The pandemic treaty, first floated by the President of the European Council Charles Michel in November last year, is now backed by at least 25 countries, including the United Kingdom, France, and Germany, as well as the World Health Organization. 

Just days before the World Health Assembly opens, the United States still appears to be stalling on an initiative led by some of its major European allies, to move ahead decisively on proposals for a “Pandemic Treaty”, according to a US draft proposal seen by Health Policy Watch.

The Pandemic Treaty proposal to create a new, high-level, binding instrument covering countries’ obligations to prepare for, prevent, and also respond to disease threats more transparently and equitably, is due to be reviewed at the WHA, which opens Monday. 

The latest text of the treaty proposal backed by countries such as the United Kingdom, France and Germany, calls flatly on the WHO to: 

“setting up a process leading to the adoption of a Framework Convention on Pandemic Preparedness and Control …and negotiate a WHO treaty/ international instrument / framework convention on pandemics” – to be finalized by March, 2022, according to a version seen by Health Policy Watch. 

In contrast, the latest United States draft, dated 19.5.21, while not opposing the treaty moves altogether, would move more slowly and cautiously.  

The US compromise text, also seen by Health Policy Watch, calls upon the WHO Director-General to convene a WHA special session in November 2021 to “establish an intergovernmental committee to draft and negotiate a WHO convention or agreement on pandemic preparedness and response.” 

The US text also suggests that a WHO-backed Working Group should make an “assessment….of the benefits of developing a WHO convention”, which would be “considered” at the upcoming World Health Assembly. 

And rather than sealing the final Pandemic treaty deal in March 2022, the US alternative would set that as the date for the convening of a high-level ministerial meeting to: “consider the potential benefits of developing a WHO convention, agreement or other international instrument.” 

Thus, the US draft appears to be slowing down attempts to negotiate a treaty – along multiple milestones of the diplomatic highway. 

Observers perplexed by US stance 

President Joe Biden speaking at the National Institutes of Health in February – re-engaged globally, and on COVID, but with domestic issues as his top priority.

The United States’ move on the treaty stands in contrast to the forward-looking approach of the Biden administration to multilateralism and vaccine equity generally, observers say.

“The line I keep hearing is ‘a treaty can’t get through the Senate’, which has some merit, but the Paris Agreement was structured precisely to get around the US Senate. So it doesn’t seem like that can be the real only reason,” said one diplomatic observer.

 “My hunch is that the Biden administration is so domestically focused they haven’t prioritized this, same with vaccine strategy – no clear US global strategy on vaccine access.”

The fear, observers say, is that a delay in moving would lead to “loss of political momentum and appetite as rich countries with vaccines get distracted by other priorities.”

Text Supported By Pandemic Treaty Proponents   

 WHO Headquarters, Geneva, during last year’s 73rd World Health Assembly, held virtually. Next week, WHA 74 will take place remotely as well.  

The version supported by the proponents of the pandemic treaty – ostensibly led by the UK and Europe, still remains in flux, with alternative phrasing still under discussion this week.  

But overall, it would contain language that squarely supports a treaty – moving towards that goal including a preamble paragraph, PP28 that states: 

“Taking note of the ongoing initiative setting up a process leading to the adoption of a Framework Convention on Pandemic Preparedness and Control.”

Two options for operative decisions are proposed, with greater and lesser degrees of force -and with clear US and Russian opposition noted in [square brackets] alongside the first text: 

  • “[NEW OP3 bis from Chile received 30 March: “DECIDES in accordance with Rule 40 of its Rules of Procedure and under article 19 of WHO’s constitution, to establish an intergovernmental negotiating body open to all Member States to draft and negotiate a WHO treaty/ international instrument / framework convention on pandemics. [del para (US, RusFed)]”
  • “OPX: Requests the Working Group prioritize consideration of the potential benefits of developing a convention, agreement or other international instrument or political declaration on pandemic preparedness and response, including elements such an instrument might address, and provide an interim report with recommendations to the Executive Board in January 2022, with a final report to be considered at a special session of the World Health Assembly to be held in March 2022.”

US Draft – More “Assessment” and “Discussion” of Treaty proposal 

In its version of the draft proposal, the US appears to be going for an even more watered down version of OPX, in a text emphasizing “assessments”, “discussions” and “reports”. 

An excerpt seen by Health Policy Watch, omits any firm statement of support for the Pandemic Treaty initiative in its preamble, stating merely that the The Seventy-fourth World Health Assembly should do one or more of the following to explore the possibility:

OP 1. DECIDES 

(1) That the Director General should convene a Special Session of the World Health Assembly in November 2021, dedicated to the establishment of an intergovernmental committee to draft and negotiate a WHO convention or agreement on pandemic preparedness and response;

(1) ALT To hold a [high-level meeting/ Ministerial Meeting] in March 2022 on the potential benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response and, as appropriate, the establishment of an intergovernmental committee to draft and negotiate such convention,  agreement or other international instrument and requests the Director General to propose options and modalities for the conduct of such a meeting, with a view to ensuring the most effective and efficient outcomes.

(2) To request the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies to prioritize an assessment of the benefits of developing a WHO convention [DEL: or] [Add: ,]  agreement [Add: or other international instrument] on pandemic preparedness and response, including draft elements such an instrument might address and to provide a report to be considered at the [Del: Special Session]  [Add: high-level meeting/Ministerial Meeting] of the World Health Assembly referred to in OP1.1 of this decision.”

Image Credits: WHO / Antoine Tardy, EU Council, ABC27 News, WHO.

Rich countries need to cough up 1 billion vaccine doses by September, and big pharma should significantly expand its network of voluntary license sharing and manufacturing – in order to avoid a vote by World Trade Organization members on a controversial proposal to waive all COVID-related intellectual property for the duration of the pandemic. 

That was the key message of former New Zealand Prime Minister Helen Clarke, at a debate Friday, co-hosted by civil advocacy groups Health Action International, Medicines Law & Policy, and Knowledge Ecology International. 

Former New Zealand Prime Minister Helen Clarke, who is also co-chair of The Independent Panel for Pandemic Preparedness and Response

“There has just not been a rapid enough scale up the production of vaccines to meet the urgent need of comprehensive global vaccination,” declared Clarke, co-chair The Independent Panel for Pandemic Preparedness and Response – which issued a crosscutting report this month.

 “And that is why the panel has called on the WHO and WTO to convene urgently a meeting of the major vaccine manufacturing countries and companies to crunch through….. licensing,  knowledge and technology transfer agreements for COVID-19 vaccines. 

“We say – if that can’t be achieved within three months, then a waiver of intellectual property rights under the proxy agreement should come into force, immediately.”

Clark spoke on the same day that 62 WO members submitted a revised proposal on the WTO IP waiver “from certain provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19”, as reported by KEI International. 

While not a major revision, the new draft of the proposal led by South Africa and India narrows the scope of the waiver more explicitly to COVID “health products and technologies”. It also makes it time-bound, calling for the waiver to remain in force “for at least 3 years from the date of this decision” with a review by the WTO General Council after that.

In her proposal, meanwhile, Clark echoed the offer of a ‘deal’ that was also raised Thursday by her Independent Panel co-chair, Ellen Johson Sirleaf – that countries flush with vaccines should share at least 1 billion doses with COVAX by 1 September, and two billion doses by the middle of 2022, to avoid a WTO vote on the waiver proposal. Said Clark: 

 “We’re all aware that the high income countries collectively have ordered far more vaccine doses than they would ever need to cover their populations.  

“So as they’re scaling up their vaccination rollouts, we call on them to provide, by September, at least a billion doses to the 92 low and middle income countries covered by GAVI [ the vaccine alliance]… and 2 billion doses in total by the middle of next year. 

