Dr Tedros Adhanom Ghebreyesus, WHO Director General, giving his closing remarks at the 74th World Health Assembly.

The 74th World Health Assembly (WHA) closed on Monday with appeals for vaccine equity, more resources for the World Health Organization (WHO) and support for a “pandemic treaty” to combat future pathogens.

WHO Director General Dr Tedros Adhanom Ghebreyesus devoted much of his concluding speech to the global body’s dearth of finances and the importance of the proposed pandemic treaty to put more teeth into international health rules around outbreak responses. Member states agreed at the WHA session that the proposed treaty would be discussed in detail at a special WHA session at the end of November.

Despite member countries’ praise for the global body’s support, Tedros said bluntly:  “We cannot pay people with praise”, adding that many of their experts were on short contracts as the WHO struggled to maintain its current level of pandemic response.

“The message that a strong WHO needs to be properly financed has been amplified by all the expert reviews that reported to this Assembly,” said Tedros, adding that the WHO Working Group on Sustainable Finance was charting a way forward to address this.

“The one recommendation that I believe will do the most to strengthen both WHO and global health security is the recommendation for a treaty on pandemic preparedness and response,” said Tedros. “That could also improve the relationship between member states, and foster cooperation.”

For Tedros, such a treaty would be a “a generational commitment that outlives budgetary cycles, election cycles and media cycles”.

Pathogens have More Power than WHO – And Globe has a “Temperature”

The current pandemic had been characterised by a lack of sharing and a lack of global accountability, he added.

“At present, pathogens have greater power than WHO. They are emerging more frequently in a planet out of balance. They exploit our interconnectedness and expose our inequities and divisions,” Tedros stressed.

“A treaty would foster improved sharing, trust and accountability, and provide the solid foundation on which to build other mechanisms for global health security,” said Tedros, including research and innovation, early warning, stockpiling and production of pandemic supplies – and equitable access to vaccines, tests and treatments.

Referring to a visit Saturday to WHO by a group of health and climate activists DoctorsXR   the WHO Director General also noted how the climate crisis has become interwoven with the pandemic as another risk to humanity whose signals need to be heeded now. 

“Our human health is very much similar to Planet health,” he noted,  “As you know, in human health, 37 ℃ is healthy. If you add 2 degrees, which is 39 ℃, you’re sick. If you add another 2 ℃, then you are at 41, and in  danger. And then if you add more and it’s 37 ℃ plus 5℃, that’s too late. 

“And for the planet it’s the same thing.  So we need to take care of ourselves and our planet. And the recommendations they have made are: 1)  focus on preventive rather than curative care; 2) promote a more sober and equitable medicine; 3) develop environmentally-friendly healthy structures, and 4) focus on community based care and support.

“Five, respect the natural environment; 6) organize information and education, and 7)  involve the population and patients in strategic decisions. And in all that leadership is key and this is a message to you which they asked me to pass to all member states.”

Debates over TRIPS Waiver, Virus Origins Investigation and Pandemic Treaty End in Whispers  

The WHA had the longest agenda in its history, and adopted over 30 resolutions, including new initiatives to promote local production of medicines; prevent and reduce non-communicable diseases;  expand access to services for the treatment of diabetes, disabilities and eye care.

It also considered reports from three different bodies – the Independent Oversight and Advisory Committee (IAOC), the Independent Panel for Pandemic Preparedness and Response (IPPR), and the International Health Regulations Review Committee (IHRC) – which revealed the WHO weaknesses in dealing COVID-19 and how to address these.

Despite the roaring debates that occurred on the Assembly’s margins, member states clearly sought to end the packed 8-day long meeting on a note of accord – if not exactly consensus. 

Disagreements over an IP waiver to spur vaccine protection or the future direction of the WHO-led investigation into the SARS-CoV-2 origins did not break out again onto the plenary floor, as could have occurred in the closing hours of the assembly.  

Rather, member states seemed happy to let the IP waiver debate move back to its natural arena in the World Trade Organization forum, which is set to meet on the issue once more next Monday – although chances for progress remain dim in light of continued European opposition.  

A key resolution of this WHA, “Strengthening WHO Preparedness for and Response to Health Emergencies, received final approval on Monday without objections – even though scientific critics and member states had complained that the already nuanced text touching on the investigation into the SARS-CoV2 origins had been weakened further during the course of negotiations. 

A terse statement by one of the leading critics of the investigation so far, the United States, seemed to throw the ball back into the court of Dr Tedros once more.  

“We call for a timely, transparent, evidence-based, and expert-led Phase 2 study, including in the People’s Republic of China,” said the US statement.

“It is critical that China provides independent experts full access to complete, original data and samples relevant to understanding the source of the virus and the early stages of the pandemic. We appreciate the WHO’s stated commitment to move forward with Phase 2 of the COVID-19 origins study, and look forward to an update from Director General Tedros.”

