored the role of traditional markets in food systems – and how greater consumer and vendor awareness of food safety issues, along with stronger regulatory frameworks, could pave the way for a more vibrant future.  

Supporting traditional markets – in which food safety is well-assured – also supports food security, local farm production, and more sustainable agro ecosystems – as part of a “One Health” approach to food systems that WHO, the Food and Agriculture Organization, UN Environment, and other actors have committed to support as part of pandemic recovery. 

Many consumers globally rely on traditional markets for affordable, accessible, and nutrient-dense foods.

Nutrition & Food Safety Risks 

Over 600 million people fall ill and 420,000 people die every year from eating contaminated food. Children under the age of 5 are among the most vulnerable. Some 75% of foodborne illnesses are in Africa and Southeast Asia, panellists noted, citing the latest WHO data. 

The incidence of foodborne illnesses is 27 times higher in Africa as it is in Europe or North America – where countries often lack strong regulatory systems to control food safety from field to marketplace. 

Food safety risks occur when foods are not safely produced, stored, handled, or prepared; as a result they can contain harmful bacteria, viruses, toxins, parasites, as well as excessive pesticides and chemical residues used at farm sites, and even physical or mechanical contaminants, like shards of plastic, metal or glass from damaged packaging or processes. Any one of these hazards can result in illness or injury, as well as death. 

And such risks are not confined to traditional markets, panellists stressed. They can also be present in fresh or packaged foods on sale at supermarkets as well. So what is needed is a new approach to food safety, and to marketplaces overall. 

Until the eruption of SARS-CoV2, very little public or policymaker attention was accorded to food safety risks generally, or traditional markets more specifically.  However, the emergence of the virus around a Chinese traditional market in Wuhan, heightened public awareness, as well as policymaker sensitivities.  A WHO-convened team of scientists recently concluded that the virus “very likely” emerged from human exposure to infected wild animals or meat somewhere along the traditional market food production or supply chain – although other critics say the virus also could have escaped from a nearby laboratory. Whatever the final verdict over SARS-CoV2, however, most experts agree that the pandemic has created a milestone moment for addressing some of the bigger, and more systemic issues around food safety – and traditional marketplaces.  

Wuhan’s Huanan seafood market that has been closed since early 2020 after one of the first clusters of COVID-19 cases were detected there.

The COVID-19 pandemic and the accompanying public health measures also disrupted delicate supply chains, access to food and sufficient nutrition, and the agricultural industry. Approximately 124 million more people were pushed into long-lasting poverty and hunger in 2020, according to a recent fact sheet by USAID’s “Feed the Future” initiative on global hunger and food security. 

The pandemic also changed the behaviour of both customers and vendors vis a vis traditional markets, according to research conducted by EatSafe between September and December 2020 in Nigeria, Kenya and Bangladesh, coordinated by McClafferty. 

Some changes were positive – others less so. 

On the one hand, more handwashing and sanitation stations were installed in markets, measures welcomed by consumers and vendors alike. Both shoppers and vendors began to pay more attention to hand hygiene, masking and social distances, which helped to control food safety risks as well as COVID infection spread.  

But across all three countries, consumers frequented markets less – affecting businesses and sales, the study found.  And in places like India, with a strong digital economy, the pandemic also seems to have accelerated a trend among younger shoppers away from fresh food markets to more online food purchases – which may also tip the balance to consumer reliance on more processed foods. Such trends, over the long-term, do not bode as well for the future of fresh food marketplaces, nutrition or health.  

“We at GAIN are concerned about that change in the diet, what are they turning to if they’re turning away from perishable foods. It’s very important that the [food] basket remains nutritious,” said McClafferty. 

Bonnie McClafferty, Director of Food Safety at GAIN and Chief of Party for USAID’s EatSafe.

Rather than abandoning markets, which play such a positive role in fresh food systems, what is really needed is greater awareness of food safety as a neglected public health problem – and measures to address shortcomings, said McClafferty and other panellists. 

“It’s ridiculous to think about shutting these [markets] down, they’re not going anywhere,” said McClafferty. “We need to strengthen them, we need to modernize them,…they need to be in demand.”

Traditional Markets – Hubs for “Nutrient Dense” Foods 

By their very nature, traditional markets provide ready access to healthy and affordable, albeit perishable, fresh foods that play critical roles in food security and nutrition. For example, in Nigeria, traditional and informal markets account for 70% of the entire food landscape and drive the local economy. 

Particularly in low- and middle-income countries, many consumers rely on traditional markets to purchase the most important, nutrient-dense foods in their diets, such as animal-sourced foods as well as fresh fruits and vegetables, nuts, and legumes.

Vegetable seller at Gosa Market in Abuja, Nigeria. Traditional markets provide access to healthy, fresh foods that play critical roles in feeding individuals and households globally.

But such markets, located in public venues and comprising dozens or hundreds of individual vendors, often fall through the net of government food safety standards and regulations, which in many LMICS may be weak or poorly enforced. And the rules that exist may not be enforced to the same degree in a marketplace as they are in a supermarket, which is under a single roof and controlled by a single corporate entity.  

The infrastructure of traditional markets, provided by government authorities or vendors’ associations, may also be of poor quality. Good storage facilities for products are often lacking, including no concrete flooring, no access to water for wash stations, and vendor stalls exposed to the elements, hot or cold, rainy or humid.  

Vendors and Consumers Lack Knowledge and Tools

Against this landscape, both vendors and consumers often lack the knowledge and tools to ensure food safety, said Mohamed Nasser, West Africa’s Regional Advisor for Food Safety and Quality Assurance at the World Food Programme (WFP). 

Better training for market vendors in food hygiene, safe food preservation and prevention of waste are all important measures essential to establishing and maintaining safer traditional markets, Nasser said. Other measures include raising food safety awareness among market workers and customers, and better enforcement of regulations. 

Training market vendors on food hygiene, safety, and preservation could lead to improvements in food safety in traditional markets, said the panellists on Monday.

The education of consumers, particularly children and parents, on food safety practices is essential because consumer demands can shift the behaviour of vendors and marketplaces, added Priya Prakash, campaign lead at the NGO Act4Food in New Delhi, India. 

“There needs to be a consumer campaign…that enables and empowers people to make better decisions” about food purchases and hygiene with food in the home, said Prakash.

“The consumer is central to food safety because it’s a demand and supply issue: if consumers begin to push for a cleaner and safer product, vendors are going to respond positively,” added Professor Olugbenga Ben Ogunmoyela, Executive Director of Consumer Advocacy for Food Safety and Nutrition Initiative in Lagos, Nigeria.

Key practices, he noted, include frequent cleaning and disinfection of work surfaces, preventing direct contact between shoppers, live animals and contaminated surfaces, and complying with personal hygiene practices. 

Improving Hygiene Practices 

Despite the devastation COVID-19 has caused, including to food market cultures, hygiene practices that were strengthened and enforced as part of COVID-19 responses have improved food safety in traditional markets, panellists agreed:

“One of the positive points of COVID-19 actually is just to bring back the basic hygiene requirements to be implemented…This is something basic for any traditional market,” said Nasser. 

His comments were based on findings from the biweekly consumer and vendor surveys conducted by GAIN in traditional markets of Bangladesh, Kenya, and Nigeria across the autumn and winter of 2020 – inputs that contributed to the broader USAID-supported study, soon to be published.  

According to those surveys, all three countries saw the implementation of at least some COVID safety measures, such as social distancing, wearing of face masks, hand washing or sanitising, and temperature checks upon entering the market.

The enforcement of the COVID rules, however, varied, with 85% of consumers in Kenya witnessing a strong investment in COVID protocols in marketplaces, as compared to only 35% of consumers in Bangladesh.

Some 80% of vendors surveyed in Kenya in January 2021, also reported a decrease in the number of customers over the previous nine months. In all three cases, consumers reduced their frequency of shopping in the market and avoided peak shopping hours. Decreased sales and customers also were reported by two-thirds of Nigerian vendors, although only 35% reported difficulties in accessing products to sell, while 42% reported difficulties in transporting goods, during the pandemic.

