Healthier Environments Could Halve Global Disease – ‘Nature Summit’ Needed to Highlight Linkages 28/05/2021 Chandre Prince 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. Historic victory: Judge forces Shell to drastically reduce CO2 emissions https://t.co/uBwv2yv9yk — Dr Maria Neira (@DrMariaNeira) May 27, 2021 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. @andersen_inger values collaboration with @WHO stepping into a #OneHealth dimension, #planetaryhealth #veterinaryhealth #humanhealth – absolutely key! 🍃💪🏽🌎 #BuildForward healthier and greener ⛑ #WHA74 @UNEP pic.twitter.com/1z5BfYIO2J — International Pharmaceutical Students' Federation (@IPSForg) May 27, 2021 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. More Than Cables & Devices: Digital Health Event Points to Human Factors 28/05/2021 Svĕt Lustig Vijay In two decades of work on World Bank digital health initiatives, global health policy specialist Akiko Maeda found many fell short of their promises. She suggested these underperforming digital health initiatives focused too much on delivering hardware — but they failed to provide means to ensure stable electricity supplies, and similarly failed to provide adequate human resources to manage data, or to design initiatives that the most vulnerable groups could benefit from. Akiko Maeda, health economist with over 30 years of experience in international development in over 40 countries “It’s not just the infrastructure and the hardware, but how we design the software that goes with it,” Maeda said Thursday. She spoke at a World Health Assembly side event co-hosted by the Geneva Graduate Institute’s Global Health Centre, the Lancet & Financial Times Commission, and Digital Square, which is supported by USAID and the Bill and Melinda Gates Foundation. “Digital infrastructure is more than just a bunch of cables and devices,” said data literacy consultant Gulsen Guler, who is also co-chair of My Data Global, a civil advocacy group promoting equitable digital societies – adding that the stakes are high: “Digital technologies can determine what the future of a child will look like…or even more, they can determine between life and death.” Digital Health Saves Resources to Reach Universal Health Coverage Roger Kamba, Special Advisor to the Democratic Republic of the Congo (DRC), called digital technologies crucial in low-income countries. He said these tools can help countries reach universal health coverage and that digital health can help to meet Sustainable Development Goals. “Digital health is not an option, but rather a necessary step towards universal health coverage,” Kamba said. “I remain personally convinced that there can be no universal health coverage without a substantial contribution from digital health.” However, he said that for that to happen, governments must prioritize digital transformation through a multi-sectoral approach that goes beyond the health ministry. In 2019, the DRC adopted its digital technology strategic plan, Kamba said. Implemented by a newly-created ministry, the plan engages all sectors, including health. “All governments need to take a systems approach to digital transformation. It’s not just the health ministry that needs to be working on health care anymore.” An Epidemiological Nerve Centre – The Emergency Operations Centre Kamba said existing digital health initiatives, notably the nation’s Emergency Operations Centre (EOC), have proven useful in quickly containing infectious disease outbreaks like Ebola. Set up two years ago by PATH, USAID, and the Bill and Melinda Gates Foundation in collaboration with the DRC Centers for Disease Control, the EOC acts as the country’s epidemiological nerve centre to coordinate efforts to prevent, detect, and rapidly respond to public health emergencies. “The center uses tools such as digital mapping, Geographic Information System (GIS) mapping, and mobile health technologies to produce layers of information that help reveal patterns that enabled more effective interventions during the Ebola epidemic,” he said. “Actionable surveillance data and digital epidemic maps made the response faster and more focused, and was the first time that response data was digitized and centralized”. Recently the EOC expanded its scope to investigate regional and local malaria trends; it also facilitates disease control strategies using advanced data analyses. Kamba warned that digital health initiatives depend on reliable and affordable electricity, which can be a challenge in low-income countries: “We’re talking here about the potential of digital solutions to help us overcome long standing infrastructure challenges in sub-Saharan Africa … Investments in digital health in DRC must be coupled with energy solutions at the national level.” “These [digital] infrastructures are also faced with a fundamental financing gap,” said Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. “To really have sustainable financing that’s also reflected in the budgets of countries is a truly, truly big challenge.” Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. Digital Health in Burkina Faso Improves Care Quality Meanwhile in Burkina Faso, Swiss NGO Terre des Hommes (Tdh) has worked for over a decade with the Ministry of Health to develop Ieda – a digital job aid tool that enhances the clinical diagnosis of childhood diseases and improves health workers’ performance using artificial intelligence (AI) algorithms. Ieda already is available in 80% of health-care facilities in the country and has helped with a whopping 10 million digital consultations. This generates savings of US$1.6 million every year, Tdh health programmes research head Riccardo Lampariello said. “Digital health solutions at scale bring financial savings for the authorities, of course after the initial national investment, of $1.6 million every year. Hence the importance of investing in digital health.” Lampariello stressed that the bulk of digital health expenditure is not on infrastructure but on human resources required to build necessary technical and regulatory capacity. He noted that governments need to run local data centers, extract and analyze data, update software and fix data platforms when they crash. Riccardo Lampariello, head of Tdh’s health programmes “Digital health is human resource-intensive, and we should equally invest in infrastructure — which is not only tablets and solar power panels, it is also data centers, for example — and in human resources, including local authorities, including the government, the MOH, in technical skills … and also look to teach them the governance skills to regulate labor use.” Thanks to this