But President Joe Biden was not taking any chances either.  As the WHA session was in full swing, Biden announced the launch of a US investigation into one key element of the controversy –  whether the virus more likely first infected humans via contact with the pathogen in a wild animal or food-borne source – or via a biosafety accident at the Wuhan Virology Institute, that was studying bat-borne coronaviruses at the time the Wuhan outbreak first began.  

Member States Describe Pandemic Challenges and Successes 

Malaysian Prime Minister Tan Sri Muhyiddin Yassin

Instead of touching on those sensitive nerves, leaders of member states addressing the closing plenary talked about the struggles that they still faced to contain the pandemic – as well as the qualified successes that some countries had seen. 

Malaysian Prime Minister Tan Sri Muhyiddin Yassin said his country was experiencing another surge in infections – but it had only secured 6% of the 53 million vaccines it needed to protect its citizens.

“Vaccine equity is still a major issue and we cannot win this war against the virus unless everyone has equal and rapid access to vaccines,” said Yassin, expressing his country’s support for the proposed TRIPS waiver of intellectual property on COVID-19 related products.

Argentina’s President Alberto Fernández said that his country was “going through very, very difficult times… the worst time of the pandemic”.

“We’ve got, say, a dozen countries who can produce vaccines and have managed not only to produce but to purchase about 90% of them. Everyone else has had to go searching for the vaccines in order to try and get sufficient quantities to vaccinate our people. Solidarity there has been fairly non-existent,” he said.

Fernández described the ongoing economic blockade of Cuba and Venezuela during the pandemic as “obscene”, and called for it to be lifted alongside the lifting of patents on vaccines. Cuba is reportedly in advanced stages of R&D into an indigenous COVID-19 vaccine which could be relevant for its Latin American neighbours unable to readily access sufficient supplies from the big producers in US, Europe, India, China or Rusia. 

Bhutan’s Success Mitigated by Vaccine Scarcity 

Bhutan’s Prime Minister, Lotay Tshering

On a brighter side, Azerbaijan President Iham Aliyer said that the country had vaccinated two million people – 20% of its population – mostly using the Sinovac vaccine, and would be removing most pandemic restrictions by 1 June. 

Buthan’s Prime Minister, Lotay Tshering, talked about how the tiny country had been able to vaccine 90% of its population thanks to AstraZeneca vaccines donated by India – and that had, in turn, kept the pandemic at bay.

But he expressed doubts about “how long” the reprieve would last, if Bhutan is unable to get people their second doses because of the huge surge seen in Indian cases since. 

Afghanistan President Mohammed Ashraf Gani was meanwhile critical of “UN agencies” which had neither been able to deliver the oxygen they had promised nor “offer us timely policy advice”.

In contrast, he said, “India showed us exceptional solidarity by giving us 650,000 vaccine doses” which had enabled the country, currently in its third wave, to vaccinate its most vulnerable people.

  • Elaine Ruth Fletcher contributed to this story.

 

 

Image Credits: WHO.

Polio workers protest against WHO retrenchments.

ISLAMABAD – Despite the 18-month COVID-19 pandemic, Pakistan and Afghanistan have observed a sharp decline in polio cases which the health authorities attribute to their effective back-to-back anti-polio drives.

Officials leading the polio eradication programme believe that the decline occurred due to uninterrupted polio vaccination campaigns, improved security and the polio field teams’ accessibility to the population in high-risk areas.

However, despite a remarkable decline in poliovirus cases, officials believe that ‘vaccine refusal and hesitancy’ by parents remains a bigger challenge than COVID in completely eradicating the virus.

Pakistan and Afghanistan, both members of the World Health Organization’s (WHO) Eastern Mediterranean Region, are the only two countries in the world still fighting to eradicate wild polio virus as a cause of the crippling disease.    

In August 2020, Nigeria achieved zero wild poliovirus cases, leaving Africa to be certified by WHO as a free of the wild poliovirus. 

However, some 16 countries in Africa are still experiencing periodic outbreaks of vaccine-derived polio cases (cVDPV2). While rare, vaccine-derived polioviruses cases can occur when the weakened live virus in the oral polio vaccine passes among under-immunized populations and, over time, changes to a form that can cause acute disease.  If a population is adequately immunized with polio vaccines, it will be protected from both wild polio and circulating vaccine-derived polioviruses.

A WHO report on the global battle to eradicate polio was the subject of a wide-ranging discussion Saturday at the World Health Assembly – with WHO and other member states commending Pakistan and Afghanistan and Africa on the progress seen – while also highlighting the uphill battle still faced to completely eradicate both wild and vaccine-derived forms of the disease. Member states also called upon WHO to remain committed to polio eradication – including building the capacity of national health teams to gradually take over the roles of the WHO-supported Global Polio Eradication initiative.

“We are accountable to children,” said WHO Polio Director Aidan O’Leary, in describing the challenges still faced to eradicate the last remaining cases of wild poliovirus – along with tackling vaccine derived cases that continue to circulate not only in Africa and Asia, but other regions as well.