COVID-19 regulations, such as social distancing, wearing of face masks, hand washing or sanitising, and temperature checks upon entering the market, have been implemented to varying degrees across the three countries surveyed.

Sustaining Food Safety Measures Post-Pandemic

Key concerns about shopping in the market, as reported by consumers in Nigeria, included the fear of contracting COVID-19 (70%), food unavailability (34%), and the inconvenience of taking protective measures (32%).

Despite their inconvenience, significant numbers of consumers still welcomed the new safety and hygiene measures. In Bangladesh, some 46.2% of consumers saw the disinfection of marketplaces as the most useful COVID measure implemented, while 57.5% of vendors considered mask mandates to be the most effective. 

As pandemic fears wane, a major concern of panelists is whether newly adopted safety and hygiene measures can be maintained.

“I’m happy to have [basic safety measures] everywhere and applied by everybody, but at the same time, this is basic and should be continued. It’s nothing related to COVID-19, it’s something related to the fact that we need to ensure the safety of the food,” said Nasser. 

Already in some cases pandemic fatigue seems to be setting in, with vendors and customers abandoning the masks and gloves and reverting back to their original purchasing practices. 

Improving awareness and education will be important to sustain the improvement to food safety brought by COVID, the panellists concluded.

Despite the shortcomings in the COVID response, “we can take quite a few things from this particular experience to strengthen our traditional markets,” observed Ogunmoyela. Those lessons include ensuring that governments provide basic infrastructure support and guidelines so that basic safety standards can be met.

“We have to look at how to change attitudes through messaging that will go directly to both consumers and vendors at the market centres,” he added, saying: “The radio jingle is a very effective tool in this environment, and even infographics…that as people are approaching these markets, they know the do’s and don’ts.” 

Professor Olugbenga Ben Ogunmoyela, Executive Director of Consumer Advocacy for Food Safety and Nutrition Initiative in Lagos, Nigeria

The Case of India 

A strong shift away from markets and to online food orders has been particularly evident in India, and among younger generations – who have made use of new digital apps to order food deliveries – rather than venturing out to marketplaces where they feared being infected with COVID. 

“The process of going to a traditional market has broken down and now the distance from the consumer to the traditional market has started to increase,” said Prakash. Foods on sale in the traditional markets are often perceived as less sanitary than supermarkets, she added, even though that may not at all be the case. 

“We need to understand that the interaction and relationship that the younger generation will have with traditional markets will probably not be the same and it might have to change,” said Prakash. 

During the pandemic, “the way commerce is done has fundamentally changed for a lot of people,” she observes. People who never had a bank account set up digital accounts online, and moved to using digital money, which has now become central to the way in which money is exchanged. 

The digital transformation also was encouraged by the Indian government, which created apps that were required for people to register for vaccinations and to enter and exit certain venues, as part of surveillance and contact tracing efforts. 

“A large chunk of the population has started operating in this way in a very accelerated, unprecedented span of time,” Prakash said. Now, she says, traditional markets need to enter digital age as well – in order to remain vibrant centers of commerce post-COVID. 

Priya Prakash, Campaign Lead at #ACT4FOOD #ACT4CHANGE in New Delhi, India.

“The first basic thing that traditional markets can empower themselves with is the entire concept of digital money and transactions,” said Prakash.

“The whole concept of cash being given, which was a typical operating principle in the traditional markets, is changing rapidly. We need to introduce technology as a means to try to connect and [put] these traditional markets on the map for younger generations,” said Prakash.

“There might be a different way that [traditional markets] interact with consumers, with businesses, with technology companies, but traditional markets will always be at the heart of any food system. Going forward, there will be a transition where a lot of these farmers, a lot of these vendors will be empowered enough to sell directly online or represent themselves directly online,” said Prakash. 

“That is going to take a long period of time…[but] we’re looking at this decade of technology transformation…and I feel like that’s the future direction.” 

Updating and Transforming Traditional Market Design

But for the billions of consumers who will also continue to frequent markets in person, new effort also need to be invested in upgrading and modernizing markets’ physical facilities to ensure their safe design, the panellists emphasised. 

The markets “need to be reshaped, we need to build nutrition and food safety education into the system, we need to identify the critical needs and priorities across the landscape, and ensure that policies actually…embrace these markets,” said Ogunmoyela. 

Much closer attention to the details of the physical layout, facilities and organisation of marketplaces can provide the basis for promoting safer and healthier food and reducing the risk of transmission of foodborne and zoonotic disease. 

Greater investment is needed to expand on basic infrastructure in traditional markets and improve on the layout to reduce the risk of transmission of foodborne and zoonotic diseases.

Governments need to invest in implementing basic infrastructure, including an adequate water supplies for cleaning, water drainage systems, and toilets with hand-washing facilities. 

In addition, any market stalls or cages holding live animals, which are high risk areas for the transmission of pathogens, should be located far away from consumers – with the slaughtering process carried out in separate facilities, the panelists stressed. Such measures also have been the focus of new WHO guidance for traditional marketplaces.

Architects and urban designers can become critical intervenors in traditional markets – insofar as improving market design is critical to better food safety. Key measures should include “the use of better spacing, less crowding, [and] better traffic flow,” said McClafferty. 

While stronger regulatory frameworks also are key, consultations with consumers and vendors are also critical before new regulations are put in place, so as to gain a greater understanding of real market conditions, and ensure the uptake of any new rules and policies.  

“Food safety best practices should be customized based on the situation of each group,” said Nasser. “It is not something you can put in [a single set of] guidelines and it will be applicable everywhere in the world.”

Mohamed Nasser, Regional Advisor for Food Safety and Quality Assurance at the World Food Programme (WFP) in Dakar, Senegal.

Transforming Agri-Food Systems 

Rediscovering the value of traditional markets sits within a wider picture on the food chain – facing a wide range of challenges. 

At farm level, pesticide and bacterial contamination still need to be addressed in order to assure that food reaching the marketplace is healthy and safe. As a result, efforts to change behaviours should also be focused on the small food producers that supply the markets – farmers, fishermen, and butchers – to ensure that they reduce their use of pesticides and other potential chemical contaminants in all stages of the food production cycle. 

“Behaviour can be changed, not just by creating the knowledge, but also by actually demonstrating it and by reinforcing the messages across the landscape,” said Ogunmoyela.

In the marketplace, food quality assurance needs to be improved, in particular, for most sensitive products, like milk, cheese and meat, in countries that have warm climates or even tropical conditions.  

Vendors selling their produce at the open-air Gosa Market in Abuja, Nigeria. The infrastructure in traditional markets can expose products to the weather elements, which highlights the need for greater food quality assurance and basic infrastructure.

“We have a golden opportunity this year to transform our agri-food system to be safer, to be more inclusive, more resilient, and to really feed the whole population with nutritious and safe food,” said Ismahane Elouafi, FAO Chief Scientist, speaking separately, at a joint press briefing with WHO on World Food Safety Day, in which WHO released a new handbook to help countries assess their own foodborne disease burden, and identify food safety system needs. 

“Food should sustain and support human health, not harm it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the briefing. “When food safety is improved, we reduce hunger, malnutrition and infant mortality; children miss fewer days at school; adults increase their productivity; and the strain on health systems is reduced.”

Image Credits: Michael Casmir, Pierce Mill Media, Pierce Mill Media, Michael Casmir/Pierce Mill Media, Deutsche Welle, GAIN, Madina Maishanu , Pierce Mill Media.

Greenpeace Switzerland activists project messages in various languages outside the WTO building in Geneva in support of the TRIPS waiver.

While European Union (EU) member states continue to oppose a waiver on intellectual property rights for COVID-19 vaccines and medicines, they may soon find themselves at odds with the European Parliament, which is expected to pass a resolution in support of the waiver on Wednesday.

Negotiations on the controversial waiver proposal, co-sponsored by India and South Africa, will resume again on Tuesday at the World Trade Organization’s (WTO) Trade-Related Aspects of Intellectual Property Rights (TRIPS) Council. 

The waiver would extend to patents, copyright, industrial designs, and “trade secrets” related to all COVID-19 “products and technologies”.  According to an amended version of the initiative, it would be time-limited to three years – with WTO  review annually.