already-existing digital health infrastructure, when the coronavirus hit it took only a few weeks for Burkina Faso’s Ministry of Health to deploy digital tools to support training, awareness-raising and triage, and to reach vulnerable groups in remote and unsafe areas, Lampariello said. But he warned that the digital health landscape is still fragmented in low-income countries, challenged by duplication, a lack of interoperability and waste of precious devices and electricity. “Even before COVID, it wasn’t rare to pay a visit to a health-care facility in a very poor country, open a cupboard and find two or three tablets or smartphones [for] dealing with different platforms and databases. In a context of limited resources, this represents a lot of wasted tools,” Lampariello said. “And not to mention, for example, the additional unnecessary e-waste and energy consumption related to that.” Speakers Ask For Well-Designed & Equitable Digital Health Initiatives Digital health initiatives are likely to be more impactful if they designed to be equitable, added panelists on Thursday. In Japan, for example, vaccine uptake in older age groups was hampered by the country’s response plan failing to consider that booking vaccine appointments online can be a struggle for older people. “It’s a design issue, and it’s not a complex issue, but it was not adequately designed for the elderly, so there’s a huge problem going on right now in Japan,” said Maeda. Ann Aerts, Head, Novartis Foundation “Every solution, digital- or AI-driven, has to be human-centered,” said Novartis Foundation head Ann Aerts. “And that’s quite obvious, although it’s not always the case. The best way is to use a human-centered design with input from the people who will have to use a solution, and by thinking up-front how the solution will be integrated in the processes of the health workforce, or the workflow.” According to a World Bank study, successful digital health initiatives tend to share characteristics like strong leadership and regulatory systems, substantial financial commitments to digitize health systems, and national frameworks to facilitate data flows between systems, added Aerts. Washington Call to ‘Redouble Efforts’ on SARS-CoV2 Virus Origins Investigation – But Will There be Action at WHA? 27/05/2021 Elaine Ruth Fletcher White House Deputy Press Secretary Karine Jean-Pierre discusses President Joe Biden’s order to the US intelligence community to take a fresh look at the origins of SARS-CoV2 with answers in 90 days. Amidst fresh calls from US President Joe Biden ordering the science and intelligence community to come up with a more detailed account of how the SARS-CoV2 virus emerged – it’s unclear how much action the World Health Assembly will really see on the issue. Language in the the final-agreed draft of a WHA resolution, Strengthening WHO preparedness and response to health emergencies, appears to have been muted to assuage objections by China and other allies- with the removal of any explicit reference to an “investigation” of the virus origins from the text. The reference to “investigation” of the virus origins had been included in an earlier, 20 April version of the text seen by Health Policy Watch, although it was presented there as a phrase that was still up for debate. Countries’ Adherence to ‘National’ as well as ‘International laws’ The resolution, set to be debated on Saturday, also has watered-down language about countries’ obligations to adhere to provisions of the WHO’s international health regulations that mandate transparency and rapid action on emerging pathogens – adding the term, “taking into account national”… as well as international, laws. That loophole, which can checkmate international mandates, has been another big concern for critics of the investigation so far. That, in light of the fact that China has alerady held back on providing valuable data from national blood banks that could have revealed when the virus really began to spread – saying that it would violate national privacy laws. So far, the earliest cases that China acknowledges formally date from December 2019 – although a series of US intelligence leaks, as well as scientific and surveillance reports of increased hospital occupancy, flu cases and even mask purchases earlier that fall or winter, suggest that cases were occurring well before that in China. Earlier circulation of the virus in Wuhan and Hubei province, a major center of trade and business with Europe, would also explain why surveillance reports from Italy and elsewhere in Europe have also found evidence of SARS-CoV2 antibodies in populations dating as early as August or September. Horseshoe bats found in southwestern China’s Yunnan province carry the viruses most similar to SARS-CoV2 – they also were the subject of intense study at the Wuhan Instiute of Virology. “It is absolutely critical that the World Health Assembly mandate a comprehensive investigation into pandemic origins before the 2021 session closes on Monday,” Jamie Metzl, a senior fellow of the US Atlantic Council, told Health Policy Watch on Thursday. “If China should block that process, the only way forward will be for interested countries to work together to set up a parallel investigation process. We must not let China have a verto over whether or not we investigate the worst pandemic in a century which has unnecessarily killed so many millions of people. Metzl was one of the co-authors of a detailed open letter penned by an international group of scientists to the World Health Assembly in late April, urging WHO member states to seize the moment of the upcoming World Health Assembly to adopt a much tougher mandate, with more rigorous scientific measures, to get to the truth of whether the SARS-CoV2 virus first infected humans from a natural source, a wild animal market, or in a laboratory. US Mandates Major Investigation Perhaps out of frustration with Geneva’s inaction, Biden’s administration only this week ordered a major investigation of its own – ordering scientists and intelligence experts to explore with equal vigour the two main pathways by which the virus may have escaped – from a laboratory or via a more natural route. Tune in for a briefing with Principal Deputy Press Secretary Karine Jean-Pierre. https://t.co/omSyVeSo9S — The White House (@WhiteHouse) May 26, 2021 “”Today the president asked the intelligence community to redouble their efforts to collect and analyze information that could bring us closer to a definitive conclusion, and to report back to him in 90 days,” said Principal Deputy Press Secretary Karine Jean-Pierre, speaking at a White House briefing on