‘Last Mile’ in Pakistan ? 

On both sides of the shared 2,640 kilometer border, Pakistan and Afghanistan are focused on both forms of the virus – working alongside about dozen international health and donor agencies.

Speaking to Health Policy Watch ahead of the WHA, key Pakistani health officials expressed hope that the wild poliovirus could soon be eradicated altogether in that country.

“This is our last mile and hopefully we will achieve zero cases in 2022,” said National Coordinator Dr. Shehzad Baig.  He told  Health Policy Watch that the last three anti-polio campaigns had been very effective reaching 90 to 95% of targets in  eradicating the virus from the country – and if that track record can be maintained then the eradication target can be met.

He said that the silver lining of the COVID-19 pandemic’s lockdown rules meant that children had been easier to reach: “Mostly children in high-risk areas remained at home and were accessible to polio teams for vaccination,” said Baig.

Stability in Pakistan’s security situation since last year also contributed to effective anti-polio drives, he said adding: “Since November, there was no security challenge for 286,000 field polio workers accessing areas for polio drives in security risk regions,” he said.

A WHO report submitted to the World Health Assembly (WHA) on Saturday, stated that WPV transmission is ongoing in traditional reservoirs in the northern corridor (Peshawar/Khyber), Karachi and the southern corridor (Quetta block, Balochistan), with expansion of virus to previously polio-free areas (Punjab and Sindh), and detection of virus across the country.

It also said that circulating vaccine-derived poliovirus type 2 continues to spread geographically, notably in Khyber Pakhtunkhwa, with ongoing breakthrough transmission complicated by a large nationwide accumulation of populations susceptible to type 2 poliovirus. 

Afghanistan also Sees Progress – But Poor Reporting May be Factor 

In Afghanistan, reports of polio virus cases were also on the decline this year as compared to 2020 – although surveillance remains an issue, particularly in areas where the reach of the central government is weak, officials cautioned.

Just one wild polio virus case has been reported so far in Afghanistan so far in 2021, as compared to 56 in 2020, according to the Independent Monitoring Board, an international body monitoring the performance of the polio programs by the countrie. And only 38 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) had been reported in Afghanistan, in contrast to 308 cases in 2020. 

In the wake of three WPV cases in November 2020, some 54 cross-border teams and 288 permanent transit teams (PTTs) were deployed across Afghanistan, the IMB said. The teams vaccinated 79,489 adults and 538,674 children.  Wild Polio Virus type 1 is endemic to the southern and eastern regions of Afghanistan, but  WPV, along with more vaccine derived cases, can encroach previously polio-free areas in the north and west of the country in the absence of containment vaccine campaigns. And those had been suspended in the first six months of the pandemic.    

In Pakistan, cases so far in 2021 have declined even more dramatically.  According to the official data of Pakistan Polio Eradication Program (PPEP), the country saw 84 Wild Polio Virus (WPV) cases and 83 circulating vaccine-derived poliovirus type 2 (cVDPV2) virus cases in 2020 (the IMB says the number of vaccine derived cases in 2020 was even higher – 135). 

This year, there has been just one WPV case reported so far, and no cVDPV2 cases.

Speaking at the WHA, the Afghan representative said, however, that still 3.5 million children are missing from the country’s vaccination campaigns. Afghanistan also urged the global community for more financial support to expand the immunization campaigns in the security risk areas.

Setbacks at Start of Pandemic Followed by Renewed Vaccine Drives  

In both countries, campaigns were initially suspended for the first six months of the year.  For instance in Pakistan,  after the first surge of COVID-19 pandemic, the country’s polio programme had to suspend its scheduled April National Immunization Drive (NID) –  which meant that around 40 million children missed the polio drops.

That followed on interruptions in vaccine drives in 2019, as well, after attacks on polio teams occurred in the country’s southern and western regions.  As a result, around 250,000 children missed the polio drops as a result leading to 134 polio cases reported in 2019.

However, after the decline of the first COVID-19 wave, Pakistan’s polio programme, led by Dr Rana Muhammad Safdar, then National Coordinator on Polio Program now the Director General of Pakistan’s Health Ministry, rebounded. It conducted two national and three sub-national anti-polio drives between July and December  2020 to cover the immunity gaps. Then, in 2021 the country conducted another national drive to vaccine 40 million children with polio drops.

Impact of CIA’s Fake Polio Campaign

Pakistani efforts to eliminate polio were seriously undermined a decade ago when the US Central Investigation Agency (CIA) conducted a widely-criticized fake polio campaign as part of its intelligence gathering operations on the whereabouts of Osama Bin Laden in Abottabad; the al-Qaeda leader was finally ambushed and killed by US troops in his compound on 2 May 2011.