“That redistribution will help cover the highest priority groups in low and middle income countries,” she said. 

With 62 sponsors now for the waiver deal, the possibility of an unprecedented vote on the waiver proposal looms as a real possibility for the WTO’s 164 members. 

Not Only Health Security – Pandemic Treaty Should  Focus On Access & Equity 

So far, an overriding focus of the pandemic treaty debate (see related story) has been the need for a stronger legal instrument to require countries to prepare for, transparently report on, and respond to outbreak risks, along with strengthening WHO’s investigative capacity. 

But any Treaty should also be a statement of equitable access to medicines, treatments and vaccines, proponents said:

“We can no longer afford to rely solely on a model of charitable giving, which proves inadequate in the face of global infectious threats,” said Clarke.

Pandemic Treaty mechanisms also need to go beyond the current donor-driven models of distributing vaccines and medicines to LMICs – to insure more stable global public-sector funded finance for their production and distribution, she and other panelists said.  

Said Anna Marriott, Health Policy Advisor for Oxfam: “long-term sustainable funding will be needed to invest and maintain manufacturing facilities,” especially in the global South where they are dire.

Broad in Scope 

The Pandemic treaty mechanisms must also be broad enough in scope to ensure that not only access to vaccines, but to also treatments and diagnostics, is more assured, said UNITAID’s Executive Director Phillippe Duneton. He described, for example, how the extreme shortages in oxygen supplies seen in South Asia and some Latin America countries is also exacerbating the coronavirus death toll. 

“We need to have all the tools, it’s about access to vaccines, it’s about access to treatments, about access to diagnostics. So, there is not only one [of those] that needs to be considered.”

And if voluntary licensing permissions for COVID treatments are struck with Pharma, those should not be limited to just certain countries or regions of the world – as they have been in the case of other treatments for HIV, hepatitis, and other diseases. Instead they should be available everywhere, including middle-income countries of Latin America and South East Asia, panelists added. 

Evergreen, Elastic Vaccine Manufacturing Capacity – Keys to Practical Success

Martin Friede, WHO’s Coordinator of the Initiative for Vaccine Research

On a more practical level, new regional vaccine manufacturing facilities, as they come into being, need to be build to adapt to changing market conditions – as well as being assured markets for their products in slack times – as well as during pandemic peaks, said WHO’s Martin Friede. 

“This will work if the [Pandemic] Treaty supports sustainable markets between pandemics as well as during pandemics,” he emphasized. 

Friede, a former biotech innovator and high-level pharma official, is leading WHO’s work on a mRNA technology transfer hub – to build regional capacity to produce new mRNA vaccines.

He cited the H1N1 pandemic as an example, where new manufacturing facilities that were created to fill the immediate needs of the pandemic survived only if they could also produce and supply markets for more routine vaccines in non-pandemic periods.  

“If a facility is not producing something that it is selling on a day to day basis, it will not be maintained,” said Friede, explaining that the incentives to maintain production capacity for goods that are rarely needed are weak. 

In addition, financial partners and buyers – from countries to big donor institutions – need to recognise that the medicines and vaccines produced by new, start-up facilities may be more expensive than those of well-established multinationals operating in Asia or the United States.  

So big global agencies as well as national governments need to recognize the long-term benefits of local procurement, and procurement from a healthy mix of suppliers – rather than always chasing after the lowest-priced options from the largest producers thousands of kilometers away, Friede stressed: 

“We are seeing facilities being closed down because the national government says we don’t need influenza vaccines’ or we can buy influenza vaccines on the international market cheaper than we can make them ourselves’.”

More Transparency Needed

Jamie Love, Director of Knowledge Ecology International

Greater transparency from the biopharmaceutical sector will also be needed to support the expansion of manufacturing capacity around the world, said Jamie Love from Knowledge Ecology International.

“It would be helpful if there was just more openness and transparency about what facilities are out there that have some capacity to manufacture,” he said, noting that on average, technology transfer takes about 6 months, based on previous agreements that have been sealed. 

“There are facilities which right now can manufacture without any changes, they’re ready to go. And then there are other facilities that would require some modifications and some changes in addition to whatever knowledge transfers is required…[it would be helpful to know] what facilities are out there, and what would it take in terms of time, money, and know how to get those facilities online.”

Image Credits: Sinopharm, Health Action International, Health Action International.

South Africa introduced a sugar tax in 2018 in support of a strategic plan for the prevention and control of obesity.

A sugar tax that generated R3-billion in revenue for South Africa in one year and a mandatory minimum unit price for alcohol products that contributed to a 10% decrease in alcohol-related deaths in Scotland are two examples of proven  successful policies governments have adopted for products that negatively impact health and that have helped raise revenue.

Speaking on the sidelines of the 74th World Health Assembly during a Vital Strategies and NCD Alliance virtual ‘VitalTalks’, health advocates called on governments to implement “concrete policies” to help save lives and prevent Non-Communicable Diseases (NCDs), to phase out incentives for unhealthy commodities and invest in social programs to improve lives.

Lynn Moeng-Mahlangu, SA health department’s chief director for health promotion and nutrition, pointed out that measures like a sugar tax are one part of combatting illnesses. She explained how her government introduced the health promotion levy on sugary beverages in support of a strategic plan for the prevention and control of obesity. The objective was to reduce obesity by 10% by 2020 and other non-communicable diseases.

The tax that came into effect in April 2018 was a triumph, but at about 11% is below a World Health Organization-recommended 20% increase. The WHO recommends that taxes on sugary drinks help to reduce consumption and prevent obesity. The global health body previously said that : “Taxation on sugary drinks is an effective intervention to reduce sugar consumption. Evidence shows that a tax on sugary drinks that rises prices by 20% can lead to a reduction in consumption of around 20% thus preventing obesity and diabetes.”

Moeng-Mahlangu however said the sugar tax had proven that fiscal measures contribute to reducing consumption on unhealthy foods and beverages, but said there was a need for more investment in research that will support policy making decisions.

She called for greater awareness programmes on issues that contribute to NCDs. “It’s also important to educate communities so that they can buy into the policy decisions that governments have taken.”

Scotland’s Fight Against Alcohol Abuse

The introduction of a mimum unit price on alcohol resulted ina a 10% drop in alcohol-related deaths in Scotland in 2019, with 1,020 fatalities compared to 1,136 the previous year.

Scotland became the first country to introduce a minimum unit pricing on alcohol after “it literally became cheaper to buy a cider than a bottle of water”,  said Allison Douglas, chief executive of Alcohol Focus Scotland. 

The primary purpose of minimum unit price (MUP) was to save lives and improve health. It was introduced in May 2018 after years of delays from legal challenges and targeted low-cost, high-strength products, seen as a source of problem drinking, by setting a minimum unit price of 50p per unit of alcohol.

The introduction of the public health measure was to save lives, said Douglas, revealing a 10% drop in alcohol-related deaths in Scotland in 2019, with 1,020 fatalities compared to 1,136 the previous year. The amount of alcohol sold in Scotland also dropped by 3% during the first year of introducing minimum pricing.

The COVID-19 pandemic has accentuated the need to act on NCD prevention and Douglas believes that interventions similar to the MUP are needed now “more than ever”.

“Public health prevention works and has never been more badly needed, Every country needs to look at the best ways of  increasing price controlling availability and reducing marketing to improve and save lives.”

Stop Incentivising Unhealthy Commodities

In the context of post COVID-19 recovery, governments should phase out incentives to unhealthy commodities, reinvest in social protection and use fiscal policies to prevent NCDs, said Nandita Murukutla, Vice President, Global Policy and Research, Vital Strategies.