Wednesday. “Back in early 2020, the President [then Donald Trump] called for the CDC to get access to China to learn about the virus, so we could fight it more effectively- getting to the bottom of the origin in this this pandemic will help us understand how to prepare for the next pandemic,” she added. “As we have done throughout our COVID response, we have been committed to a whole of government effort to ensure we’re doing everything to both understand and end this pandemic and to prevent future pandemics. “This is why the President is asking the US intelligence community, in cooperation with other elements of our government, to redouble efforts to collect and analyze information that can bring the world closer to a definitive conclusion on the origin of the virus and deliver a report to him again in 90 days. It will be another hole of government of effort, as I mentioned, including work by our national labs and other agencies.” With regards to the WHO-led investigation, which even WHO Director General Dr Tedros Adhanom Ghebreyesus had admitted was flawed, Jean-Pierre said: “Importantly, we will continue to pushing for a stronger, multilateral investigation into the origins of the virus in China, and we will continue to press China to participate in a full transparent, evidence based, international investigation with the needed access to get to the bottom of a virus that’s taken more than 3 million lives across the globe. And critically, to share information and lessons that will help us all prevent future pandemics. The White House statement marked the first time since Biden’s election that Washington has taken a direct lead on the thorny and geopolitically charged origins issue. Although Trump’s administration had also launched an investigation into the same questions – that earlier quest was laced, from the start, by the hyperbole and politics around Trump’s overall approach to China and the WHO, leading many to dismiss the lab escape hypothesis a conspiracy theory. However, in the intervening months, as the WHO investigation fumbled, while more shards of evidence emerged elsewhere about the problematic conditions in the Wuhan Virology Institute, its research into horseshoe bats that carry the same coronaviruses most similar to SARS-CoV2, and, most recently, reports that scientists in the virology lab may have fallen ill shortly before the COVID outbreak visibly began in Wuhan. That has led to concerns among more and more mainstream scientists about the holes and omissions around the narrative about the virus emergence – emerging from both China and the WHO-led investigative team. In addition, the speed and ease at which the virus became transmissible in humans, once it emerged, suggested to many that it may not have emerged from a natural, animal-borne route. Said former US Centers for Disease Control Director Robert Redfield, a respected virologist, in a recent CNN interview, I do not believe this somehow came from a bat to a human. Normally when a pathogen goes from a zoonotic source to a human, it takes a while for it to figure out how to become more and more efficient in humans, in human transmission. … so I just don’t think this makes biological sense. ” Image Credits: NIH/David Veesler, University of Washington. WHA Approves Resolution To Scale Up Services For Disabled People 27/05/2021 Disha Shetty Disability services should be incorporated into primary health care programmes at the community level, states a resolution adopted at the 74th WHA. A new resolution adopted on Thursday by the 74th World Health Assembly aims to scale up access to services and treatment for people living with disabilities – using a more “gender-sensitive and inclusive” approach. The resolution co-sponsored by Israel and Australia, calls upon member states to ensure that disability services are incorporated into primary health care programmes at the community level – and that conversely disabled people also have full access to health services. It also calls for special attention to be paid to the “unique vulnerabilities of those who may be living in care and congregated living settings in times of public health emergencies such as COVID-19, and for special protection against infections in particular for at-risk groups,” including more education for health care workers. And, the resolution calls upon WHO to etch out a global research agenda on disabilities, as well as to develop, by the end of 2022, a global report on disabilities, updating estimates on the numbers of disabled people worldwide, from a decade old World Report on Disability (2011). Countries Said Community-based Interventions Are Key Israeli diplomat Nitzan Arny speaks about the resolution on persons with disability led by Israel. One in seven persons worldwide experience some form of disability. The numbers are increasing due to factors such as ageing populations and widespread chronic health conditions. Many countries highlighted the roles community-based interventions can play in improving access – in reactions that warmly supported the initiative overall. The resolution broadly calls for collection of reliable data that allow for disaggregation by disability. It also advocates equal access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. Persons with disabilities face inequality in social, economic, health and political spheres and are more likely to live in poverty than those without disabilities. They are also more likely to have risk factors for noncommunicable diseases and less likely to have access to essential health services. “Nothing about us without us’ is not just a catchphrase. Meaningfully involving persons with disabilities in decision-making processes is a precondition for ensuring disability inclusion,” said Israel’s delegate to the WHA, Nitzan Arny, in presenting the initiative. Australia, the resolution’s co-sponsor said: “We recognize the importance of promoting disability inclusion in the health sector to ensure persons with a disability enjoy the highest sustainable highest attainable standard of health, including access to quality disability inclusive health services, information and education across their lifetimes.” Israel, Australia, the United States, European Union, Kenya, Botswana, the United Kingdom, Japan, Mexico and a dozen other countries co-sponsored the resolution. Today during #WHA74 the assembly adopted 🇮🇱 #Israel led resolution on persons living with #disabilities 🎥 pic.twitter.com/BootPAvNNr — Nitzan Arny 🎗 (@NitzanArny) May 27, 2021 Meanwhile, the resolution gives new impetus for action, particularly in light of the fact that WHO’s current Global Disability Action Plan 2014–2021 