Following the disclosure of the CIA mission, the Taliban also launched an intense anti-vaccine propaganda campaign on both sides of the Pakistani-Afghan border. Polio teams were attacked in both countries by the militants, and several field workers were killed.

It is likely that these factors eroded parental confidence in vaccines and health workers and declines in vaccination rates. 

Cross Border Transmission and Vaccine Hesitancy    

To this day, parental refusal remains a bigger challenge in both Afghanistan and Pakistan than cross border transmission of the virus, said Baig.

He said that the ratio of parents’ refusal from polio drops fluctuates between 2% and 5% in different areas of Pakistan.

Meanwhile, Dr Faisal Sult, the Special Assistant to the Prime Minister (SAPM) on health, warned, however, that “we have been close before and lowered our guard and polio surged back, so rather than congratulate ourselves on efforts to date, we need to double our efforts and drive harder than ever if we are to truly protect Pakistan’s, and the world’s children from this devastating disease.”

He also stressed the need for a coordinated whole of government approach encompassing nutrition, primary health care and water and sanitation.

Risk of Resurgence

Despite the sharp decline in the polio cases in Pakistan, polio officer Anil Kumar from Sindh province believes that the risk of resurgence remains as dedicated polio vaccine teams are gradually reduced or reassigned – in Pakistan as well as worldwide.

Kumar criticized the recent WHO moves to abolish around 850 posts of national polio officers – even while the virus lingers in the country.

The cutbacks have come as part of a gradual WHO move to phase out its huge and costly ground support for the polio elimination programme – with an eye to the day when the world reaches polio eradication.

However, the strategy has been controversial among countries which have relied heavily upon the polio teams to conduc other vaccine drives too. And indeed, over the past several years, WHO has shifted gradually from talking about outright staff cuts to a more gradual integation of WHO-supported polio teams with other national immunization efforts – as part of developing stronger national immunization capacity.

In the wake of COVID, which saw national polio teams also supporting COVID  testing, tracking and containment followed by a groundswell of needs for vaccine teams generally, that approach has been validated.

But even so, countries like Pakistan say that the reality on the ground doesn’t always match the rhetoric in Geneva.

In Sindh province, one key at-risk region, the Deputy Commissioner (DC) of the Umerkot district wrote a letter to the WHO team lead in the province appealing for the retention of its lost polio officers.

In March 2021, polio workers staged a protest outside WHO’s Pakistan country office, demanding a restoration of the 850 cancelled posts. But the head of WHO’s Pakistan country office, Dr Palitha Mahipala, turned down their demand.

Warned Kumar, “some of the posts have been abolished in high-risk areas where there is still a chance of resurgence of the virus.” 

 

 

 

 

Image Credits: Pakistan Polio Eradication Program.

US delegate Colin Mclff urged bold action.

The World Health Assembly (WHA) passed a resolution on preventing violence against women and girls at Monday’s plenary – but only after heated discussion on Saturday resulted in a watered-down version with no reference to “sexuality education”. 

However, during the plenary session after the resolution had been adopted, Argentina’s representative, María Jimena Schiaffino, expressed disappointment on behalf of over 30 countries at the compromise that had been adopted “in order to not break consensus on voting on technical issues”.

“We have remained disappointed that similarly the long-standing practice of this association was not employed by objecting member states,” added Schiaffino. 

Comprehensive Sexuality Education ‘Agreed On’ in UN

“We want to take this opportunity today to again reiterate our support for comprehensive sexuality education for children to realise their health, well-being and to learn how to build relationships. For real communication, self-protection and risk-reduction skills are a fundamental part of efforts to prevent, recognise or respond to violence against children,” she said.

She added that “the term comprehensive sexuality education is based on already agreed consensus language use in other UN fora” and that the WHA  needs discussions to evolve its language to support “this evidence-based standard for the benefit of all children everywhere”.

The resolution is aimed at strengthening the health sector’s capacity to prevent and respond to violence against children. Every year around a billion children are affected by physical, sexual or emotional violence. 

During Saturday’s committee meeting on the draft resolution, US delegate Colin Mclff called for member states to “be bold” in order to “move forward with our shared goal of ending violence against children”, emphasizing that “sexuality education” would allow for a pathway to tolerance leading to “acceptance, inclusivity and empowerment”.

Countries like New Zealand also drew attention to the intersectionality of violence against children with their race, gender and other identities. 

Heated discussion over language

However, a number of countries including Kenya, Syria, Egypt, Bahrain and Iran disagreed with the language of the draft resolution, particularly with the inclusion of the term “sexuality education” over “sex education” for children. 

The push for bold language that would recognise multiple gender identities came from co-sponsor countries including the United States, Canada, the European Union, Oman and Paraguay, among others.  