The proposal has met with continued opposition from the European Union (the European Council and the European Commission) which tabled its own counter-proposal at the TRIPS council last week.  In contrast to the blanket waiver, the EU initiative would continue to rely upon the use of existing IP exceptions to allow countries to produce COVID-19 vaccines and medicines under compulsory licenses as needed. 

Last month, Ambassador Xolelwa Mlumbi-Peter, South Africa’s Permanent Representative to the WTO and co-sponsor of the proposal, condemned the “circular discussion” on the waiver proposal – which was made eight months ago.

Ambassador Xolelwa Mlumbi-Peter, South Africa’s Permanent Representative to the WTO, 

Her Indian counterpart and co-sponsor, Ambassador Brajendra Navnit, says that waiver opponents have been using “delaying tactics” by  “changing goalposts” to raise new problems once their earlier concerns had been addressed.

Groundswell of European Parliamentary Support 

However, a groundswell of support for the broader waiver initiative is emerging among European parliamentarians.  The draft resolution due to go to the plenary on Wednesday calls for “a temporary TRIPS waiver for COVID-19 vaccines and related health technologies, and for the EU to actively participate in text-based negotiations at the World Trade Organization (WTO) to achieve this”.

A motion to approve the resolution already passed by a comfortable majority in the European Parliament’s Committee on International Trade on 19 May, and is widely expected to be carried by the plenary.

Proponents of the waiver say it is an essential tool to stimulate more vaccine production in countries and manufacturing sites that have idle capacity – and thus get 11 billion vaccines made and distributed as fast as possible to immunise 70% of the world’s adults against SARS-CoV2.

Vaccine dose-sharing has so far only yielded 200-million doses at most – and on Monday WHO launched another urgent appeal to G7 leaders, meeting this coming weekend, for donations of another 100 million doses now, and 250 million doses by September. 

The net result is that while the US and the EU are moving to normalise their societies as they mass-vaccinate, poor countries in Africa and Latin America, which lack vaccines, are facing third and fourth waves of the pandemic.  

In Latin America, the rate of new COVID cases is now three times that of India – and these swelling numbers could also give rise to more virus variants in a region that has already seen significant variants of concern emerge in countries like Brazil from uncontrolled infection spread.

At the same time, a number of reputable vaccine manufacturers – notably in Indonesia and Bangladesh – have stated that they have the capacity to produce COVID-19 vaccines – but cannot because none of the pharma companies that have successfully developed a COVID vaccine have signed them onto manufacturing deals. 

Compulsory Licenses Are a ‘Legitimate Tool’

Even so, the EU remains resolute in its opposition to the TRIPS waiver on COVID-19 products and technologies – despite the groundswell of support the waiver initiative has gained among 60 WTO members, including a US endorsement of a waiver on vaccine-related IP.

Last Friday, the EU made public its counter-offer to the waiver that proposed that WTO actions focus on three very modest fixes: 

  • Lifting cross-border trade restrictions on COVID-19 vaccines, treatments and components; 
  • Encouraging vaccine producers to voluntarily expand production; 
  • Facilitating the use of compulsory licensing within the TRIPS Agreement.

“Voluntary licenses are the most effective instrument to facilitate the expansion of production and sharing of expertise,” the EU stated.

“Where voluntary cooperation fails, compulsory licenses, whereby a government grants a targeted license allowing a willing producer to make a vaccine without the consent of a patent-holder, are a legitimate tool in the context of a pandemic.” 

Current Rules for Compulsory Licenses Onerous – Critics Say

Free the Vaccine Activists held protests across the US last week calling for wealthy nations to support the TRIPS waiver.

But critics say compulsory licenses designed to satisfy the domestic needs of a country in crisis – are too complicated and onerous for the kind of quick and large-scale global actions needed now to combat the pandemic. 

In particular, medicines or vaccines produced under a compulsory license by one country cannot easily be exported to another country – without the producers’ fulfilling yet another series of detailed conditions that only permit such exports under closely curtailed TRIPS “exceptions”.  

The WTO export restrictions on products manufactured under compulsory licenses bode ill, in particular, for vaccine producers – which use components procured from multiple suppliers, in processes that also may take place in diverse countries – from producing the active biological ingredients to “fill and finish”. 

Moreover, in order to ensure sustainability and even quality control, vaccine producers typically fabricate their products in large volumes for export to multiple countries – something difficult to do under existing TRIPS rules. 

Bolivia’s Compulsory License ‘Test Case’

Bolivia, for instance, is currently involved in a compulsory licensing “test case”.  The Bolivian government is trying to get the Canadian government to issue a compulsory license to the Canadian company Biolyse, so that it can export vaccines to Bolivia and other countries with vaccines. 

Biolyse says it has the capacity to produce 20 million COVID-19 vaccine doses for use by low and middle-income countries like Bolivia – but cannot do so because of IP restrictions.

A number of other manufacturers – notably in Indonesia and Bangladesh – have also indicated that they have the capacity to produce COVID-19 vaccines but cannot because they have not received voluntary licenses from the pharma companies that have successfully developed a COVID vaccines so far. 

Meanwhile, Médecins Sans Frontières (MSF) has documented examples of countries that issued compulsory licenses for domestic production medicines, as already allowed by TRIPS, have faced pressure from wealthier nations.

“Since India issued its first compulsory license on pharmaceutical patents, the US has applied continuous pressure on India to discourage any further compulsory licensing on patented medicines,” according to MSF.

“The US Trade Representative’s annual Special 301 report systematically criticises developing countries who either reform their IP law to include TRIPS flexibilities or make use of compulsory licenses,” MSF elaborated.

“The EU’s annual IP enforcement report also criticises a number of developing countries for compulsory licensing laws and other uses of TRIPS flexibilities. This kind of pressure continued at the peak of the COVID-19 pandemic in April 2020.”

EU Accused of Delaying Text-Based Negotiations

Ursula von der Leyen, President of the European Commission.

Last month, China and Russia voiced support for the waiver, and in a surprise move on 5 May, the US broke ranks with the EU and Japan, announcing its support for text-based negotiations on removing IP and patents for COVID-19 vaccines only – as opposed to “products and technologies” proposed by the waiver.

“The Administration 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 Trade Ambassador Katherine Tai. “We will actively participate in text-based negotiations at the WTO needed to make that happen.” 

In the wake of the United States announcement on 5 May that it would support an IP waiver, at least for COVID vaccines, waiver advocates have turned up the heat on the EU, whose member states are now widely perceived as the key remaining barrier to some kind of compromise text on the IP waiver initiative.  They also stress that time is of the essence.  

“In addition to muddying the water and diverting attention, the EU is also hoping that its empty-package compulsory licensing proposals will delay text-based negotiations of a waiver agreement so long that implementing the waiver would be economically impractical for alternative producers and countries,” said Professor Brook Baker, Senior Policy Analyst for Health GAP.

‘Necessary and Proportionate’ 

In an pre-print paper, London School of Economics Associate Professor of Intellectual Property Law Siva Thambisetty and colleagues argue that the TRIPS waiver “is a necessary and proportionate legal measure for clearing intellectual property (IP) barriers in a direct, consistent and efficient fashion, enabling the freedom to operate for more companies to produce COVID-19 vaccines and other health technologies without the fear of infringing another party’s IP rights and the attendant threat of litigation”.

“The phenomenon of COVID-19 ‘vaccine nationalism’ has brought into sharp relief the misalignment of current legal and financial incentives to produce and distribute vaccines equitably,” they argue. 

“The crisis further demonstrates the failure of high-income countries (HICs) to realise the promise they made at the time of the TRIPS negotiations in 1994, that by agreeing to the terms of TRIPS, lower and middle-income countries (LMICs) would benefit from technology transfer and the building of productive capacity.”

Widening Support in Global Health Community 

Free the Vaccine activists in San Francisco call on Japan to support the TRIPS waiver

Broader recognition of the failure has also helped drive a series of high-level expressions of support for the waiver proposal from the mainstream global health community including the Bill and Melinda Gates Foundation. 

Even WTO Director-General Dr Ngozi Okonjo-Iweala has stressed the need to “get to a conclusion on this [TRIPS waiver] debate, promote technology transfer and know-how to get lasting increases in production capacity”. 