is set to expire this year. New Zealand, however, said it supports extending the Global Disability Action Plan because “This would demonstrate continued international commitment to this goal, and provide guidance for how this can be achieved.” New Zealand is committed to improve health outcomes for persons with disabilities, the country tells #WHA74 @WHO. It also supports extending WHO's Global Disability Action Plan. pic.twitter.com/l6etILNoyD — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 COVID’s Impacts on Persons With Disabilities The pandemic has harmed people with disabilities in various ways, yet few member states collect data that are disaggregated by disability. Women and girls living with disabilities face particular challenges. “Women, young women and girls who are disabled have a high risk of being marginalized and seriously discriminated against. That reduces their economic and social status, it increases the risk of sexual violence and sexist attitudes against and towards them and [of] limited access to justice,” Canada said. “These challenges have only increased during the COVID-19 pandemic, and disabled women and girls continue to fight for their rights for equality and for changes to the system.” The resolution highlighted the role of community health workers in advancing equitable access of persons with disabilities to safe, quality, accessible and inclusive health services. Stress on Community-Based Rehabilitation Among the stakeholders invited to collaborate under the resolution are organisations of persons with disabilities, private sector companies, scholars and teachers. “Community-based rehabilitation is a strategy to improve access to the services to persons living disabilities in middle-and low-income countries through the optimal use of local resources,” said Colombia. Speaking about the @WHO's Global Disability Action Plan, #Colombia says community based rehabilitation can improve access in low and middle income countries for persons with disability. pic.twitter.com/bC3rSk7t9J — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 Civil society organisations have welcomed the resolution. “We welcome that the resolution calls on governments to actively involve people living with disabilities in decision-making and programme design. This will ensure that health systems and responses to health emergencies can better deliver on the needs of the people most affected,” said Nina Renshaw of the NCD Alliance. “As we’ve seen in other fields of global health, such as HIV and TB, meaningful inclusion of lived experience is absolutely fundamental to catalyse overdue progress.” Image Credits: PicPedia. Africa CDC Warns COVID-19 Could Become Endemic; France Pledges Vaccine Support 27/05/2021 Paul Adepoju A Nigerian health workers receives his COVID-19 vaccine. With vaccine deliveries delayed by India’s decision to prioritise local vaccination over export requests, Africa’s leading disease control agency suggested COVID-19 could become endemic. John Nkengasong, director of Africa’s CDC, told reporters on Thursday that Africa needs to immunise population majorities quickly, but the vaccine delays make this unlikely. “With the rate of immunisation in Africa, we are lagging behind in the battle against the pandemic,” Nkengasong said. He asked the global community to consider vaccine access a collective security issue that needs to be addressed everywhere. “If we keep vaccinating at this pace, we are not going to achieve our target. And that will delay our ability to eliminate the virus from our population — and my greatest concern is that we may actually begin to move towards the endemicity of this virus,” he said. WHO Regional Director Echoes Concerns About Eradication At a separate briefing, Matshidiso Moeti, WHO Africa Regional Office director, also said Africa faces challenges that make it unlikely to eradicate the disease anytime soon. She said vaccine delays disproportionately affect African countries, and these point to further poor outcomes for the continent. Dr Matshidiso Moeti, WHO Africa Regional Office director, warned of slow pandemic progress. Moeti discussed WHO research saying Africa needs at least 20 million doses of the Oxford-AstraZeneca vaccine in the next six weeks in order to get second doses to all who received a first dose within the 8-12 week recommended interval between doses. Compared with 1.5 billion vaccine doses already administered globally, Africa has to date administered 28 million doses, or fewer than two per 100 people. “As supplies dry up, dose-sharing is an urgent, critical and short-term solution to ensuring that Africans at the greatest risk of COVID-19 get the much-needed protection,” said Moeti. “Africa needs vaccines now. Any pause in our vaccination campaigns will lead to lost lives and lost hope.” “We are expecting, not only in Africa, but globally, that this is a virus that we are going to live with in the future,” Moeti said in response to a question from Health Policy Watch. “ So instead of talking about quickly eradicating COVID-19, the main objective is to minimise severe illness and deaths from the virus”. She said Africa should continue to develop needed vaccines and therapeutics, and that African health systems must not be overwhelmed by the pandemic waves. She stressed the need for more vaccine access on the continent going into 2021 to “reach that level of vaccination that’s needed to enable African countries to open up and return to a more normal life”. While the threat of endemicity remains, Moeti said, public health stakeholders on the continent are anticipating and hoping very much that COVID-19 will not become endemic in Africa. France, Europe Pledge Support for Africa Vaccine Quest The French government meanwhile, announced a new, and larger, phase of vaccine dose sharing with African countries. Speaking at the WHO briefing briefing, Stéphanie Seydoux, French Ambassador for Global Health, Seydoux said that France would now share half a million doses with six African countries within weeks. France was the first developed country to volunteer to share COVID-19 vaccines from domestic supplies, donating over 31,000 doses to Mauritania, with another 74,400 set for imminent delivery. Stéphanie Seydoux, French Ambassador for Global Health Issues, said Africa should benefit from tools established to fight the pandemic. Seydoux noted that while Africa has largely been spared from the full brunt of the pandemic, the continent and all regions should benefit from tools established to fight COVID-19. She also noted France’s commitment to Africa’s vaccine manufacturing capacity. France also is committed to