Eventually, in an effort to pass the resolution with consensus, Monaco, Australia and Japan suggested a compromise that would drop the contentious paragraph:

“To provide accessible gender-sensitive, free from gender stereotypes, evidence-based and appropriate to age and evolving capacities sexuality education to children, and with appropriate direction and guidance from parents and legal guardians, with the best interests of the child as their basic concern to empower and enable them to realize their health well-being and dignity, build communication, self-protection and risk reduction skills, as a fundamental part of the efforts to prevent, recognize and respond to violence against children”

While countries agreed to the compromise, F Mamdouhi of Iran said his country disassociates itself from the parts of the resolution “that may imply in any manner whatsoever, recognition, protection, or promotion of those behaviours that are unethical under its legal system, or socio-cultural norms or which may contradict its world, and religious values accordingly.”

There were also discussions on protecting children from the growing challenge of online bullying.

Resolution on violence against women

The resolution also included suggestions to take a multi-sectoral approach to interpersonal violence as well as that in particular against women and children. While both boys and girls are at equal risk of physical and emotional abuse and neglect, girls are at a greater risk of sexual abuse. 

There was consensus on considering violence against women an issue of public health concern. 

The WHO will support their member states to train their frontline healthcare workers to respond better to violence against women and girls. Around 60 countries have already adopted or used WHO guidelines to inform their national protocols. 

While there was consensus on the need to prevent violence against women, Zimbabwe reminded the Assembly that violence against boys and men must not be ignored. 

“It is important to take particular attention not to sideline the boy child who also suffers from sexual violence in all forms of violence, including physical, inside of the ruling,” said J Chimedza of Zimbabwe. 

Image Credits: WHO.

Women-led sectors and nations have been at the forefront of the COVID-19 response – despite only a quarter of global leaders being women, speakers at a World Health Assembly side-event noted on Friday. 

“Women have been delivering good health pre-pandemic – and during the pandemic,” said Dr Farah Shroff, head of the Maternal and Infant Health (MIH) Canada, which co-sponsored the event with the Geneva Graduate Institute’s Global Health Center.

Calling women’s leadership during the pandemic “a game-changing moment for women at the helm,” Shroff said a “big difference” in COVID-19 response effectiveness was found in two groups: countries with female leadership and countries that prioritize the well-being of society, as opposed to more individualistic or business-oriented leadership. 

“[They] have really been the unsung heroes and ‘she-roes’ of this pandemic; 2021 is the tipping point for female leaders.”

Female Leaders Acted Sooner 

Marcia Castro, chair of the Department of Global Health and Population at the Harvard TH Chan School of Public Health

Women-led countries have flattened curves, implemented efficient vaccine rollouts and taken effective economic measures, she said. Research shows that these leaders were quicker to respond to the crisis, increasing public health spending, closing borders and enforcing mandatory stay-at-home orders.  

“Countries that have had some of the best responses are led by women,” Harvard University Professor Marcia Castro agreed. “Although women are still the minority in leading countries, we need to take that as an example — and carefully look at the differences in leadership, particularly when we face a major public health emergency.”  

Rwanda is noted for leading the world in women’s leadership – 67% of parliamentarians are female –  but its public health progress is just as noteworthy. Despite low resources (per-capita GDP is US $820), Rwanda has a vaccination rate of 90%.

Ninety-three percent of girls ages 12 to 22 are vaccinated against the human papilloma virus (HPV) to prevent cervical cancer, said Agnes Binagwaho, Vice Chancellor of Rwanda’s University of Global Health Equity. 

“Even during the time of COVID today, where primary health care resources are pulled out of health care systems to respond and be prepared for COVID-19, [Rwanda] has kept that line of primary care and family planning,” she said. “Despite the huge gender discrimination women are facing, we are making the difference.” 

Agnes Binagwaho, Vice-Chancellor of the University of Global Health Equity, Rwanda

Satya Lakshmi, director of India’s National Institute of Naturopathy, spoke about the unsung heroes of the pandemic, from doctors to community health workers, including Accredited Social Health Activists (ASHAs), local women trained as health educators and promoters with health ministry funding. 

Lakshmi also said collective self-help groups helped Kerala’s women by spurring local production and exchange of goods during lockdowns. 

Leadership Lessons For Future Pandemics

Speakers emphasized that compassionate leaders governing on behalf of society as a whole made a difference in the current pandemic, and they asked that these qualities not be forgotten in future crises.

“We know there’s going to be other pandemics – not just viral pandemics, but a whole variety of other pandemics that have been brewing and stewing for a long time,” said Shroff. Giving racism, neo-colonialism, violence against women, and other issues as examples.

She said leaders must “not go back to business as usual. … This COVID moment can catalyse a kinder, gentler world where we prioritise science, we prioritise human health, and we can collaborate with each other across borders.”

Image Credits: Graduate Institute Geneva.

The 74th World Health Assembly meeting virtually in Geneva – how will it shape the direction of the future investigation over the origins of SARS-CoV2?

The debate over the future direction of WHO’s investigation into the origins of SARS-CoV2 appeared to be heading for a showdown in the closing days of the World Health Assembly – following another sharp statement from the United States on the issue – this time directed squarely at WHO and WHA member states.