Whether the next two days of talks in the TRIPS Council go in circles yet again or make progress towards text-based negotiations depends largely on waiver opponents – most notably, the EU, Japan and Brazil.

Meanwhile, the easiest way for vaccine manufacturers to pre-empt the “threat” of the waiver would be for developed countries to massively share existing vaccine doses – and for manufacturers to pledge more production to the World Health Organization’s COVAX global vaccine facility. Calls for both were issued again on Monday by WHO Director General Dr Tedros Adhanom Ghebreyesus.  

Tedros also called upon pharmaceutical companies to join the WHO’s COVID-19 Technology Access Pool (C-TAP) and Technology Transfer Hub, sharing their know-how voluntarily and entering into licensing agreements with other global manufacturers to speed up vaccine production and access. 

With or Without Waiver – WHO Pushes Ahead on Vaccine Technology Transfers 

Meanwhile, said Tedros at Monday’s WHO press briefing, WHO is also moving ahead on measures that aim to build longer-term capacity for technology transfer to developing countries, including an “mRNA Vaccine Technology Transfer Hub”. 

“Two months ago, WHO also issued a call for expressions of interest to establish an mRNA technology transfer hub to facilitate increased global production of mRNA vaccines,” said Tedros, who added that a technical review of expressions of interest from companies interested in transferring their technology, and countries wanting to receive the technology was being conducted.

“We continue to call on companies with mRNA technology to share it through the COVID 19 technology access pool. The result can be a win-win for both the owner of the know-how as well as for public health,” added Tedros. 

“The biggest barrier to ending the pandemic remains sharing: of doses, of resources, of technology.”

 

Image Credits: Maxime Gautier/ Greenpeace, Twitter – Ursula von der Leyen.

WHO’s Director General Dr Tedros Adhanom Ghebryesus called on leaders of the  G7 Group of the world’s most industrialized nations to share at least 100 million more COVID-19 vaccine doses with low- and middle-income countries in June and July and 250 million doses by September. 

His appeal, at a WHO press conference Monday,  added to the growing chorus of voices being directed at G7 leaders to step up donations of vaccines and funding – when they meet this coming weekend in Cornwall, England for the first face-to-face meeting since the pandemic began.

See 100 Former World Leaders Urge G& to Donate $US 44 Billion

“Increasingly we are seeing a two track pandemic,” Tedros said, adding that the inequitable distribution of vaccines is “a threat to all nations” because it ‘increases the chances of a variant emerging that renders the vaccine less effective.” 

He also called upon vaccine manufacturers to commit 50% of any new volumes of vaccines produced to the WHO co-sponsored global COVAX facility – or at the least give COVAX the first right of refusal to those new vaccine volumes. 

Amidst Global Declines in Cases – Latin America Remains Global Hotspot   

The G7 meeting takes place with some good news on the horizon. For the sixth week in a row, the world has witnessed sharp declines in new COVID cases. 

However, “a mixed picture” remains with more deaths reported last week than the week previous, in three WHO regions – Latin America, the African region and the Western Pacific, Tedros said.  

Latin America, in particular, remained a global hotspot – with yet another wave of rising COVID cases over the past month.  That wave hit a weekend peak of about 300 cases per million people. That is currently more than three times the number of new cases being seen by hard-hit India, five times that of Europe and six times higher than the global average. 

“We continue to see encouraging signs in the trajectory of the pandemic,” Tedros said, “However we still see a mixed picture around the world.  Many countries still face an extremely dangerous situation while some of those with the highest vaccination rates are starting to talk about ending restrictions.

“Six months since the first vaccines were administered, high income countries have administered almost 44% of the world’s vaccines, while low income countries have administered just 0.4%. 

“But the frustrating thing about this situation is that it hasn’t changed; and inequitable vaccination is a threat to all nations, not just those with the fewest vaccines. 

At the World Health Assembly I call for a massive global effort to vaccinate at least 10% of the population of all countries by September, and at least 30% by the end of the year.  To reach those targets we need an additional 250 million doses by the September.  And we need 100 million doses in June and July.  The G7 nations have the power to meet these targets, and I am calling on the G7 not to just commit to sharing doses, but to commit to sharing them in June and July. 

Quest for Origins of SARS-CoV2 Virus 

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

Regarding the ongoing quest to identify the source of the SARS-CoV2 virus, WHO officials said that the Organization lacks any mandate to compel member states such as China to disclose data or information that Beijing may be withholding. 

Within the context of the WHO inquiry, the entire investigation must be conducted on a “consensus” basis with member states, stressed Dr Mike Ryan, Executive Director of WHO’s Health Emergencies programme. 

“WHO does not have the power to investigate or enter countries without the express permission and cooperation of that country. That is the basis on which the organization is established in its constitution, it’s a member state organization. And that says 194 Member States agree on the rules,” Ryan said, in response to a reporter’s question about whether WHO would follow up on allegations that China has suppressed valuable epidemiological about the early case trial in Wuhan, as well as laboratory data on related horseshoe bat viruses. 

“So from that perspective, WHO has no powers to compel.  What we do is we work through cooperation, we work through consensus, and that has worked extremely well for WHO in polio eradication, in smallpox eradication, in dealing with multiple outbreaks and emergencies that occur every year.  We get remarkable cooperation from most of the vast majority of countries in engaging in outbreak investigations and outbreak response in emergency response.” 

While acknowledging it is “very, very important that the world understands what the origins of SARS-CoV2 was, ….it’s not always easy to determine that,” Ryan added. “For many other diseases it has taken years of study.”

In that vein, he said that the WHO-convened team of experts that are studying the origins of the virus – and which in March issued their first report of intial findings – would propose the necessary Phase 2 studies “to take our understanding and knowledge to the next level.” The preliminary findings of the first report had stated that the infection of humans was “very likely” due to food-borne exposures to wild or domesticated animals, or animal products, infected with the virus. 

The same report concluded that it was “extremely unlikely” that the infection originated in the escape of the virus from a laboratory, such as the Wuhan Institute of Virology, which was studying closely related bat viruses.

That provoked an outcry among scientific critics who said that the Chinese government had suppressed and concealed vital data and databases, and thus the WHO-convened group lacked a real factual basis for ruling out the lab escape possibility. 

WHO’s Director General Tedros later acknowledged that the laboratory escape hypothesis had not been adequately explored in the initial investigtion phase.  But WHO so far has not outlined a way forward on the investigation, despite recent diplomatic pressures from the United States and other member states – including a US announcement of its own investigation during the 24 May-June 1 World Health Assembly. 

 

Image Credits: WHO.

President of Uganda Yoweri Museveni addressing the nation

Uganda has imposed more stringent measures to control COVID-19 transmission after it recorded over 1000 new cases per day on 2 June – its highest tally ever, mostly among people aged between 20 and 39 years.

On Sunday, President Yoweri Museveni instituted a 42-day lockdown during which time all schools and institutions of higher learning will be closed. Teachers will also have to be fully vaccinated before they are accepted back to the classrooms.

Since March, Uganda’s education institutions have been a major source of COVID-19 infections with a total of 948 reported cases in 43 schools from 22 districts. 

Over 60% of cases have come from Kampala, Gulu, Masaka and Oyam districts. 

“We believe this number is much higher, only that most schools are not reporting. They are hiding because they don’t want to be closed and most of them want to get money,” said Museveni. 

The increased COVID-19 infections in schools has been attributed to poor compliance with behavioural guidelines such as mask-wearing, inadequate sanitation facilities and overcrowding.

Communal gatherings of over 20 people, including at places of worship, conferences and cultural gatherings, have also been suspended for the next 42 days.

However, the Cabinet, legislature, and the judiciary are allowed, as are small gatherings under 20 people and agriculture activities, factories, construction, shopping malls, food markets and supermarkets. But all have to close by 7pm.

Test Positivity Reaches 18%

Last Friday, the Ministry of Health’s testing results indicated 1,259 new cases out of 7,289 samples tested and nine deaths. 

Uganda’s cumulative confirmed cases are 52,935 and deaths are up to 383. Active cases on admission at health facilities are 634 and the test positivity rate has increased to 18.1%.  