Murukutla said billions of dollars is given to the alcohol industry every year through tax breaks, tax rebates, marketing subsidies and other incentives, particularly in low-and middle-income countries. This despite alcohol being a “a major public health and societal issue responsible for more than 3 million deaths annually”.

“And we know that it costs society. In the US alone,  It’s responsible for nearly $250 billion a year in social and other health costs.”

 A recent report by Vital Strategies, The Sobering Truth: Incentivizing Alcohol Death and Disability examined how the industry interferes in government policies that are aimed at reducing consumption of alcohol products. “As we seek to build resilient health systems, we have to urge governments, policymakers and health advocates to actively monitor the alcohol industry’s interference in policy and to question the cost and benefits of economic incentives, ”  the report states.

“(It) comes at a time when governments are grappling with the fallout of the COVID-19 pandemic, strained budgets, and an increased risk of people under COVID-19 restrictions turning to alcohol in ways that can harm health and increase mortality.”

Public Health Policies Save Lives

Nina Renshaw, NCD Alliance policy and advocacy director, said the COVID-19 pandemic had “accentuated the need to act on NCD prevention” and that the policy examples cited during the webinar proved that legislative tools  vital to save lives and improve people’s health.

A key message from the Vital Talks session, she said, was that important results were delivered for population health where solid measures and policies were implemented.

“And we heard from South Africa that these instruments can raise significant revenue, which can be reinvested into promoting and protecting health and bring further equity gains,’ she said.

Referencing an OECD report published on 19 May that details efforts over the past year to help developing countries create better tax policy measures, maximize revenue collection, and navigate the challenges of the COVID-19 pandemic, Renshaw said governments should implement robust pricing policies for alcohol as “the return on investment is $16 for every dollar spent on alcohol policies”.

Going forward, Renshaw called on governments to better understand NCDs as a vital part of health security and preparedness for health threats. “ A healthy population is the bedrock of resilience.” 

Image Credits: rawpixel/unsplash.

South African President Cyril Ramaphosa, who is also the ACT-Accelerator co-chair.

The G20 Global Health Summit on Friday elicited more promises from wealthy nations to share COVID-19 vaccines, an undertaking by drug companies to make over a billion doses available by year-end – and an indication by the European Union that it would propose an alternative to the TRIPS waiver at the next World Trade Organization (WTO) meeting.

Hosted by Italy and the European Commission (EC), the summit ended with the adoption of the Rome Declaration, a 16-point commitment to improving pandemic preparedness, increasing local manufacturing capacity and investing in worldwide health systems.

Team Europe – primarily France, Italy and Germany – promised to share 100 million vaccine doses with low- and middle-income countries (LMIC) by the end of the year, while Pfizer committed to manufacturing a billion vaccine doses, Johnson & Johnson 200 million and Moderna 100 million – some of which would be supplied “at cost” to poor countries.

However, the European Union stood firmly against the proposal for a waiver on intellectual property rights on COVID-19 products under the Trade-Related Intellectual Property Rights (TRIPS) agreement during the pandemic – the TRIPS waiver proposal made by India and South Africa to the WTO.

“I’ve been listening very carefully to the developing countries…and they are complaining that it is difficult for them to use the flexibilities of TRIPS within the Doha Declaration,” EC President Ursula von der Leyen told a media briefing after the summit.

The European Union (EU) had thus decided to provide developing countries with “certainty” that they could use the flexibilities contained in the Doha Declaration during the pandemic, added Von der Leyen.

EU to Propose Third Way at WTO Meeting in June

EC President Ursula von der Leyen

The EU intends to propose a “third way” to the WTO meeting in June, 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”, she added.

“It’s important that the G20 has convened behind the Doha Declaration and the TRIPS agreement, and will work within it, with flexibilities,” she added.

The EU’s 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 put forward by South Africa and India.

In addition, on Friday  62 WO members submitted a revised proposal on the WTO IP waiver “from certain provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19”, as reported by KEI International. 

The revised proposal narrows the scope of the waiver to COVID-19 “health products and technologies” and also calls for it to remain in force “for at least three years from the date of this decision” to be reviewed by the WTO General Council after that.

Despite the EU decision, WTO Director-General Ngozi Okonjo-Iweala told the summit that WTO member states should get ready for text-based negotiations on the proposed waiver. 

“We must act now to get all our ambassadors to the table to negotiate a text. This is the only way we can move forward quickly, we can’t move forward with speeches and polemics,” she told the summit.

“I am hopeful that by July we can make progress on a text and by our 12th Ministerial Conference in December, WTO members can agree on a pragmatic framework that offers developing countries near automaticity in access to health technologies, whilst also preserving incentives for research and innovation,” she added.

However, South African President Cyril Ramaphosa, who is also the co-chair of the Access to COVID-19 (ACT) Accelerator – the WHO-led global effort against COVID-19, said that “it cannot be justified that in this 21st century, Africa has only received 20 million vaccine doses, which is apparently 2% of the global supply”.

Describing the fight against the pandemic as a “war”, Ramaphosa said all countries needed weapons to fight the virus which was why his country and India had proposed a temporary TRIPS waiver.

“Such a waiver would enable developing countries, in particular, to expand their pharmaceutical sectors to facilitate technology and skills transfer, and above all, at this point in time, save lives,” said Ramaphosa.

IMF Boosts Global Reserves to Finance ‘Exit from COVID-19 Crisis’

IMF Director-General Kristalina Georgieva

IMF Director-General Kristalina Georgieva warned the summit of the “dangerous divergence of economic fortunes”, as the gap widens between wealthy countries that have access to vaccines in poor countries that do not.

The IMF estimated that $50 billion was needed to address three key issues – vaccinating 60% of the world’s population by 2022; protection against variants, including possible booster shots; and public health measures to manage the pandemic while vaccinations were taking place.

“With the support of our membership, we are working towards making an important contribution to the exit from this crisis by boosting global reserves with $650 billion special drawing rights — particularly important for countries faced with the toughest challenges.  We are stepping up lending where needed, and we are working on debt sustainability,” said Georgieva.

“Pledges today from a handful of countries are welcome, but the world remains in the grip of a devastating global emergency. It demands bold, collective action. Today, global leaders of the G20 missed this critical opportunity,” said Alex Harris, Wellcome Trust’s Director of Government Relations.

“The moment has passed for warm words and piecemeal contributions – we need courageous, united leadership from countries that can most afford to help others. Next month’s G7 Summit is an historic opportunity to do this. It must not be wasted,” he added.

World Bank West and Central Africa Regional Director, Dena Ringold, says COVID-19 has exacerbated poverty on the African continent.

Africa’s delayed COVID-19 vaccine rollout could cost the continent close to $14-billion a month – and the situation could get worse.

World Bank West and Central Africa Regional Director, Dena Ringold,  said in addition to the severe impact of weak health systems, the pandemic was straining economies across Africa and has “exacerbated poverty” on the continent with tens of millions of people falling deeper into poverty.

Addressing a World Health Organization (WHO) African Region press briefing on Thursday,  Ringold said the delays in accessing COVID-19 vaccine on the continent is having significant impacts on economies.

“In addition to the loss of lives and human capital, we estimate that every month of delayed COVID-19 vaccination has the potential to cost the African continent close to $14 billion in lost GDP,” Ringold said.

The World Bank has recorded an increase in requests for financial support from governments and institutions in Africa and beyond, Ringold revealed, noting that the COVID-19 response has been the global financial institute’s largest and fastest response to a crisis in the history of the institution. 

“If I roll back to March of last year, our initial global package for health funds involved preparing in 100 days to help countries fight the pandemic through building capacity for testing, surveillance, and treatment. In Africa, this involves  $2-billion for 39 countries in Africa,” said Ringold, adding that they were “saving livelihoods through social protection estate, ensuring sustainable business growth and working to build more resilient recovery”. 