The terse statement posted by the United States Mission in Geneva said: “Phase 1 of the WHO-convened COVID-19 origins study was insufficient and inconclusive. We call for a timely, transparent, evidence-based, and expert-led Phase 2 study, including in the People’s Republic of China.

“It is critical that China provides independent experts full access to complete, original data and samples relevant to understanding the source of the virus and the early stages of the pandemic. We appreciate the WHO’s stated commitment to move forward with Phase 2 of the COVID-19 origins study, and look forward to an update from Director General Tedros,” the statement added.

The US statement came only a day after US President Joe Biden ordered the US science and intelligence community to “redouble efforts” into finding out how the SARS-CoV2 virus emerged.

Debate in the WHA will largely revolve around the diplomatically explosive fine print of a draft WHA resolution on, Strengthening WHO preparedness and response to health emergencies.

Explicit reference to an “investigation” of the virus origins was removed from the text during negotiations over the past month.  Meanwhile, language hedging countries’ obligations to adhere to international law was hedged with a reference to their adherence to “national laws” as well.

If WHO Doesn’t Move, US Can Investigate On Its Own

The WHO invstigative team visited the Wuhan Institute of Virology on 3 February during their mission to the city to investigate the origins of the SARS-CoV2 virus, but their report concluded that a biosafety incident at the laboratory studying coronaviruses was an unlikely explanation for the COVID-19 outbreak .

Observers predicted, however, that debate on the floor of the WHA would include ad-hoc efforts by member states to modify the current draft further.  And if those efforts don’t succeed, the United States is now positioned to take independent action, said some critics of the current process – who have become pessismistc of WHO’s ability to act.

“It has become apparent that opposition from China and Russia will block calls for an effective international investigation from within the WHA and the WHO,” said Richard H. Ebright, of Rutgers University, in a comment to Health Policy Watch.  “These developments at the international level have been unsurprising but, even so, have been disappointing.

“However, these developments at the international level have had the salutary effect of making it much more likely that the US White House and the US Congress will open investigations at the national level,” Ebright added. “Many investigative leads are available in US and would be accessible to a Congressional investigation with subpoena power.

Process is being “Poisoned by Politics” – WHO Says

Dr Mike Ryan, WHO Executive Director of Health Emergencies, at the World Health Assembly.

Speaking on Friday, Mike Ryan, the Executive Director of WHO’s Health Emergencies division, called upon member states not to politicize the science around the origins quest.

Speaking at a press conference, Ryan said “We continue to work with the international team in looking at the recommendations from the first commission we’ve engaged with, and with  a large number of member states to seek their inputs into the next phase of the studies that are needed.

“And I think this is important to restate that, WHO and our Member States when they made the resolution last, last May, (WHA 73.1), specifically referred to studies and missions, because it was clear that it was going to take time, and it was going to take multiple studies,… to fully elucidate the origins of the virus, if that were ever possible, given the difficulty historically, with being able to do that.”

As for the future direction of the WHO-convened origins investigation, involving an international panel of experts and a parallel panel of Chinese scientists, Ryan asserted that, this would be determined in consultation with WHO member states:

“We will be reaching out to member states in the way we normally would, in order to seek their guidance as to whether there’s further expertise available that could join with this international effort, especially in the next phase, where more specialist studies may be needed in order to further elucidate the origins of virus. 

“We would though, like for everyone out there to separate, if they can, the politics of this issue from the science.

“This whole process is being poisoned by politics. And if you expect scientists to do their work.

“If you expect scientists to collaborate and actually get the answers that you want, actually seek in a non-blame environment to find this, the origin of the virus, so we may all learn how to prevent this happening in future, we would ask that this be done in a de-politicised environment where science and health is the objective of this, and not blame and politics. Because quite frankly, over the last number of days, we’ve seen more and more and more discourse in the media with terribly little actual news or evidence or new material.

“And this is this is quite disturbing, quite frankly,” Ryan said. “Every country and every entity is free to pursue their own particular theories of origin. It’s a free world.

“WHO is a member state organisation, we seek to work with all of our member states to seek answers collectively. We do that within the framework of the mandate that we have as an organization. We do that in collaboration, by consensus.  That is the way our organisation works. The Director General has been clear.  All hypotheses for the origins of the virus remain on the table; further studies are going to be needed across the board to further elucidate those origins.  We believe we can make more progress, especially with the suport of our member states and the support of scientists working in a positive manner. 

“To do that, we need space, we need governments to work together and to create the space where this can be done successfully.  

“Putting WHO in a position, like it has been put in, is very unfair to the science we’re trying to carry out. And it puts us as an organisation, frankly, in an impossible position to deliver the answers that the world wants. So we would ask that we separate the science from the politics.”

“Toxic Mileu”

However, it appears that the battle between scientists – and not only politicians, is becoming more and more toxic.