“A test positivity above 10% is a cause for concern especially in a country where testing is reasonably being done,” said the World Health Organisation regional director for Africa, Dr Matshidiso Moeti. 

Museveni said this situation is beginning to stress the health facilities, with pressure of available  beds and oxygen in hospitals.

“The intensity of the illness and severity among the COVID-19 patients is higher than what we experienced in the previous phase,” said Museveni about the second wave. He encouraged people to work from home with only 30% of the staff who work in offices allowed with physical presence.  

Inter-district movement has also been suspended except for tourist vehicles and cargo trucks that have to carry only two people.

Museveni said all travelers have to undergo mandatory COVID-19 testing because some who would come into the country with purported negative PCR test results were tested positive.

To date, Uganda has confirmed a total of 126 cases from travelers coming in through Entebbe International airport out of 4,327 travelers entering the country since the pandemic started. 

 

Health Director General Henry Mwebesa

Meanwhile, the country has used 748,676 AstraZeneca vaccines out of 964,000 available, with 712,681 people having their first dose and 35,995 people having received both doses.

The country received 864,000 doses from COVAX in March and 100,000 as a donation from the Indian government.

Museveni said the government is committed to vaccinating all the 21.9 million eligible Ugandans, starting with the priority groups of 4.8 million people. 

The country is also trying to avoid wastage of COVID-19 vaccines by reassigning vaccines from low to high absorption areas. Malawi destroyed vaccines last week due to expiration.

Districts that have a below 50 percent uptake of COVID-19 vaccines in Uganda will have them withdrawn and redeployed elsewhere unless they act immediately, the Ministry of health has announced. The vaccines are due to expire by 10 July.

Vaccines to be Redeployed

Health Director General Henry Mwebesa says the withdrawn vaccines will be redeployed to the  Kampala Metropolitan Area where the infection rate and uptake are high.

“Take note that there will be penalties for those that waste vaccines or allow vaccines in their possession to expire yet these are very expensive life saving vaccines,” warned Mwebasa.

When the vaccines were delivered, the districts were given three months to vaccinate vulnerable groups including health workers, teachers, security personnel and anyone between 18 and 50 years with comorbidities.

According to some district leaders, some places have been unable to roll out vaccinations properly as they are under-staffed or newly created with inefficient management systems.

“Most of these districts have valid reasons for the low absorption. Ultimately, they have no capacity to translate policy into action,” said Alfred Driwale, the manager of the Uganda National Expanded Programme on Immunization (UNEPI) at the Ministry of Health.

Meanwhile, Museveni warned the public to either comply or face a total lockdown and fines: “Failure to observe the stated directives within a week, I will direct a total lockdown. Those who do not care for the health of Ugandans will pay financially.”

 

Boris Johnson, Prime Minister of the UK, at a press conference in mid-May.

Boris Johnson, UK’s Prime Minister, called upon the leaders of high-income countries to commit to vaccinating the world by 2022 – ahead of Friday’s Group of 7 (G7) meeting of most industrialised nations. 

His appeal came as 230 prominent figures, including 100 former prime ministers, presidents, and foreign ministers penned a letter urging G7 nations to pay two-thirds of the US$66 billion needed to vaccinate low-income countries. 

The wealthy nations must make 2021 “a turning point in global cooperation,” said the letter. 

Johnson will host the first in-person G7 summit in two years in Cornwall, with the leaders of the United States, Japan, Germany, France, Italy and Canada. 

“I’m calling on my fellow G7 leaders to join us to end this terrible pandemic and pledge we will never allow the devastation wreaked by coronavirus to happen again,” said Johnson in a statement on Saturday. 

“Vaccinating the world by the end of next year would be the single greatest feat in medical history,” he added. 

World Leaders call on G7 to Fund Global Vaccination Effort

The open letter to the G7, championed by 100 former presidents and heads of state, said that the G7 should “lead the way” by paying US$43 billion to the Access to COVID-19 Tools (ACT) Accelerator. It is estimated that ACT-A will need US$66 billion over two years to fully fund the global vaccination effort. 

“For the G7 to pay is not charity, it is self-protection to stop the disease spreading, mutating and returning to threaten all of us,” said Gordon Brown, former UK Premier and UN Special Envoy for Global Education. 

“Costing just 30 pence per person per week in the UK is a small price to pay for the best insurance policy in the world. Savings from vaccinations are set to reach around US$9 trillion by 2025,” Brown said. 

Other signatories of the letter also include former UK Prime Minister Tony Blair, former UN Secretary General Ban-Ki Moon, former Prime Minister of Korea Han Seung-soo, former President of Nigeria Olusegun Obasanjo, and former President of Ghana John Mahama. 

Public Support for G7 Investment in Vaccine Rollout and Sharing of Doses and Know-how

The plea coincided with a poll conducted by Save the Children, which found that support for G7 countries paying for global vaccinations was overwhelming among respondents across the G7’s European and American members. Japan, the G7’s only Asian member, was not included in the poll. 

In the UK, 79% of respondents were in favour of such a policy, 76% supported it in the US, 73% in Canada, 71% in Germany, and 63% in France.

Some 80% of the respondents backed both the sharing of doses and intellectual property for vaccines by G7 countries. 

“When it comes to vaccine justice what stands out is that people of different ages, in different locations and with different backgrounds are united,” said Bidisha Pillai, Global Policy, Advocacy and Campaigns Director for Save the Children. 

“They want the G7 to make the world safe again. Their publics will not accept anything less than a serious and fully-funded plan to crack the global COVID-crisis,” Pillai said. 

Commitments to Share Doses

Several G7 countries have announced plans to share doses, with the US pledging to donate 80 million surplus doses beginning in late June and Germany, France and Italy promising to share a total of 75 million doses. 

The UK, on the other hand, has committed to donating surplus doses but has not announced how many will be released or when. It is expected that Johnson will announce more details at the G7 summit. 

The UK has secured access to over 400 million jabs for a population of 66.6 million. Some 59.4% of the population has received at least one dose of a vaccine.

More than 85% of doses have been administered in high- and upper-middle-income countries, while 0.3% have been administered in low-income countries.

The comparison between vaccination rates in G7 countries and seven low-income countries with some of the world’s lowest vaccination rates is a stark visual representation of the inequity in the global vaccine rollout.

Sharing Vaccine Doses Versus Children’s Vaccination 

The stepped up pressure to share doses also comes at a time when the United States and European countries are beginning to vaccinate children and adolescents as young as 12, following regulatory approval of the Pfizer mRNA vaccine as safe for younger age groups. 

WHO’s Director General Dr Tedros has urged countries to postpone vaccinating children if it comes at the expense of vaccinating high risk groups such as older people and health workers in low- and middle-income countries.   

“I understand why some countries want to vaccinate their children and adolescents, but right now I urge them to reconsider and to instead donate vaccines to COVAX,” said Tedros during a press briefing in late May.

“In low- and middle-income countries, COVID-19 vaccine supply has not been enough to even immunise healthcare workers, and hospitals are being inundated with people that need lifesaving care urgently,” Tedros added.

Dr Tedros Adhanom Ghebreyesus, WHO Director General, at a press briefing in late May.

Other critics, however, have said that the issue is not so simple since some children have pre-existing conditions that require vaccination, and some high-income countries with traditionally high COVID rates may need to vaccinate children to advance herd immunity that also curbs the risks of variant spread.

A countermeasure to the emergence of new variants is to “get as many people within a population vaccinated and protected so the virus has less space to grow, less space to spread,” Anita Shet, Director of Child Health at the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, told Politico.

“It means that we need to get vaccines into most of the population regardless of age,” Shet added.

In addition, the Pfizer/BioNTech and Moderna vaccines are the main ones to have been approved in the United States, the United Kingdom or Europe for use among children aged 12-15 – and that vaccine has limited utility in many low-income countries due to its ultra-cold storage requirements. 

Image Credits: Telegraph, WHO.

 

A smoke-free poster at a bus stop in Yunnan

Eight campaigns and initiatives aimed at encouraging people to quit smoking were launched this week by Vital Strategies and partners to mark World No Tobacco Day on 31 May 2021. 