“We’ve been doing this in partnership with regional institutions such as the West African Health Organisation (WAHO) and the Africa CDC, which have been playing a critical role during the pandemic,” Ringold said. 

Paying for Vaccines

Matshidiso Moeti, WHO Regional Director for Africa, warns that a blockage on supplies are delaying Africa’s rollout of COVID-19 vaccines and risks curtailing plans to expand the continent’s rollout later this year.

Health Policy Watch recently reported African countries were reluctant to borrow funds to pay for COVID-19 vaccines,  but the Ringold revealed that the World Bank  has been supporting African countries with access to funding with which they can procure and deploy vaccine doses to their citizens.

As of Thursday 20 May, the World Bank had received requests from 36 countries in Africa for vaccine financing, amounting to close to US $2-billion.

The WHO also announced the COVAX Facility is now seeking other options towards addressing the global shortage of COVID-19 vaccines. 

Addressing a press conference on Thursday, Dr Matshidiso Moeti, the WHO Regional Director for Africa warned that a blockage on supplies and financial challenges are delaying Africa’s rollout of COVID-19 vaccines and risk curtailing plans to significantly expand the continent’s rollout later this year.

Moeti said deliveries to Africa through the COVAX facility ground to a near halt in May as the Serum Institute of India diverted doses for domestic use. Between February and May, the continent received just about a quarter – 18.2 million – of the 66 million expected doses through COVAX.

“As people living in richer countries hit the reset button this summer and their lives start to look normal, in Africa our lives will stay on hold. This is unjust,” Moeti said. “We are optimistic that vaccine availability will improve significantly in the second half of the year. We can still catch up and make up for the lost ground, but time is running out.”

Embracing Dose Sharing

To cover the wide vaccine supply gap that disproportionately affects African countries, Moeti recommended the adoption of dose sharing. 

“The supply gap can be closed if countries with surplus doses set aside a percentage of vaccines for COVAX,” said Moeti. 

She commended the decision of the US government to share 80 million doses with other countries, in addition to recent shipments of vaccines from France to Mauritania. 

“Dose sharing is key to ending the supply crunch and the pandemic as a whole, as no one is safe until everyone is safe,” said Moeti, further revealing that COVAX Facility is actively negotiating with other manufacturers of COVID-19 vaccines to diversify the portfolio while supporting the medium- to long-term scale up of manufacturing capacity. 

In spite of the call for more doses, Moeti admitted that funding for operational costs is also a critical barrier as only eight African countries have used up all their vaccines while over 20 countries have administered less than 50% of their doses.

Even though COVAX is providing its share of vaccines for free to lower-income countries, 60% of every dollar spent on delivering vaccines is needed for operations. 

“The World Bank calculates that on top of the money needed to buy enough vaccines to ensure adequate protection from COVID-19, another 3 billion is required to deliver the vaccines into the arms of people,” 

 

Johnson & Johnson’s single-dose COVID-19 vaccine

Johnson & Johnson will supply COVAX 200 million of its single-dose COVID-19 vaccines by the end of the year, according to a statement on Friday by Gavi, the Vaccine Alliance, announcing the advance purchase agreement.

The vaccine will be available to both COVAX members who buy their own vaccines and the COVAX AMC members. 

“Today’s agreement between Gavi and Johnson & Johnson means the COVAX Facility is able to offer participants yet another safe and effective tool against the pandemic. I welcome Johnson & Johnson’s commitment to equitable access and to expanding global manufacturing through external partnerships, which is something that will provide long-lasting benefits even after this pandemic is over,” said Dr Seth Berkley, CEO of Gavi.

Gavi and Johnson & Johnson are also discussing the possible supply of 300 million doses for COVAX in 2022. 

“As a one-dose vaccine, the J&J vaccine has particular relevance for places with difficult infrastructure, making it a very important addition to the portfolio.” 

“Our partnership with Gavi is the single greatest step we have taken to ensure our single-shot vaccine is accessible to everyone, everywhere. Our commitment today offers the potential to protect up to 500 million people from COVID-19,” said Paul Stoffels, Chief Scientific Officer at Johnson & Johnson

“COVAX now has agreements for eight vaccines and vaccine candidates – AstraZeneca/Oxford, Pfizer, Moderna, Novavax, Johnson & Johnson, Serum Institute of India (SII)’s Covishield, SII’s Covavax, and Sanofi/GSK – with the aim to expand to 10-12 vaccines in total, providing participants access to a diverse range of vaccines suitable for use in varied contexts and settings.,” said Gavi.

Gavi is also trying to raise at least an additional US$1.6 billion for the COVAX AMC to enable the supply of up to 1.8 billion doses of vaccine for 92 lower-income economies. 

Japan will be hosting the upcoming Gavi COVAX AMC Summit, bringing together world leaders, the private sector, civil society and key technical partners in a virtual event on June 2nd.

In addition to doses secured via agreements with manufacturers, Gavi and its COVAX partners the Coalition for Epidemic Preparedness Innovations (CEPI), the World Health Organization and UNICEF also call on the international community to share doses with COVAX immediately to help those countries that have been worst hit by current global supply constraints and urgently need to protect their most at-risk populations.

COVID-19 Deaths Could be 2-3 Times Higher than Officially Reported

Meanwhile, a new WHO estimate suggests that deaths from COVID-19 since the pandemic began may be 2-3 times higher than the 3.2 million deaths officially reported until 1 May 2021.

The estimates were contained in a new World Health Organization (WHO) World Health Statistics Report, released on Friday – which tracks a wide range of health statistics on disease, risks and other health indicators, across all 194 member states.  According to the report, while 1.8 milion deaths from COVID were officially reported in 2020, the real death toll last year was likely 1.2 million more than that, based on overall excess mortality rates for 2020, as compared to previous years. 

That leaves preliminary WHO estimates to suggest the total global excess deaths attributable to COVID-19, both directly and indirectly, amounted to around 3 million in the year 2020,  the report states.

And based on the data from 2020, the excess deaths recorded until now, may be 2-3 times higher than the 3.2 million deaths recorded until now – that is more than 6 million deaths, the report suggests.  The reason for the under-estimates lay in the fact that deaths from many people with pre-existing health conditions that make them more vulnerable to COVID diasese, may be recorded as dying from diabetes, heart, respiratory disease, or other such conditions – even if it was COVID that actually triggered their deterioration and death.

    

Cumulative confirmed COVID-19 deaths as of 1 May 2021, by region: a) in thousands; b) per 100 000 population; and c) by location

Cases Shifting From Wealthy to Low- and Middle-Income Countries 

In addition, while almost half (48%) of all reported COVID-19 deaths have occurred in the Americas, and one third (34%) in Europe, a shift in cases and deaths from higher- to lower-resource settings is now becoming evident, according to the report.

“ While high income countries (HICs) accounted for about 64% and 59% of the global monthly new cases and deaths, respectively, in January 2021, the shares dropped to 31% and 27%, respectively, in April 2021,” the report states.

In contrast, low- and medium income countries’ (LMIC) share of new global monthly cases rose from 8% in January 2021 to 37% in April 2021, and the share for new deaths from 8% to 22% between January and April 2021.

Meanwhile, of the 23.1 million cases reported in the South-East Asia Region to date, over 86% are attributed to India.  Until now, the WHO Region of the Americas and the European Region accounted for over three quarters of cases of the 150 million cases reported so far, with case rates per 100 000 population of 5999 and 5455 respectively. 

 

A patient getting tested for COVID-19 at the Paris Charles de Gaulle Airport in January 2021.