Scientists who support a “natural origins” theory for the SARS-CoV2 virus – as well as those that lean toward the “lab escape” theory – both appear to have become locked in a cycle of increasingly bitter attack.  That is reflected in the heated exchanges taking place recently on social media – including insults and name-calling fired, back and forth.

Both have fundamentally legitimate points to address.  The critics of the WHO process point out that the possibility of a “lab escape” of the virus was never carefully considered – and the investigative teams lacked the skills to do so.  Those that believe the virus more likely emerged naturally, from infected bats to humans, either directly or via a third intermediary host, such as a wild animal sold in a traditional “wet market”, see the lab escape as a political foil and distraction from ecosystem drivers that are posing increased risks to food safety worldwide.  Those include the progressive destruction of wilderness areas, and incursions of people into those areas to hunt and capture wild animals for meat and traditional medicines – alongside a new industry of domesticated wildlife farms, at least in China.  Those factors, along with the continued popularity of live animal markets within modern, densely-populated Asian cities can easily breed new forms of zoonotic diseases that also easily leap to humans shopping for, or slaughtering the animal hosts.

Bats are a reservoir for cornaviruses that circulate in nature. Horseshoe bats found in southwestern China’s Yunnan province carry the viruses most similar to SARS-CoV2 – they also were the subject of intense study at the Wuhan Instiute of Virology.  But other scientists point to the wide prevalence of bat-born coronaviruses throughout China and Southeast Asia.

While the “lab escape theory proponents” claim that they just want the two theories to be considered on an even playing ground – they have fired bitterly at institutions such as EcoHealth – led by one of the key experts who participated in the WHO-led mission to China in late January. At the same time, scientists  who support more investigation of the lab escape theory have been accused of being regressive, and even racist in some of the social-media back and forth.

“What many don’t realize, the origins debate is one born out of an authoritarian-adjacent leader (Trump) seeking an external enemy for us to focus on. So, we are distracted from how badly he performed,” said one apparent critic of the lab escape camp on social media.

“More studies needed” is a constant refrain in science. But this debate over a lab-leak has become toxic and risky,” noted Nature reporter, Amy Maxmen, on Twitter.

Background of Pandemic Investigation

The recent White House push on the virus investigation marks the first time since Biden’s election that Washington has taken a direct lead on the thorny and geopolitically charged origins issue.  Although former US President Donald Trump had also launched an inquiry into the same questions – that quest was overshadowed by the hyperbole and politics around Trump’s overall approach to China and the WHO – leading many to dismiss the lab escape hypothesis as a pure conspiracy theory.

However, in recent months, as flaws in the WHO investigation became more apparent, even WHO Director General Dr Tedros Adhanom Ghebreyesus has acknowledged that the possibility that the virus could have escaped from the Wuhan Virology Institute needs another serious review.

Scientists calling for a fresh review have cited China’s stonewalling over the release of data on the initial phases of the outbreak in Wuhan, as well as the large body of coronavirus research and data bases that either were blocked or went missing in China after COVID-19 emerged.  They also cite earlier US intelligence reports of biosafety flaws at the Wuhan Virology Institute, and the disappearance of archives from laboratory itself on the coronaviruses carried by the horseshoe bats that it was studying – which closely resembled SARS-CoV2.

Meanwhile, other researchers point out that the horseshoe bats that were being studied in Wuhan, are not the only ones to carry SARS-like coronaviruses. There may be other variants harbored in nature that are even more similar to the virus that causes COVID-19, suggested a new paper published Friday on the pre-print server biorxiv.org.

In that paper, researchers mapped and note the “very wide geographical disperson of the bat viruses related to SARSCoV2 across China and into Southeast Asia” concluding that “there has been relatively recent geographic movement and co-circulation of these viruses’ ancestors, extending across their bat host ranges in China and Southeast Asia over the last 100 years or so.

“We confirm that a direct proximal ancestor to SARS-CoV-2 is yet to be sampled, since the closest relative shared a common ancestor with SARS-CoV-2 approximately 40 years ago.

“Our analysis highlights the need for more wildlife sampling to (i) pinpoint the exact origins of SARS-CoV-2’s animal progenitor, and (ii) survey the extent of the diversity in the related Sarbecoviruses’ phylogeny that present high risk for future spillover.”

Said in lay terms, the implication is clear – the trail back to the virus that caused SARS-CoV2 may not be a one-way street to a Wuhan laboratory – but rather hidden in a dense thicket of biological interacts and reactions extending over decades, and across South East Asia.

 

 

 

 

Image Credits: World Health Assembly, CNN, WHO, Shutterstock .

Indonesia’s Health Minister, Budi Gunadi Sadikin

Indonesia could manufacture 550 million COVID-19 vaccine doses a year if pharmaceutical companies were prepared to share the know-how, Health Minister Budi Gunadi Sadikin told a World Health Organization event Friday.