Tobacco use is the single greatest source of preventable death and disease worldwide – responsible for eight million deaths each year and the theme of this year’s World No Tobacco Day was “commit to quit.” 

José Luis Castro, President and CEO of Vital Strategies

“Now is the time for bold, comprehensive action on tobacco. COVID-19’s tragic toll has fuelled vulnerabilities from decades of under-investment and inattention to prevention and preparedness, including more than a billion people more susceptible to illness because of current tobacco use,” said Jose Luis Castro, President and CEO of Vital Strategies, in a statement. 

Vital Strategies’ World No Tobacco Day campaigns support policies to discourage and reduce smoking, and to keep the industry out of tobacco control legislation, reaching millions around the world. 

India – “When You Quit” Campaign

Vital Strategies and WHO India launched the campaign, “When You Quit” on national radio stations and on digital television platforms, and disseminated a communications toolkit with social media resources to communicate the harms of tobacco use. 

Indonesia – New Smoke-Free Laws 

In Bandung, Indonesia, Mayor H Oded Muhammad Danial unveiled a new smoke-free law that prohibits smoking in seven types of public spaces. Bandung, with its smoke-free law, was part of the many cities that participated in the Partnership for Healthy Cities global network supported by Bloomberg Philanthropies in partnership with WHO and Vital Strategies.   

Philippines – Running to Quit

The Philippines Department of Health and Vital launched a virtual ‘Smoke-Free Challenge’, where participants competed in virtual distance-based activities, such as running, walking, and swimming, promoting health activities. 

China – Promotion of Smoke-Free Policies 

Vital Strategies promoted smoke-free policies in China with two public service announcements, “Cigarettes are Eating Your Baby Alive” and “Smoke-Free Family”, reaching more than one million people through an online event organized with the National Health Commission. 

Vital also worked with the Yunnan Health Education Center and Health Education Association to provide posters on the importance of smoke-free policies for 200,000 posters bulletin boards across the province. Other cities in China also launched social and mass-media campaigns. 

Ukraine – Tobacco Use and Risks From COVID-19

“A Doctor’s Warning” is a new media campaign on tobacco use and COVID-19 launched in Ukraine, in partnership with the Public Health Center of the Ministry of Health and the NGO Life Advocacy Center. The campaign featured a testimonial from a prominent doctor on how smoking increases the risk of COVID-19. 

Vietnam and Bangladesh – Protecting Loved Ones From Secondhand Smoke

In Vietnam, “Quit Smoking to Protect Your Loved Ones,” recounts the story of Le Thi Tinh, who developed lung cancer after regular exposure to secondhand smoke in her home. The campaign is run on national television channels and on the Smoke-Free Vietnam Facebook page through June.  

In Bangladesh, the government aired the public service announcement, “Smoke-Free” homes for six weeks on the state-owned television channel, Bangladesh Television. The messaging focused on the importance of quitting smoking to protect loved ones from secondhand smoke, and was supplemented by posts to the Facebook page, Stop Tobacco Bangladesh. 

Brazil – Ending Electronic Nicotine Delivery Systems 

The Brazilian Medical Association and Cancer Foundation launched a social media campaign focused on the importance of banning ENDS in Brazil and pushing back against industry efforts to overturn it. 

The Facebook live launch event of “Quit Smoking to Protect Your Loved Ones” in Vietnam

Stopping Tobacco Industry Interference in National Policy

Castro urged governments to enact policies that support healthier choices for all, especially through the use of effective tobacco control laws, such as the WHO’s Framework Convention on Tobacco Control (FCTC). 

“For our healthiest future, we must act to shape our society and our environment to support health,” he said, adding that this includes contending with persuasive marketing from the tobacco industry and the influence of the industry on government policies. 

The Global Tobacco Industry Interference Index 2020, released by STOP (Stopping Tobacco Organizations and Products), also showed that the tobacco industry has been using the pandemic to promote itself through donations of necessary goods, in order to gain a foothold in tobacco policies of national governments.  

Pakistan health authorities continue in their struggle to implement the FCTC, though the treaty was signed in 2004. In addition, tobacco control activists fear that the government has given in to industry pressure to close down its only government body addressing tobacco consumption, the Tobacco Control Cell (TCC). 

Meanwhile, the Kenyan government, earlier this year, had issued a directive requiring the tobacco industry to register all nicotine products as tobacco products. 

The Kenya Tobacco Control Alliance (KETCA) had also called on the government to act fast, as tobacco use is a bigger epidemic than COVID-19, and requested the Ministry of Health to tighten tobacco control regulations. 

“Tobacco use continues to kill at least 9,000 Kenyans every year. This is three times the total number of Kenyans killed by Covid-19 in the last one year. By Sunday, May 30, 2021, Covid-19 had killed 3,157 Kenyans,” said Joel Gitali, chairman of the KETCA.

 

 

Image Credits: Vital Strategies, Vital Strategies.

European Commission President Ursula von der Leyen suggests that the EU’s counter-proposal to the TRIPS waiver offers “concrete short and medium term solutions to ensure universal access at affordable prices”.

Humanitarian organisation Médecins Sans Frontières (MSF) has criticised the European Union’s (EU) opposition to the TRIPS waiver, labelling its counter-proposal published on Friday as a “manoeuvre” to replace a concrete legal solution to COVID-19 vaccine manufacturing.

Ahead of next week’s TRIPS council meeting scheduled for 8-9 June, Senior Legal and Policy Advisor at MSF’s Access Campaign, Yuanqiong Hu, said the EU’s counter proposal not only ignored critical corrections needed to overcome the shortcomings of existing rules, but also failed to address access to a sustainable supply of tests and other life saving devices beyond vaccines and therapeutics.

The EU has consistently opposed India and South Africa’s proposal at the World Trade Organization (WTO) to temporarily waive certain intellectual property rules under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), a measure that would expand access to lifesaving vaccines and other health products. 

Their entrenched position comes despite growing support for the TRIPS waiver – including an indication by the US that it was willing to move to text-based negotiations on the proposal.

On Friday, the EU published its proposal to WTO members for a multilateral trade action plan to expand the production of COVID-19 vaccines and treatments, and ensure universal and fair access. 

The EU remains adamant that, while it is open to discussing options that could help end the pandemic, the TRIPS waiver is not the solution. 

“(The EU) is not convinced that this would provide the best immediate response to reach the objective of the widest and timely distribution of COVID-19 vaccines that the world urgently needs” the body said in a statement.

Key to the new proposal is a need for voluntary licences to facilitate the expansion of production and sharing of expertise. 

“Where voluntary cooperation fails, compulsory licences, whereby a government grants a targeted licence allowing a willing producer to make a vaccine without the consent of a patent holder, are a legitimate tool in the context of a pandemic,” states the proposal.

EU Proposal Fails to Extend Beyond Vaccines

Highlighting the EU’s counter-proposal, European Commission Executive Vice-President and Commissioner for Trade, Valdis Dombrovskis, warned against “complacency” as the world continues to fight the COVID-19 pandemic. One of the main problems currently, is the lack of sufficient manufacturing capacity to rapidly produce the required quantities of COVID-19 vaccines. 

“We need to urgently concentrate on proposals that accelerate the equitable distribution of COVID-19 vaccines worldwide, said Dombrovskis, adding that: “In this respect, a strong multilateral trade response could deliver a huge boost in the fight against COVID-19.”

“The objective must be to ensure that any available and adequate manufacturing capacity anywhere in the world is used for the COVID-19 vaccines production.”

MSF’s Hu however called out the EU’s resistance to the TRIPS waiver, pointing out that its reference to compulsory licensing is already permitted in the current provisions and practices of the TRIPS Agreement.

“The EU’s counter-proposal to the TRIPS waiver is a manoeuvre to push for voluntary actions of pharmaceutical corporations as a solution to replace a concrete legal solution backed by more than 100 countries,” said Hu.

According to Hu, MSF’s analysis has found that compulsory licenses alone would not be enough to achieve urgent access to lifesaving COVID-19 medical tools, even for the EU itself, during the pandemic.   