Though the COVID-19 pandemic has largely been a story of failure, strong preparedness of public health systems coupled with decisive responses have shown that it is possible to prevent and prepare for future disease threats, according to a new report.  

The report, conducted by Resolve to Save Lives, an initiative of Vital Strategies, highlights eight case studies that show the success of epidemics that didn’t happen, or whose impact was lessened, because of careful planning and strategic action. 

“No response is perfect and there’s no one size fits all approach, but taken together, these studies demonstrate that in moments of crisis, communicating clearly and effectively while working collaboratively with partners and communities can prevent epidemics, [guiding] our conversation on the future of global health security,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives on Thursday.

The report reviews how the trajectory of an epidemic can be altered when a country invests in and prioritizes preparedness for infectious diseases outbreaks, such as Uganda and Brazil. 

Uganda’s Rapid Response and Mobilization Against Ebola Outbreak

Surveillance for Ebola Virus at the border between Democratic Republic of Congo and Uganda.

Within days of the Ebola outbreak being declared in the Democratic Republic of the Congo (DRC) in August 2018, Uganda was able to rapidly mobilize its response teams to prevent further infection. 

Within weeks, Uganda opened multiple Ebola Treatment Centers and rapid testing laboratories near the DRC border, where border screenings were conducted for all people entering the country. 

By November 2018, the Ugandan government had vaccinated nearly 5,000 health care workers and response staff.

This was all done before any cases had been identified in Uganda. 

Ugandan Minister of Health Dr Jane Ruth Aceng attributes the country’s strong outbreak response to collaboration and partnerships across sectors.

“Strong partnerships for support, both financially and also technically, as well as stakeholder engagements are critical in responding to any public health emergencies,” said Aceng.

Brazil: Mass Vaccination Against Yellow Fever 

Brazil’s successful response to containing yellow fever in 2019 produced dramatic results, with only 85 yellow fever cases and 15 deaths reported.

Brazil’s successful response to its 2016 – 2018 yellow fever outbreak was due to its scientific expertise on the disease and its role as one of the largest producers of the yellow fever vaccine – making the country well-positioned to address its yellow fever outbreak. 

However, at the time of the outbreak, vaccine supplies were low. 

To manage a large number of vaccinations needed amid a vaccine shortage, health officials requested additional supplies from an international stockpile, and stretched supply further by using partial doses of the vaccine.

Studies have shown that one-fifth of a standard dose can provide up to a year of immunity, and can be beneficial for containing outbreaks. 

Health officials also prioritized surveillance of yellow fever outbreaks among animals, which would provide advance warning of where human cases would later appear. 

By the end of the 2019 yellow fever season, these measures had produced dramatic results, with only 85 yellow fever cases and 15 deaths reported. 

Highlighting Brazil’s successful response to containing yellow fever, Dr Sylvain Aldighieri advocated for increased investments in healthcare workers – a critical issue, he said, should be stressed in the upcoming G-7 and G-20 Global Health Summits.  

“We have this population of healthcare workers dealing with a day-by-day battle for more than 16 months.”

Investment in healthcare workers includes Personal Protective Equipment, vaccinations, training, and adequate ratio of staff-to-patients.  

Aldighieri pointed out that integrated and strong primary health care was also what aided Brazil during its outbreak.

“If you have a strong primary health care system it avoids a lot of trouble in the following steps of response.”  

Seven-One-Seven Approach to Pandemic Preparedness

From these case studies, and from existing recommendations, Resolve to Save Lives has proposed a goal of seven-one-seven – identifying any suspected outbreak within seven days of its emergence, responding rapidly through investigation and reporting within one day, and establishing an effective response within seven days. 

This type of goal, said Frieden, will provide impetus and accountability to make substantial and sustained financial, technical, and political investments needed to improve global health and our capacity to find, stop, and prevent future pandemics.” 

“The COVID-19 pandemic has reinforced the need to work together. We’re all connected. And it’s on all of us to prevent epidemics.” 

Effective Global Health Governance and Collective Investment in Preparedness Needed 

Recommendations for addressing future pandemics and looking beyond COVID-19 through more effective global health governance were also considered, in light of the recently released Independent Panel Report, 

“We need a strong World Health Organisation (WHO), but we [also] need a more independent WHO that could operate independently and actually make decisions faster, said Dr John-Arne Rottingen, Ambassador for Global Health at the Norweigian Ministry of Foreign Affairs.

He emphasizes that though achieving this type of leadership is a ‘tricky balance’, it demonstrates the need for strong public health capacities not just in the WHO, but across the globe.

This is important in developing countries, which have limited resources to prepare for disease outbreaks. Though countries would ideally like to focus on themselves and their key priorities, the ‘collective investing’ in the health systems of low-and-middle-income countries would be a ‘public good’, not just at the national level but also at an international level, added Rottingen. 

“It’s good for everyone. We can avoid infectious disease threats and it’s a collective investment,” he said, noting all countries should contribute, from high-income to low-income countries, investing both domestically and to collective finance mechanisms. 

As seen with the vaccine nationalism of the current COVID-19 pandemic, countries primarily focus on the needs of their people before considering the ripple effects of disease outbreak in other countries. 

Investment towards countries with ‘lower purchasing power’ would contribute to pandemic preparedness. 

“We need to demonstrate that we can deliver equitable access in this pandemic; if not we will not be trusted in the future.” 

Image Credits: Flickr – International Monetary Fund, WHO Afro, Matt Taylor, WHO.

Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, at a press conference on Thursday.

The hostilities between Israel and Hamas over the past 10 days have caused significant damage to the health system in Gaza, putting the Palestinian population at risk of increased spread of COVID-19 – after six weeks in which new cases had been in sharp decline.

The health system in Gaza is now facing severe shortages of essential medicines and supplies and it’s only COVID test facility was destroyed. The closure of border crossings has restricted the entry of medical supplies – although Israel said late Thursday night that it would begin opening the borders to humanitarian aid if a cease-fire with Gaza’s Hamas authorities, due to take effect at 2 a.m. local time, holds. 

“WHO calls for the urgent facilitation of humanitarian access to the Gaza Strip to allow entry of essential medical supplies, referral of patients to facilities outside the Gaza Strip, and passage of medical teams and humanitarian personnel,” said Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, at a press conference on Thursday that came just ahead of the Egyptian-brokered cease-fire agreement with Israel. Hamas began a missile assault on Israeli cities 10 May, in reprisal for Israeli moves to evict several Palestinian families from homes in East Jerusalem and Israeli police clashes with Palestinians around the city’s Al-Aqsa Mosque, Islam’s third holiest site.  Israel responded with heavy aircraft raids over Gaza, targeting offices and high-rise buildings of strategic importance, and damaging a vast labyrinth of underground tunnels, which Israel says were used by Hamas fighters hide from Israeli attack.  

Over 245 deaths and 6,700 injuries have been reported in the Gaza Strip and West Bank during the violence, according to WHO, while in Israel, 12 people including two children have been killed.

What’s more, however, the aerial bombing of Gaza damaged or destroyed 19 health facilities, a desalination plant that supplies clean water to 250,000 people, and Gaza’s main COVID-19 testing laboratory. 

Gaza, which has been under an Israeli blockade since the Islamist Hamas Party took control of the enclave in 2007, has seen intermittent flareups with Israel that have grown in intensity as Hamas gained more missile power to hit deeper into Israeli territory. Neither Hamas nor the Israeli government recognize each other as legitimate authorities.

More than 90 attacks on health care workers have been recorded in the West Bank and Gaza Strip, with 21 recorded in the Gaza Strip and 70 in the West Bank, Mandhari said, adding that, “WHO also calls for the immediate cessation of hostilities and an end to attacks that either directly or indirectly impact health care in the occupied Palestinian territory.” 