a European Union plan to provide 100 million COVID-19 vaccine doses for low-income countries by year’s end. The United States has similarly pledged to share 80 million doses with lower-income countries. Lesotho Explains How to Share “Half a Loaf” Lesotho was hoping to receive more than 130,000 COVID-19 vaccine doses through the COVAX facility. Instead, it received about 36,000 doses of Oxford-AstraZeneca vaccine on 3 March. Health Minister Semano Henry Sekatle said the country takes a “half loaf is better than none” approach in vaccination planning. Lesotho Health Minister Semano Henry Sekatle: “Those who have surplus should be kind enough to return the doses”. This approach allowed vaccination of 95% of health workers, he said. He then appealed to vaccine-rich countries to share with those in need: “Those who have surplus should be kind enough to return the doses. It is also quite important that all these countries that are producing these vaccines should seriously consider the liberalisation of the patents,” Sekatle said. Added Nkengasong,“Now [it is] critically urgent for countries sitting on excess doses to redistribute — and redistribute quickly, so that we can put vaccines in the arms of the people. And the people of Africa should understand that these vaccines are safe. He cautioned, however, that as Africa cannot expect to receive very large quantities of vaccines anytime soon, the continent needs to continue focusing on key preventive measures such as masks and social distancing, as well as careful surveillance of hot spots in new cases and improved treatment, including sufficient oxygen supplies to treat seriously ill patients. All of those measures can help prevent health systems from getting overwhelmed. At the same time, he noted that the public needs to do its part too: “By having safe vaccines, you’re ensuring that your neighbour is safe, your loved ones are safe. So I urge everyone that has access to getting vaccinated to quickly do so, so that we can continue to protect ourselves, and protect our loved ones.” WHO Calls For More Investment In Primary Health Care; ‘World Is Far Behind’ in Reaching Universal Health Coverage 27/05/2021 Chandre Prince WHO member states are lagging behing in achieving Universal Health Coverage by 2030, as outlined in the Sustainable Development Goals. While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring Universal Health Coverage (UHC). Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed. WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030. WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work. There, too, countries fall far short of the mark. Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports. “But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.” Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF. UHC is a Right, Not a Privilege US Health and Human Services Secretary Xavier Becerra said UHC is “a right and not a privilege”. US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010 – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization. Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said. “Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra. To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits. “We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.” UHC 2030 steering committee co-chair Justin Koonin UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”. For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers. “If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said. Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.” Somalia Calls for UHC ‘Roadmap’ Somalian Health and Human Services Minister Fawziya Abikar Nur While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”. She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians. Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said. COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame WHO DG Dr Tedros Ghebreyesus called on all member states to strengthen primary health care. Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months. “Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said. Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”. UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness. Image Credits: UNICEF. China Sidesteps COVAX Vaccine Donations; Africa Highlights Pandemic Fallout on Health Systems & Societies 27/05/2021 Paul Adepoju Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing. COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge. But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. “China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna. At #WHA74 #China calls for equitable distribution of vaccines and says it will continue to support it. #China said it would continue bilateral donations but refrained from any commitments to #COVAX. pic.twitter.com/5Lf7XYas6R — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. “The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. “However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms. Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.” Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs). “While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.” Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center. COVID – One Among Many Outbreaks Africa Faces Dr Matshidiso Moeti, WHO Regional Director for Africa. WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases. Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.” The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.” ‘Last Pandemic’ Report Approved The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats. See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind. Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.” “We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said. The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”. Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics. ‘Two-tiered World’ of Vaccinated and Unvaccinated Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand. As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. “Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states. “At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. Said Clark: “The return on investment would be enormous – both for people’s health and for economies.” Image Credits: Paul Adepoju , Paul Adepoju. Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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More Than Cables & Devices: Digital Health Event Points to Human Factors 28/05/2021 Svĕt Lustig Vijay In two decades of work on World Bank digital health initiatives, global health policy specialist Akiko Maeda found many fell short of their promises. She suggested these underperforming digital health initiatives focused too much on delivering hardware — but they failed to provide means to ensure stable electricity supplies, and similarly failed to provide adequate human resources to manage data, or to design initiatives that the most vulnerable groups could benefit from. Akiko Maeda, health economist with over 30 years of experience in international development in over 40 countries “It’s not just the infrastructure and the hardware, but how we design the software that goes with it,” Maeda said Thursday. She spoke at a World Health Assembly side event co-hosted by the Geneva Graduate Institute’s Global Health Centre, the Lancet & Financial Times Commission, and Digital Square, which is supported by USAID and the Bill and Melinda Gates Foundation. “Digital infrastructure is more than just a bunch of cables and devices,” said data literacy consultant Gulsen Guler, who is also co-chair of My Data Global, a civil advocacy group promoting equitable digital societies – adding that the stakes are high: “Digital technologies can determine what the future of a child will look like…or even more, they can determine between life and death.” Digital Health Saves Resources to Reach Universal Health Coverage Roger Kamba, Special Advisor to the Democratic Republic of the Congo (DRC), called digital technologies crucial in low-income countries. He said these tools can help countries reach universal health coverage and that digital health can help to meet Sustainable Development Goals. “Digital health is not an option, but rather a necessary step towards universal health coverage,” Kamba said. “I remain personally convinced that there can be no universal health coverage without a substantial contribution from digital health.” However, he said that for that to happen, governments must prioritize digital transformation through a multi-sectoral approach that goes beyond the health ministry. In 2019, the DRC adopted its digital technology strategic plan, Kamba said. Implemented by a newly-created ministry, the plan engages all sectors, including health. “All governments need to take a systems approach to digital transformation. It’s not just the health ministry that needs to be working on health care anymore.” An Epidemiological Nerve Centre – The Emergency Operations Centre Kamba said existing digital health initiatives, notably the nation’s Emergency Operations Centre (EOC), have proven useful in quickly containing infectious disease outbreaks like Ebola. Set up two years ago by PATH, USAID, and the Bill and Melinda Gates Foundation in collaboration with the DRC Centers for Disease Control, the EOC acts as the country’s epidemiological nerve centre to coordinate efforts to prevent, detect, and rapidly respond to public health emergencies. “The center uses tools such as digital mapping, Geographic Information System (GIS) mapping, and mobile health technologies to produce layers of information that help reveal patterns that enabled more effective interventions during the Ebola epidemic,” he said. “Actionable surveillance data and digital epidemic maps made the response faster and more focused, and was the first time that response data was digitized and centralized”. Recently the EOC expanded its scope to investigate regional and local malaria trends; it also facilitates disease control strategies using advanced data analyses. Kamba warned that digital health initiatives depend on reliable and affordable electricity, which can be a challenge in low-income countries: “We’re talking here about the potential of digital solutions to help us overcome long standing infrastructure challenges in sub-Saharan Africa … Investments in digital health in DRC must be coupled with energy solutions at the national level.” “These [digital] infrastructures are also faced with a fundamental financing gap,” said Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. “To really have sustainable financing that’s also reflected in the budgets of countries is a truly, truly big challenge.” Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. Digital Health in Burkina Faso Improves Care Quality Meanwhile in Burkina Faso, Swiss NGO Terre des Hommes (Tdh) has worked for over a decade with the Ministry of Health to develop Ieda – a digital job aid tool that enhances the clinical diagnosis of childhood diseases and improves health workers’ performance using artificial intelligence (AI) algorithms. Ieda already is available in 80% of health-care facilities in the country and has helped with a whopping 10 million digital consultations. This generates savings of US$1.6 million every year, Tdh health programmes research head Riccardo Lampariello said. “Digital health solutions at scale bring financial savings for the authorities, of course after the initial national investment, of $1.6 million every year. Hence the importance of investing in digital health.” Lampariello stressed that the bulk of digital health expenditure is not on infrastructure but on human resources required to build necessary technical and regulatory capacity. He noted that governments need to run local data centers, extract and analyze data, update software and fix data platforms when they crash. Riccardo Lampariello, head of Tdh’s health programmes “Digital health is human resource-intensive, and we should equally invest in infrastructure — which is not only tablets and solar power panels, it is also data centers, for example — and in human resources, including local authorities, including the government, the MOH, in technical skills … and also look to teach them the governance skills to regulate labor use.” Thanks to this already-existing digital health infrastructure, when the coronavirus hit it took only a few weeks for Burkina Faso’s Ministry of Health to deploy digital tools to support training, awareness-raising and triage, and to reach vulnerable groups in remote and unsafe areas, Lampariello said. But he warned that the digital health landscape is still fragmented in low-income countries, challenged by duplication, a lack of interoperability and waste of precious devices and electricity. “Even before COVID, it wasn’t rare to pay a visit to a health-care facility in a very poor country, open a cupboard and find two or three tablets or smartphones [for] dealing with different platforms and databases. In a context of limited resources, this represents a lot of wasted tools,” Lampariello said. “And not to mention, for example, the additional unnecessary e-waste and energy consumption related to that.” Speakers Ask For Well-Designed & Equitable