Sadikin was addressing the first anniversary of the WHO’s COVID-19 Technology Access Pool (C-TAP), set up to encourage countries and manufacturers of COVID-19 products to voluntarily share knowledge, intellectual property and data to facilitate the rapid expansion of manufacturing.

C-TAP has failed to live up to expectations largely because large pharmaceutical companies have been unwilling to join it, preferring to pursue lucrative bilateral deals with wealthy countries instead.

“We’re holding the door open for pharmaceutical companies that have become household names, although too few households have benefited from the lifesaving tools they have developed,” Director-General Dr Tedros Adhanom Ghebreyesus said.

“They control the [intellectual property] that can save lives today, end this pandemic soon, and prevent future epidemics from spiralling out of control and undermining health economies and national security.”

Vaccines with Halal Certificates

Sadikin said Indonesia is the largest vaccine manufacturer in Southeast Asia, and has the capacity to “upscale our vaccine productions to meet regional and global demand”. What it lacks, he said, is the know-how and technology needed to make some COVID-19 vaccines, particularly mRNA vaccines.

“Currently, we have six manufacturers with a production capacity of 550 million doses per annum,” said Sadikin. In addition, he said, the Indonesian vaccines would come with halal certificates, which are crucial in some vaccination programmes. 

Abdul Muktadir, Managing Director of Incepta Pharmaceuticals in Bangladesh, said his company was also ready to produce vaccines if know-how and technology were shared.

“We have seen some statements like ‘Low- and middle-income countries do not have the ability to acquire the technology and deliver quality products,’ ” he said. Yet he pointed out that the vast majority of the world’s medicines are made by generic companies, particularly in Southeast Asia.

Bilateral Deals Trump Multilateral Sharing

Costa Rican President Carlos Alvarado Quesada

Costa Rican President Carlos Alvarado Quesada said that C-TAP – which his country has championed – was intended to foster multilateral sharing of information. But instead, he said, the world contends with “overcoming the challenges generated by bilateral negotiations and property rights”.

WHO expects more countries and manufacturers will join C-TAP, and is currently in talks with two vaccine manufacturers and five therapeutics companies, said Mariangela Simao, WHO Assistant Director-General for Access to Medicines.

Spain’s Foreign Affairs Minister Arancha González Laya also announced at the event that her country had decided to join the 42 current C-TAP members, and said she hopes this will help to boost global vaccine production.

Jesús Marco, vice-president of the Spanish National Research Council (CSIC), elaborated on this hope, saying that his country would share CSIC technologies and was considering licensing its vaccine candidates on a “non-exclusive basis”.

Untapped Vaccine Manufacturing Potential 

“We succeeded in developing vaccines at an unusual speed, but we failed to share COVID-19-related technology and knowledge and to speed up their production,” said Belgian Minister of Development Cooperation Meryame Kitir. “According to UNICEF, only 43% of the world production capacity for approved vaccines is used.”

Referring to the capacity in Indonesia and Bangladesh, WHO Chief Scientist Soumya Swaminathan said that the two countries have the “capacity, interest, and willingness to ramp up production”. 

“There’s really a call for those who have the know-how and the capacity to come and collaborate with us at the Manufacturing Task Force and through C-TAP,” she said.

Meanwhile, Health Access International (HAI) said that the “high expectations of C-TAP to halt the global catastrophe as it unfolds have not been realised”. 

“This is largely down to the refusal of the pharmaceutical industry to engage, preferring instead to protect short-term profits over global public health,” said HAI, which also blamed countries for lack of will to make C-TAP work.

“The need for an effective and functioning C-TAP remains as strong today as it did last year, as evidenced by the insufficient manufacturing capacity of patent holders to deliver on signed contracts and the difficulties endured by the COVAX facility to secure enough vaccine doses for LMICs,” the HAI statement said. 

“There is still a time and place for C-TAP within the global response to COVID-19, and that time is now. WHO should lead the efforts to secure the implementation of a game-changing mechanisms – if we can just agree that status quo is no longer acceptable.”

Image Credits: AstraZeneca.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevent  and Respond to Sexual Abuse Cases

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

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

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

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

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

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

Hotlines and Training Help Raise Awareness

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

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

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

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

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

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

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

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

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

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

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

US delegate A Lipstein Fristedt,

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

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

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

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

Price Transparency

Ethiopia’s Alegnta Gebreyesus Guntie

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

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

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

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

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

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

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

 

.

 

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

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

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

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

Emphasis on One Health, Community Approaches 

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

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

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

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

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

Africa, Bangladesh Speak for Low-Income Countries 

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

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

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

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

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

Image Credits: Wikimedia Commons.

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

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

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

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

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

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

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

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

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

WHO’s Green Manifesto

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

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

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

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

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

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

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

WHO Director-General  Dr Tedros Adhanom Ghebreyesus

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

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

A Healthy Planet Makes Healthier People

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

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

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

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

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

Education to Promote Environmental Awareness

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

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