In the Israeli-occupied West Bank, the Palestinian Authority, which is recognized by Israel, has limited self-rule, under the terms of the 2003 Oslo Accords. However, the past two weeks also saw a wave of West Bank Palestinian demonstrations and clashes with Israeli troops in support of the Hamas as well – creating barriers to access of health facilities, particularly in East Jerusalem, which is under Israeli control.

The WHO situation overview of casualities and damage caused since 7 May in the occupied Palestinian territories.

Damage to Health and Water Facilities – Interrupts Essential Health Services and COVID Testing and Vaccinations

In Gaza, the only functioning COVID-19 testing lab, housed in the Al-Rimal health clinic in Gaza city, was damaged on Monday by an airstrike. It processed over 2,500 tests per day, as well as administering COVID vaccinations and providing other essential health services. 

The damage to water desalination plants and water sanitation hygiene (WASH) infrastructure increases the risk of waterborne diseases and impacts hygiene, which is a central component of COVID-19 public health measures, said WHO officials.

Along with that, 46% of essential drugs and 33% of essential medical supplies also are out of stock in Gaza. And heavy damage to roads, including the main road to Shifa Hospital, one of Gaza’s largest hospitals, is obstructing ambulance access.

The health impacts of the escalation in violence in the occupied Palestinian terriories.

WHO has procured and delivered US$200,000 worth of essential medicines to hospitals in East Jerusalem, and has a convoy ready with US$500,000 worth of rapid diagnostic tests, equipment, and medical supplies destined for the Gaza Strip. 

“The fighting must stop immediately. Until a ceasefire is reached, all parties to the conflict must agree to humanitarian pause to ensure access into and out of Gaza for humanitarian staff and critical goods…to allow for safe movement, and for the delivery of assistance,” said Dr Rik Peeperkorn, WHO Head of the Regional Office for the West Bank and Gaza Strip.

“We need a ceasefire, we need a humanitarian pause,” said Dr Richard Brennan, WHO Regional Emergency Director for the Eastern Mediterranean. “We need the humanitarian access. We want all the crossings to be opened to let the aid in and let the sick and injured out.”

“If we are speaking about the current political and security situation in the region and in the occupied Palestinian territory in particular, there is no health without peace,” said Mandhari.

Some 75,000 people have been displaced by the violence, with 47,000 seeking shelter at 58 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East. The overcrowding at these shelters could facilitate the spread of the SARS-CoV2 virus, WHO officials said. 

COVID Figures Likely Don’t Reflect Local Situation 

Both the West Bank and Gaza were just coming out of a third COVID wave when the violence escalated. The damage to health infrastructure, testing capacity, and water sanitation facilities will likely cause the pandemic to worsen, officials said. 

Even before the hostilities started on 10 May, cases were sharply declining from a peak of 2,500 new cases in April, to less than 600 as of May 10. And that trend has continued over the past week. However, officials are concerned that recent data is misleading, due to the current absence of testing and tracking procedures, particularly in Gaza. 

About 5.4% of Palestinians in Gaza and the Occupied West Bank have received at least one dose of a COVID-19 vaccine – doses obtained through the WHO co-sponsored COVAX initiative or from donations.   

This is in stark contrast to Israel’s national vaccination campaign, which has immunized 62.8% of the population with at least one dose. 

WHO currently has a convoy of 10,000 more Sinopharm COVID-19 vaccines waiting to enter Gaza as soon as possible to provide jabs to more of the population, said officials.

“Overall there is still a huge shortage of vaccines in the occupied Palestinian territories and the coverage is still way too low,” said Peeperkorn.

Dr Rik Peeperkorn, WHO Head of the Regional Office for the West Bank and Gaza Strip.

WHO announced that US$7 million will be needed for the health response in the occupied Palestinian territories over the next six months. 

The plan is to first provide assistance to Gaza for acute health needs and then focus on rebuilding the health infrastructure and strengthening the health system to ensure a functional primary health care system is established once again, said Peeperkorn.

In the midst of the ongoing conflict, a heated political debate is expected to take place in the upcoming World Health Assembly (24 May -1 June) on a draft resolution on the health conditions of and assistance to provide the Palestinian population.  Israel has long complained that setting the resolution as a separate agenda item for the WHA represents disproportionate and politicized treatment of the Palestinian issue – as compared to the many other humanitarian flash points around the world – which do not get the same prioritization at the WHA forum.

Image Credits: WHO.

With an agenda that is more packed than ever – and razor sharp political crises from Gaza to Taiwan to Myanmar also coming to the fore – will the upcoming World Health Assembly prove to be the decisive moment that it should be for global health? 

Now, more than ever perhaps, huge tensions and inequalities plague the global health scene – with new COVID cases in high-income countries slowly declining, and international borders reopening, while India as well as other low-income countries in South East Asia and the Americas battle continue to battle huge case counts and death tolls. 

Against that landscape, however, some far-reaching recommendations for reform that will be on the table this year could make a big difference, said a group of high-level global health voices at an “Introduction to WHA 74 session,” sponsored by the Global Health Centre of the Geneva Graduate Institute.  

They referred to proposals by The Independent Panel for a Pandemic Treaty; limiting the Director General’s term to one five-seven year stint to remove the position from political influences; and the granting of stronger investigative powers to visit countries and publish data on outbreak threats, said Julio Frenk, former minister of health for Mexico and president of the University of Miami, speaking at the event.  

”The main problem until now has been that the member states by design or by behaviour have weakened the operation of their own organisation,” said Frenk at the session, which also featured Ellen Johnson Sirleaf, co-chair of The Independent Panel on Pandemic Preparedness and Response, Gro Harlem Brundtland, former Prime Minister of Norway as well as WHO director general Tedros Adhanom Ghebreyesus, and Joy Phumaphi, of the UN Secretary General’s Every Woman, Every Child Accountability Panel.  

Julio Frenk, Former Minister of Health of Mexico and President of the University of Miami.

Limiting the director-general’s tenure to just one term in office would be a “major step” towards a more independent and depoliticized WHO – “so as not to have a director who is also campaigning for re-election,” Frenk asserted. 

Added Brundtland, who gained worldwide acclaim for key health reforms that she instituted at WHO during her 1998-2003 tenure, “A seven year term is a better choice. Because then, no leader of WHO, in the future will be in the situation to be lobbying to be reelected.”

But the inequalities in access to vital COVID-19 vaccines and other health products, is the bigger pandemic picture that must urgently be addressed, she said.

“The world again was taken unprepared. The vaccine situation is an illustration that a whole-of-government approach, whole-world approach at the highest level is not there.”

“I was shocked when we realized that not only with regard to vaccine distribution, but also PPE, therapeutics, nothing could be done, frankly, by our financial institutions who serve the developing countries, because they have no mechanism for supporting global public goods.  This illustrates how important it is that we pursue these kinds of recommendations – broadly speaking, to be prepared.” 

Reforms that stimulate more equitable access could be stimulated by the creation of a high-level Global Health Threats Council – annother recommendation emerging out of the Independent Panel: 

“A Global Health Threats Council is something I think needs to be institutionalized – with a financing mechanism that is not based on ODA [donor aid] and the idea of giving gifts to countries – but rather a responsibility of all countries, based on ability to pay,” Brundtland said.

Gro Harlem Brundtland, Co-Chair, Global Pandemic Preparedness Monitoring Board.

Intellectual Property Waiver – A Novel Suggestion

Ellen Johnson Sirleaf, former president of Liberia and co-chair of The Indepdendent Panel.