Digital Health Initiatives Digital health initiatives are likely to be more impactful if they designed to be equitable, added panelists on Thursday. In Japan, for example, vaccine uptake in older age groups was hampered by the country’s response plan failing to consider that booking vaccine appointments online can be a struggle for older people. “It’s a design issue, and it’s not a complex issue, but it was not adequately designed for the elderly, so there’s a huge problem going on right now in Japan,” said Maeda. Ann Aerts, Head, Novartis Foundation “Every solution, digital- or AI-driven, has to be human-centered,” said Novartis Foundation head Ann Aerts. “And that’s quite obvious, although it’s not always the case. The best way is to use a human-centered design with input from the people who will have to use a solution, and by thinking up-front how the solution will be integrated in the processes of the health workforce, or the workflow.” According to a World Bank study, successful digital health initiatives tend to share characteristics like strong leadership and regulatory systems, substantial financial commitments to digitize health systems, and national frameworks to facilitate data flows between systems, added Aerts. Washington Call to ‘Redouble Efforts’ on SARS-CoV2 Virus Origins Investigation – But Will There be Action at WHA? 27/05/2021 Elaine Ruth Fletcher White House Deputy Press Secretary Karine Jean-Pierre discusses President Joe Biden’s order to the US intelligence community to take a fresh look at the origins of SARS-CoV2 with answers in 90 days. Amidst fresh calls from US President Joe Biden ordering the science and intelligence community to come up with a more detailed account of how the SARS-CoV2 virus emerged – it’s unclear how much action the World Health Assembly will really see on the issue. Language in the the final-agreed draft of a WHA resolution, Strengthening WHO preparedness and response to health emergencies, appears to have been muted to assuage objections by China and other allies- with the removal of any explicit reference to an “investigation” of the virus origins from the text. The reference to “investigation” of the virus origins had been included in an earlier, 20 April version of the text seen by Health Policy Watch, although it was presented there as a phrase that was still up for debate. Countries’ Adherence to ‘National’ as well as ‘International laws’ The resolution, set to be debated on Saturday, also has watered-down language about countries’ obligations to adhere to provisions of the WHO’s international health regulations that mandate transparency and rapid action on emerging pathogens – adding the term, “taking into account national”… as well as international, laws. That loophole, which can checkmate international mandates, has been another big concern for critics of the investigation so far. That, in light of the fact that China has alerady held back on providing valuable data from national blood banks that could have revealed when the virus really began to spread – saying that it would violate national privacy laws. So far, the earliest cases that China acknowledges formally date from December 2019 – although a series of US intelligence leaks, as well as scientific and surveillance reports of increased hospital occupancy, flu cases and even mask purchases earlier that fall or winter, suggest that cases were occurring well before that in China. Earlier circulation of the virus in Wuhan and Hubei province, a major center of trade and business with Europe, would also explain why surveillance reports from Italy and elsewhere in Europe have also found evidence of SARS-CoV2 antibodies in populations dating as early as August or September. Horseshoe bats found in southwestern China’s Yunnan province carry the viruses most similar to SARS-CoV2 – they also were the subject of intense study at the Wuhan Instiute of Virology. “It is absolutely critical that the World Health Assembly mandate a comprehensive investigation into pandemic origins before the 2021 session closes on Monday,” Jamie Metzl, a senior fellow of the US Atlantic Council, told Health Policy Watch on Thursday. “If China should block that process, the only way forward will be for interested countries to work together to set up a parallel investigation process. We must not let China have a verto over whether or not we investigate the worst pandemic in a century which has unnecessarily killed so many millions of people. Metzl was one of the co-authors of a detailed open letter penned by an international group of scientists to the World Health Assembly in late April, urging WHO member states to seize the moment of the upcoming World Health Assembly to adopt a much tougher mandate, with more rigorous scientific measures, to get to the truth of whether the SARS-CoV2 virus first infected humans from a natural source, a wild animal market, or in a laboratory. US Mandates Major Investigation Perhaps out of frustration with Geneva’s inaction, Biden’s administration only this week ordered a major investigation of its own – ordering scientists and intelligence experts to explore with equal vigour the two main pathways by which the virus may have escaped – from a laboratory or via a more natural route. Tune in for a briefing with Principal Deputy Press Secretary Karine Jean-Pierre. https://t.co/omSyVeSo9S — The White House (@WhiteHouse) May 26, 2021 “”Today the president asked the intelligence community to redouble their efforts to collect and analyze information that could bring us closer to a definitive conclusion, and to report back to him in 90 days,” said Principal Deputy Press Secretary Karine Jean-Pierre, speaking at a White House briefing on Wednesday. “Back in early 2020, the President [then Donald Trump] called for the CDC to get access to China to learn about the virus, so we could fight it more effectively- getting to the bottom of the origin in this this pandemic will help us understand how to prepare for the next pandemic,” she added. “As we have done throughout our COVID response, we have been committed to a whole of government effort to ensure we’re doing everything to both understand and end this pandemic and to prevent future pandemics. “This is why the President is asking the US intelligence community, in cooperation with other elements of our government, to redouble efforts to collect and analyze information that can bring the world closer to a definitive conclusion on the origin of the virus and deliver a report to him again in 90 days. It will be another hole of government of effort, as I mentioned, including work by our national labs and other agencies.” With