Importantly, said Hu, the EU counter-proposal only applies to patent barriers and fails to address intellectual property (IP) barriers that need to be waived when countries and manufacturers seek to scale up the manufacturing and supply of COVID-19 vaccines, medicines and other health technologies. 

“It also fails to mention the need to ensure access to a sustainable supply of tests and other life saving devices beyond vaccines and therapeutics,” said Hu.

“Concrete Short and Medium Solution” to Vaccine Manufacturing

However, EC President Ursula von der Leyen said the EU’s counter-proposal offers “concrete short and medium term solutions to ensure universal access at affordable prices”.

“Beyond the current crisis, it is important to ensure global preparedness for future pandemics: diversifying manufacturing so that it is not centralised only in a handful of countries and strengthening the resilience of the healthcare infrastructure in least developed countries,” said von der Leyen.

The EU’s proposal is based on trade facilitation and disciplines on export restrictions, support for the expansion of production, and clarifying and simplifying the use of compulsory licences during crisis times”.

Elements of the proposal include limiting the use of export restrictions for vaccine-producing countries and keeping supply chains open and uninterrupted; calling on governments to encourage and support vaccine manufacturers and developers to expand production and ensure the affordable supply of vaccines to low- and middle-income countries. 

“Such actions could include licensing agreements, the sharing of expertise, tiered pricing including non-profit sales to low-income countries, contract manufacturing and new investments in manufacturing facilities in developing countries,” states the proposal.

Image Credits: R Santos/HP Watch.

Ultra-processed food is a staple diet for Mexican 10-year-old Ricky and his mother, Alicia.

UK farmers use half the antibiotics they did in 2014; Mexico has reduced stunting by 6% in the last 30 years, and Pakistan is offering conditional cash transfers to poor families to improve their nutrition. 

These examples of how countries are trying to fix broken food systems were offered at Friday’s Healthy Food Systems dialogue, co-hosted by the World Health Organization (WHO), EAT, and the Global Alliance for the Future of Food.

Opening Friday’s dialogue, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that “we need a new food systems narrative that embraces the interconnectedness of humans, animals, and the planet that sustains us”. 

The dialogue marked the start of a week-long series of global conversations in preparation for the United Nations (UN) Food Systems Summit in September and the civil society “pre-summit” next month.

UN Secretary-General Antonio Guterres has called the summit to address how to build healthier, more sustainable and equitable food systems to achieve the Sustainable Development Goals (SDGs) by 2030.

Tedros told the dialogue that the  WHO proposes a new food system based on five major pathways:

“First, unhealthy diets, and food insecurity, with impacts including overweight and obesity, undernutrition, micronutrient deficiencies and diet-related non-communicable diseases,” he said.

“Second, zoonotic pathogens and antimicrobial resistance which impacts farm ranged and wild-caught animals. 

“Third, unsafe and adulterated foods, including those containing hazards such as pathogens, chemicals and toxicants. 

“Fourth, environmental contamination and degradation through pollution of soil, air and water resources and fifth, occupational hazards, including harm to physical and mental health, suffered by workers in the food system,” said Tedros.

New Food System Narrative is Needed

Dr Agnes Kalibata, UN Special Envoy to the Food Systems Summit

Francesco Branca, WHO’s Director Nutrition and Food Safety, said that the Food Summit provides an opportunity “to develop a new food system narrative centred around upholding human, ecological and animal health using a One Health approach”.

“Current narratives do not always recognise these interconnections and could miss the opportunity of a radical food system transformation, building on the pandemic recovery process,” he added.

Dr Agnes Kalibata, UN Special Envoy to the Food Systems Summit, said that although “we thought our food systems have been designed to provide us with food”, instead we were faced with obesity, hunger, malnutrition and biodiversity loss.

She added that food system dialogues had been taking place all over the world and over 2,500 proposals to fix the broken system had already been put forward.

“I hope that we don’t squander the opportunity that the Food System Summit is giving us to pivot our food system into something that works for all of us,” said Kalibata.

“We have a lot of inequity in our systems. So we need our food system to work for us from a health perspective and from a food perspective.”

Mexico Struggles with Stunting and Obesity

Juan Rivera, Director General of Mexico’s National Institute of Public Health

Juan Rivera, Director General of Mexico’s National Institute of Public Health, outlined a major problem facing many developing countries – the seemingly paradoxical problems of stunting and obesity.

“Stunting dropped in the last three decades from 20% to 14%. And I think that what worked was a combination of nutrition-sensitive actions, such as the provision of nutritional supplements and nutrition education, along with the access to health care of children under five targeted to the poorest population, and conditional cash transfers to incentivise the utilisation of those services,” said Rivera.

“On the other hand, during the same period, we experienced a huge increase in overweight and obesity in Mexico,” he added. 

“In adults, we went from 35% to 70% overweight and obesity and in adolescents from 11% to 40%,” which had made Mexico vulnerable to severe illness and death from COVID-19,” said Rivera. Mexico has one of the highest obesity rates in the world.

“In the last seven years, we have implemented measures to limit the availability and accessibility of unhealthy foods and beverages through taxes, limiting availability to children through school regulations, restraining advertising of unhealthy food for children and adolescents and providing simple and clear information to consumers, and trying to reduce food processing through front of packet warning labels to reduce the intake of unhealthy ultra-processed food,” said Rivera.

Johanna Ralston, Chief Executive of the World Obesity Federation, said that “90% of deaths due to COVID are occurring in countries with high rates of obesity which tells us that probably COVID is the second predictor after age of poor outcomes”.

“COVID-19 highlighted the extremes about all that’s broken in our food systems,”  added Ralston, who said that obesity was “particularly exacerbated by consumption of ultra-processed foods and unhealthy beverages”.

G7 Commits to Addressing AMR 

Dame Sally Davies, the UK’s Special Envoy on AMR

Dame Sally Davies, the UK’s Special Envoy on Antimicrobial Resistance (AMR) reported on a glimmer of hope on addressing AMR.

“Through a collaborative and multi-sectoral voluntary approach to antibiotic stewardship in livestock production, antibiotic sales for food-producing animals in the UK has halved since 2014. This makes the UK one of the lowest users of antibiotics in agriculture, amongst those countries, with a significant livestock farming industry,” said Davies.

She was also encouraged by the commitment by climate and environment ministers at last week’s G7 meeting to reduce the inappropriate use of antimicrobials and to make the manufacturing of antibiotics more friendly for the environment.

“Our dependence on antimicrobials has become so excessive that our systems are now unsustainable and our treatments are becoming less effective,” warned Davies.

“This silent pandemic is on the rise. And if we don’t get our act together, it could kill 10 million people each year by 2050. 

“You see antimicrobials being used for food-producing animals to promote rapid growth for a faster route to market. That increases the prevalence of antibiotic-resistant bacteria in animals, potentially untreatable infections. This approach is short-term and risks the sustainability of our food systems.”

Well-being of Animals and People is Connected

Philip Lymbery, CEO of Compassion in World Farming, said that one lesson that could be learned from COVID-19 “is the well-being of people, animals and the planet are all interconnected”.

“COVID has been linked to the ill-treatment of wildlife. A source of both past and future pandemics is industrial animal agriculture or factory farming,” said Lymbery. “Keeping thousands of animals caged, crammed and confined is inherently unhealthy, producing the perfect breeding ground for disease,” he added, pointing out that swine flu from factory farms had killed about half a million people worldwide. 

“Industrial agriculture is not only the biggest causes of animal cruelty on the planet. It is also a major driver of deforestation, decline in the world’s wildlife and a consumer of more than two thirds of the world’s antibiotics.”

Hundreds of local, national and international events are being convened to discuss food system transformation, with those involved in food policy urging a global adoption of a “One Health” approach –  upholding human, ecological, and animal health – before the next pandemic.

 

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Image Credits: The American Society for the Prevention of Cruelty to Animals, UNICEF.

Africa CDC Director Dr John Nkengasong is optimistic that the WHO’s approval of two Chinese-made COVID-19 vaccines and its inclusion in the COVAX facilty will help expedite Africa’s vaccination programmes.