As for the debate over current proposals by WHO and many other global health advocates to implement a World Trade Organization waiver on intellectual property (IP) rights for COVID health products, for the duration of the pandemic, Johnson-Sirleaf  suggested a novel proposal.  She said that high-income countries flush in vaccines should commit to turning over at least 1 billion doses to the COVAX global vaccine facility by 1 September – and two billion doses by 2022, supported by more agreements for voluntary licensing by big pharma of manufacturing in the global south, and tech transfer agreements. And in the absence of such commitments, then WTO members should rally around the proposed agreement to waiver IP rights set out in the WTO TRIPS Agreement altogether.

“We feel if that doesn’t happen, there should be a waiver of TRIPS,” she declared. ” So that, that can come into force with immediate effect. What this will require is that the major vaccine producing have the power to make that happen.”

Sirleaf said she was looking to Friday’s G-20 Global Health Summit, hosted by Italy and the European Commission, for clear responses.

“The Independent Panel’s impact is a moral force and setting the expectations, but we have very little leverage. It is the inter-governmental forces such as the G-20 and the G-7 that are the useful institutions to create the peer pressure, and to promote a sense of momentum. The key message from us the the scale of vaccine distribution needed.  With 1 billion doses by September. Not 10 million. Not 100 million… we need 1 billion by that date. Anything short of this, will simply not be enough to start slowing the pandemic, towards eradication.”

Increasing Annual Contributions to WHO 

Another key reform with meaning would be increasing the regular annual contributions to WHO from member states, beginning with a gesture by the United States to reverse the 1999-era  Helms/Biden Act – which froze it’s regular WHO contributions in time, emphasized Frenk.   

“We’ve got to change the funding, there’s no national health agency that could function, if 80% of its funding came from voluntary contributions.  

“If this is really the organisation of member states, then member states need to pay for their organisation,” declared Frenk at the session. “Therefore, the increase to two-thirds of the budget coming from assessed contributions with an equitable formula. That has to happen, and the United States needs to lead the way. 

“Because the process that led us to the current situation was an amendment to a law that bears the name of the current president, President Biden, it’s called the Helms/Biden Act, and it froze the nominal amount of assessed contributions. And since then, the proportion that’s covered by those assessed contributions has been coming down to be now, very very insufficient.” 

In RealPolitik Prospects for Key Reforms are Dim 

However, in the realpolitik of WHA negotiations, the changes that key reform measures might receive the consensus vote they need for approval remains dim to doubtful, people close to the organisation told Health Policy Watch. 

“On the single term DG issue, there’s not a chance that it can be considered in operational terms at this World Health Assembly because formally it does not fall within the scope of the existing items on health security. It requires reopening the issue of DG elections,” said one diplomatic observer, adding, “and I doubt that that reform – as objectively desirable as it can be – will ever pass because it would deprive key countries of influence and control over the DG if he/she cannot run for re-election.” 

Prospects for a Pandemic Treaty – most likely to take shape as a Pandemic Framework Convention supervised by the WHO if it happens at all – appear to be equally troubled by opposition from major countries such as the United States, Russia and Brazil.  The unusual set of allies have argued that negotiations over a treaty would be too time-consuming to conduct right now, as the world remains in the midst of battle with COVID-19. 

This is despite support the pandemic treaty concept has received from some two dozen other G-20 countries, as well as the WHO.  

That ambivalence has led to the circulation of two versions of a draft WHA resolution on follow-up to the Independent Panel’s recommendations. According to one version, WHA member states would explicitly agree to begin negotiations towards a legal treaty or convention. But the other version would merely agree upon the creation of a working group to take forward the recommendations of the Independent Panel as well as those of two other investigative committees, exploring gaps that emerged during the pandemic in the existing International Health Regulations as well as WHO’s own emergency response 

“I understand that there are negotiations going on now on whether and how to combine them –  given the fact that the US, Russia, Brazil and some other big countries are against starting negotiations now and want to kick that issue down the road,” said one observer. 

Geopolitical Rifts Also Threaten Unity 

Gian Luca Burci, Professor of International Law at The Graduate Institute, and former WHO legal counsel.

Along with the burning global health issues that need to be faced, some serious geopolitical rifts are likely to disturb the proceedings of the WHA – already from the first day of the Assembly. 

That will be when member states debate a proposal to admit Taiwan as an observer to the WHA – after freezing it out since 2016.  The controversial proposal is now supported by 13 leading member states, including G-7 countries. 

There will also be an equally heated debate on which government should represent Myanmar. Since the military coup – two claim that role – the junta now in power and a shadow, opposition government. 

Finally, the thorny issue of the Palestinian humanitarian situation in Gaza will also be debated – after being front and center in the news over the past 10 days, following intense exchanges of missles and fire power between the Hamas-controlled Gaza strip and Israel. 

”There will be political issues and issues of  participation,” said Gian Luca Burci, a professor of international law at The Graduate Institute and a former WHO legal counsel.  He noted that politically-laden procedural hurdles that will  have to be navigated in addressing all three issues. 

“Thirteen states have  again made invitation for Taiwan to attend the Health Assembly as an observer, ” he said. “There will certainly be a very difficult, very controversial debate and vote on the draft resolution on assistance to Palestinian population in the occupied Palestinian territory in view of the current circumstances. There will be two governments that would like to represent Myanmar. One is a military government that has taken power in the coup in February, and the other is the civilian government deposed. Both presented credentials, and these will need to be considered in the credential committee. 

“On the positive side, the WHA will invite the Holy See, which has already been observing the Health Assembly for many years at the invitation of the director general, to be formally invited to participate as a non member observer state.” 

Big Agenda – Modest Expectations  

Dr Tedros Adhanom Ghebreyesus, WHO Director General and moderating John E. Lange, Senior Fellow of Global Health Diplomacy at the United Nations Foundation, at the Global Health Centre event.

“This year’s Health Assembly is arguably one of the most important in the history of WHO, and the COVID 19 pandemic means we will once again gather, virtually – but that has not limited the scope or importance of the discussions,” said WHO Director General Dr Tedros, in a video-cast message at the opening of the Global Health Centre panel discussion. 

“In fact, this year, We have one of the heaviest agendas on record.”

Actions taken in response to the recommendations of the Independent Panel and two other investigative panels, which have reviewed WHO’s own internal emergencies response and the International Health Regulations, “ will have far reaching ramifications for the Global Health architecture of the future, “ he noted. 

Items on “the global health workforce, and accountability issues around the prevention of sexual exploitation and abuse,” are other issues of particular note, Tedros added. 

Despite the big agenda, Burci has modest expectations.

“This crisis is quite different from Ebola and so on.  There’s (as of now) hardly any agreement on anything except at a high level of generality.  Besides advocating for big changes and criticizing states’  short-sightedness, there should be some serious analysis why this is the case – because it may show more systemic changes in the world that we need to understand.

“The upside is probably that the WHA will set up an intergovernmental process to at least discuss the various reviews and sketch some ways forward.  It sounds like a talk shop, but states need to be brought back to the centre of the policy debate within WHO rather than through the usual G7/G20 clubs.  

Memories Are Short 

Suerie Moon, Co-Director of the Global Health Centre,

Along with being a milestone moment, this year’s WHA also has one of the largest agendas ever on record, noted Suerie Moon, co-director of the Global Health Center at the Geneva Graduate Institute, who moderated the panel. 

“There are about 70 agenda items on the WHA agenda, beyond COVID-19 – and this is a timely reminder that who is more important for the health of all of us, than it’s ever been.” 

“Clearly there’s no shortage of challenges, nor potential solutions to address some of these weaknesses, but there’s also no guarantee that we will seize this moment, and that we will seize this moment to strengthen the WHO.” 

 “This pandemic is not yet over, and yet we know that memories are short. Opportunities are limited to fix the global system that COVID has shown is deeply inadequate,” said Moon.  

“And whether or not COVID becomes a game changer will depend on at least four things. I would say political leadership, political courage, political wisdom and political mobilization.”

Editor’s Note- Health Policy Watch is a media partner in the Geneva Health Centre’s series of WHA week events. 

 

Image Credits: Global Health Center.

 

Inspecting a pig’s health in Busia, western Kenya in 2010. Livestock often serve as a bridge for the transmission of zoonotic diseases.

A new international expert panel launched by four international organisations on Thursday aims to blunt the emergence and spread of zoonotic diseases through better understanding of human, animal, and environmental interactions that enable animal-borne diseases to break into human populations.  

The One Health High Level Expert Panel will advise the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the United Nations Environmental Programme (UNEP) on developing a long-term global plan of action to avert outbreaks of diseases, such as Ebola, Zika, and COVID-19.

The panel was borne out of the COVID-19 pandemic and was proposed by Germany and France at the Paris Peace Forum last November. 

“The rapid establishment of this panel shows the commitment of the international community to learn from all lessons of the current health crisis,” said Jean-Yves Le Drian, France’s Minister for Europe and Foreign Affairs, at a press conference on Thursday.

“The COVID-19 pandemic is a powerful demonstration that human health does not exist in a vacuum, and nor can our efforts to protect and promote it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General. 

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

“The close links between human, animal, and environmental health, demand close collaboration, communication and coordination between the relevant sectors,” said Tedros.

Zoonotic Diseases as a Major Neglected Health Risk Area

Some 75% of all emerging infections are transmitted from animals and 60% of the known infectious diseases in humans can be transmitted by animals through direct contact or through food, water, and the environment. 

Neglected zoonotic diseases kill at least two million people annually, mostly in low- and middle-income countries.

Health threats are becoming increasingly complex due to the interdependent relationships humans have with animals and the environment for food, livelihoods, and wellbeing. Factors include poaching and ecosystem destruction that brings people into closer contact with wild animals as well as commerce in wild animals for food and traditional medicines.  

Zoonotic diseases, including rabies, zoonotic influenza, Ebola, and Rift Valley fever, as well as food-borne diseases and antimicrobial resistance, have major impacts on health, livelihoods, and economies.

Emerging pathogens are crossing the animal-human barrier with increased frequency or greater impact, potentially due to environmental changes in rural and urban areas. In rural areas, deforestation can lead to increased human contact with wild animals that harbour and transmit diseases.

In urban areas, the crowded conditions used to house animals in industrialised livestock production systems allow infections to easily mutate and jump to human hosts. 

Certain wild animals – including rodents, bats, carnivores and non-human primates – are most likely to harbour zoonotic pathogens, with livestock often serving as a bridge for transmission. 

Global demand for animal meat has risen by 260%, which has prompted large scale industrialised livestock production and is exacerbating the risk of spreading zoonoses.

Risk of Zoonotic Epidemics Rises as Humans Increasingly Cause Environmental Degradation

The rising trend in zoonotic diseases is likely being driven by increased demand for animal protein; unsustainable farming practices; increased exploitation of wildlife; unsustainable use of natural resources accelerated by urbanization and extractive industries; increased travel; changes in food supply; and climate change, according to a UNEP report published in July 2020. 

“As we exploit more marginal areas, we are creating opportunities for transmission,” said Eric Fèvre, Professor of Veterinary Infectious diseases at the University of Liverpool, in a press release. “There is an increasing risk of seeing bigger epidemics and, eventually, a pandemic of the COVID-19 type as our footprint on the world expands.”

Antimicrobial resistance (AMR) is another growing public health threat that is linked to the use of antibiotics in livestock and agriculture. The overuse or misuse of antibiotics in food-producing animals can lead to antimicrobial resistant infections in humans that cause longer illnesses, more frequent hospitalizations, and treatment failures. 

Testing for antimicrobial resistance at the Liverpool School of Tropical Science.

Currently, at least 700,000 people die each year due to drug-resistant diseases. 

“We need, among other things, to break down disciplinary and organisational silos, to invest in public health programmes, to farm sustainable, to end the over-exploitation of wildlife, to restore land and ecosystem health and to reduce climate change,” said Jimmy Smith, Director General of the International Livestock Research Institute, in the UNEP report. 

Most efforts to control zoonotic diseases to date have been reactive instead of proactive. The COVID-19 pandemic has demonstrated that the root causes of novel zoonotic diseases need to be addressed in order to prevent future outbreaks, said officials at the press conference. 

The purpose of the new expert panel will be to consider the impact of human activity on the environment and wildlife habitats and its link to zoonotic diseases. 

The One Health approach is widely considered the optimal way to respond to and prevent future pandemics, as it unites medical, veterinary and environmental expertise and recognises the links between the health of people, animals, and the environment.

The launch of the One Health High Level Expert Panel is the latest attempt from the tripartite alliance to promote the One Health approach.

Panel will Take ‘One Health’ Concept to the Next Level

While the One Health concept is not new and the tripartite alliance between WHO, FAO, and OIE was formed over a decade ago to develop the concept, “the high level expert panel is a much needed initiative to take it to the next level,” said Tedros. 

“The high level expert panel will advise us on how to bridge the gaps between sectors, connecting veterinary and human medicine, and environmental issues and to address the challenge of implementation at both the global and country level,” Tedros added. 

The 26-member panel held its inaugural meeting on Monday, in which four working groups were established. The working groups will focus on implementing “One Health”; extracting best practices from existing global programmes and projects; establishing surveillance and early warning systems; and identifying spillover factors. 

Dr Thomas Mettenleiter, co-chair of the One Health High Level Expert Panel.

The next meeting will take place before the summer and the panel plans to release its first tangible results by the fall, said Dr Thomas Mettenleiter, co-chair of the expert panel. 

The initial efforts of the new body will be to examine the factors that lead to the transmission of a disease from animals to humans, develop risk assessment frameworks, and identify capacity gaps to prepare for and prevent zoonotic outbreaks. 

“This panel will contribute to advancing the One Health agenda, by helping to better understand the root causes of disease emergence and spread, and informing decision-makers to prevent long-term public health risks,” said Dr Qu Dongyu, Director General of FAO.

Dr Qu Dongyu, Director General of FAO.

It will “provide robust scientific analysis…and evidence-based recommendations on policy approach[es] with long term relevance that will reduce the risk of emergence of zoonosis with pandemic potential,” said Dr Monique Eloit, Director General of the OIE. 

“The work of the panel will help us advocate for bold policy measures and investments to reduce the risk of future pandemics, and to change harmful practices that threaten us now and in future generations,” said Tedros. 

France Calls for “Other Sweeping Measures”

At the press conference on Thursday, France announced its commitment of €3 million to support the secretariat of the panel.

“We hope that the creation of this panel…will be followed by other sweeping measures,” said Jean-Yves Le Drian.

Jean-Yves Le Drian, France’s Minister for Europe and Foreign Affairs.

Pandemic-related reforms and new measures will be debated at the G-20 Global Health Summit, which will take place virtually tomorrow, and at the upcoming 74th World Health Assembly (24 May-1 June).

A draft ‘Rome Declaration’ that will be issued at the G-20 meeting on Friday, calls for a “One Health approach…to address threats emerging at the human-animal-ecosystems interface, and antimicrobial resistance.”

Hot on the agenda for the World Health Assembly are talks for a “pandemic treaty” to better prevent, prepare and respond to infectious disease outbreaks. If such a treaty were to exist, there would be pressure from numerous experts to take a One Health approach. 

Image Credits: Nettverk for dyrs frihet / Net. for Animal Freedom, ILRI / Charlie Pye-Smith, WHO, Flickr – UK Department for International Development.