A deal is in the works for the global COVAX vaccine facility to procure two Chinese-made COVID-19 vaccines recently approved by the World Health Organization for emergency use – greatly expanding vaccine choices for low- and middle income countries, Africa Centers for Disease Control Director John Nkengasong, told Health Policy Watch on Thursday.

“The good news is that the Chinese vaccines that have just been provided with the emergency use authorization by WHO, will also be engaging with COVAX so that they can make available their vaccines to the COVAX facility,”  Nkengasong said at a press briefing. 

The addition of those options to COVAX will help expedite Africa’s vaccination programmes and put the continent on track towards achieving herd immunity, he said. 

“I think that will improve our ability and diversify our options,” he added.  

Last week, WHO’s expert committee said it would approve the two-dose Sinovac COVID-19 vaccine for its “emergency use listing”. That made it the eighth vaccine to receive WHO approval and followed on from WHO’s approval of the Chinese Sinopharm vaccine on 7 May.

The COVAX facility, which is supplying vaccines to over 100 low and middle income countries, has been desperately short of vaccines since it’s main supplier, the Serum Institute of India, redirected all of its production to domestic use following a huge domestic surge in infections that began in April. 

“We can only be optimistic and hopeful that the new vaccines that have been approved will actually also help us increase the uptake of vaccines on the continent,” Nkengasong said. “I believe they will improve our abilities and diversify our options to access vaccines which up to now were extremely constrained with the crisis that India went through.”

Unlike the next-generation mRNA vaccines, both the Sinopharm and SinoVac vaccines are based upon a conventional vaccine delivery platform – using an inactivated SARS-CoV2 virus to stimulate immunity. 

The vaccines can be stored at normal fridge temperatures, making them  easier to roll out in resource limited settings in various African countries. This in contrast to the mRNA vaccines by Pfizer/BioNTech and Moderna, which need to be stored at freezer conditions or below, creating major logistical problems, especially in rural areas.

Countries shouldn’t rule out use of the mRNA vaccines or others that require stricter cold chain storage conditions  – but rather be selective about where they are used, Nkengasong stressed. 

“I would encourage countries to look at things through their vaccine plans and not ‘excuse’ any vaccine but make it part of the vaccination strategy and implementation plan,” Nkengasong said.

“Sputnik Light” Single dose Vaccine Also Being Rolled Out  

Adding yet another vaccine to the array is a new Russian single dose COVID-19 vaccine that was just approved by the first African country. On Wednesday, Mauritius granted emergency use authorization to the “Sputnik Light vaccine, which also may be rolled out soon in India.  

Sputnik Light is in fact simply the first dose of the two-dose Sputnik V vaccine; its developers claim that the first dose alone achieves an efficacy rate of 79.5 %, as compared to 91.6% for the original two dose regime. 

A technologically more advanced vaccine than its Chinese counterparts, Sputnik V used the SARS-CoV-2’s DNA instructions for building the distinctive coronavirus spike protein as a vehicle for stimulating the body’s immunity. That DNA is delivered in an inactivated  adenoviruses, a kind of virus that causes colds. 

If the efficacy data reported so far by Sputnik’s developers, the Russian Direct Investment Fund (RDIF) is validated by WHO or another independent regulatory authority, that would make Sputnik Light as efficient – or even more so, than the two Chinese vaccines, and comparable with the efficacy of the single dose Johnson & Johnson vaccine, which is being deployed in South Africa.  So far, however, neither the European Medicines Agency nor WHO have approved the vaccine for emergency use. 

However, according to latest WHO update on its reviews of Covid-19 vaccines, the Organization’s review of the original Sputnik V two-dose vaccine is still lagging far behind its Chinese counterparts.  Additional clinical and non-clinical data are still to be provided by RDIF, and manufacturing facility inspections are pending for June.  As for the Sputnik Light, no dossier has even yet been submtited to WHO for review.

COVAX Deliveries Resuming 

Another bright spot on the horizon, said Nkengasong, is the fact that the first donations of vaccines by rich countries are reaching more African countries now. There are, however, indications, that COVID-19 vaccination in Africa could soon be back on track with three African countries receiving doses of Oxford-AstraZeneca and Pfizer vaccines via COVAX.

A major boost for Africa is the announcement of United States President Joe Biden on Thusday tht his country would share 80 million surplus US COVID-19 vaccine doses with other countries in need by the end of June – approximately 5 million would go to Africa.

On May 27, Rwanda received 247,000 doses of AstraZeneca vaccine from the COVAX facility and this included 117,600 doses donated by France. 

“With these doses, Rwanda will be able to resume its vaccination campaign and fully immunize those who previously received the first dose of the vaccine,” Nkengasong said.

Rwanda received 100,600 additional doses of the Pfizer vaccine from COVAX on June 1, while  Burkina Faso received 115,200 doses of the AstraZeneca vaccine from the COVAX facility on Monday. Two days later, on Wednesday, Burkina Faso launched its national COVID-19 vaccination campaign. Togo also received about 100,000 doses of the Pfizer vaccine.

WHO Warning – Southern and Eastern African Countries Experiencing a Surge 

Dr Matshidiso Moeti, director of WHO’s Africa Regional Office.

But doses are quickly running dry in many African countries, WHO also said on Thursday, noting that  nearly 20 African countries have used up more than two-thirds of their doses.

And at the same time that new vaccine approvals and COVAX procurement deals may hearken light at the end of the COVID-19 tunnel, southern and eastern African countries are witnessing COVID-19 resurgence, underlining the need for an urgent boost in critical care capacity to prevent health facilities from being overwhelmed.

“Weak observance of preventive measures, increased population movement and interaction as well as the arrival of winter in southern Africa have heightened the risk of COVID-19 resurgence in many countries,” said Dr Matshidiso Moeti, director of WHO’s Africa Regional Office, in another press briefing.

Over just the last two weeks, the continent had recorded a 20% increase in COVID-19 cases compared to a fortnight ago. The pandemic is also trending upwards in 14 countries and in the past week alone, eight countries witnessed an abrupt rise of over 30% in cases,  said Moeti.

While Africa’s reported infection rates throughout the pandemic have generally been lower than almost any other region of the world,  African public health officials have been nervously eyeing the India experience, where historically low rates were followed by an extraordinary surge in cases. At the peak, infection rates approached 400,000 cases a day, creating unprecedented demands on health systems and in particular on oxygen supplies. 

If a similar scenario were to play out in African countries with even weaker health systems, the results would be nightmarish – particularly in light of the fact that African countries have even less access to vaccines than India, which is manufacturing two vaccines in the country. As a result,  any trend of rising cases is a cause of concern.   

“South Africa is reporting a sustained increase in cases, while Uganda saw a 131% week-on-week rise last week, with infection clusters in schools, rising cases among health workers and isolation centres and intensive care units filling up. Angola and Namibia are also experiencing a resurgence in cases,” Moeti said.

Of the 53.5 million COVID-19 vaccine doses delivered so far to 50 African Region member states, 38.1 million doses have been administered, according to Africa CDC.

So far, only 0.54% of the African population has been fully vaccinated, although that represents  an increase of 0.8% compared to the previous week. WHO and CDC officials said. 

Five countries are leading vaccine rollouts on the continent (Morocco – 14 million doses, Egypt – 2.4 million doses, Nigeria – 2 million doses, Ethiopia – 1.8 million doses, and Zimbabwe – 1 million doses). Five African Union member states – Tanzania, Saharawi Republic, Eritrea, Chad and Burundi – are yet to commence vaccine rollouts at all. 

Some  29 countries are now reporting the presence of the more infectious B.1.1.7 variant, originally reported in the UK, while 26 countries are reporting the B.1.351 variant, originally reported in South Africa. 

In light of all of those factors, Moeti warned that the threat of a third wave in the continent “is real and rising”, adding that the priority now is to swiftly :get vaccines into the arms of Africans at high risk of falling seriously ill and dying of COVID-19”.

“Many African hospitals and clinics are still far from ready to cope with a huge rise in critically-ill patients. We must better equip our hospitals and medical staff to avert the worst effects of a  runaway surge,” said Moeti. “Treatment is the last line of defence against this virus and we cannot let it be breached.”

Image Credits: Paul Adepoju.