regards to the WHO-led investigation, which even WHO Director General Dr Tedros Adhanom Ghebreyesus had admitted was flawed, Jean-Pierre said: “Importantly, we will continue to pushing for a stronger, multilateral investigation into the origins of the virus in China, and we will continue to press China to participate in a full transparent, evidence based, international investigation with the needed access to get to the bottom of a virus that’s taken more than 3 million lives across the globe. And critically, to share information and lessons that will help us all prevent future pandemics. The White House statement marked the first time since Biden’s election that Washington has taken a direct lead on the thorny and geopolitically charged origins issue. Although Trump’s administration had also launched an investigation into the same questions – that earlier quest was laced, from the start, by the hyperbole and politics around Trump’s overall approach to China and the WHO, leading many to dismiss the lab escape hypothesis a conspiracy theory. However, in the intervening months, as the WHO investigation fumbled, while more shards of evidence emerged elsewhere about the problematic conditions in the Wuhan Virology Institute, its research into horseshoe bats that carry the same coronaviruses most similar to SARS-CoV2, and, most recently, reports that scientists in the virology lab may have fallen ill shortly before the COVID outbreak visibly began in Wuhan. That has led to concerns among more and more mainstream scientists about the holes and omissions around the narrative about the virus emergence – emerging from both China and the WHO-led investigative team. In addition, the speed and ease at which the virus became transmissible in humans, once it emerged, suggested to many that it may not have emerged from a natural, animal-borne route. Said former US Centers for Disease Control Director Robert Redfield, a respected virologist, in a recent CNN interview, I do not believe this somehow came from a bat to a human. Normally when a pathogen goes from a zoonotic source to a human, it takes a while for it to figure out how to become more and more efficient in humans, in human transmission. … so I just don’t think this makes biological sense. ” Image Credits: NIH/David Veesler, University of Washington. WHA Approves Resolution To Scale Up Services For Disabled People 27/05/2021 Disha Shetty Disability services should be incorporated into primary health care programmes at the community level, states a resolution adopted at the 74th WHA. A new resolution adopted on Thursday by the 74th World Health Assembly aims to scale up access to services and treatment for people living with disabilities – using a more “gender-sensitive and inclusive” approach. The resolution co-sponsored by Israel and Australia, calls upon member states to ensure that disability services are incorporated into primary health care programmes at the community level – and that conversely disabled people also have full access to health services. It also calls for special attention to be paid to the “unique vulnerabilities of those who may be living in care and congregated living settings in times of public health emergencies such as COVID-19, and for special protection against infections in particular for at-risk groups,” including more education for health care workers. And, the resolution calls upon WHO to etch out a global research agenda on disabilities, as well as to develop, by the end of 2022, a global report on disabilities, updating estimates on the numbers of disabled people worldwide, from a decade old World Report on Disability (2011). Countries Said Community-based Interventions Are Key Israeli diplomat Nitzan Arny speaks about the resolution on persons with disability led by Israel. One in seven persons worldwide experience some form of disability. The numbers are increasing due to factors such as ageing populations and widespread chronic health conditions. Many countries highlighted the roles community-based interventions can play in improving access – in reactions that warmly supported the initiative overall. The resolution broadly calls for collection of reliable data that allow for disaggregation by disability. It also advocates equal access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. Persons with disabilities face inequality in social, economic, health and political spheres and are more likely to live in poverty than those without disabilities. They are also more likely to have risk factors for noncommunicable diseases and less likely to have access to essential health services. “Nothing about us without us’ is not just a catchphrase. Meaningfully involving persons with disabilities in decision-making processes is a precondition for ensuring disability inclusion,” said Israel’s delegate to the WHA, Nitzan Arny, in presenting the initiative. Australia, the resolution’s co-sponsor said: “We recognize the importance of promoting disability inclusion in the health sector to ensure persons with a disability enjoy the highest sustainable highest attainable standard of health, including access to quality disability inclusive health services, information and education across their lifetimes.” Israel, Australia, the United States, European Union, Kenya, Botswana, the United Kingdom, Japan, Mexico and a dozen other countries co-sponsored the resolution. Today during #WHA74 the assembly adopted 🇮🇱 #Israel led resolution on persons living with #disabilities 🎥 pic.twitter.com/BootPAvNNr — Nitzan Arny 🎗 (@NitzanArny) May 27, 2021 Meanwhile, the resolution gives new impetus for action, particularly in light of the fact that WHO’s current Global Disability Action Plan 2014–2021 is set to expire this year. New Zealand, however, said it supports extending the Global Disability Action Plan because “This would demonstrate continued international commitment to this goal, and provide guidance for how this can be achieved.” New Zealand is committed to improve health outcomes for persons with disabilities, the country tells #WHA74 @WHO. It also supports extending WHO's Global Disability Action Plan. pic.twitter.com/l6etILNoyD — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 COVID’s Impacts on Persons With Disabilities The pandemic has harmed people with disabilities in various ways, yet few member states collect data that are disaggregated by disability. Women and girls living with disabilities face particular challenges. “Women, young women and girls who are disabled have a high risk of being marginalized and seriously discriminated against. That reduces their economic and social status, it increases the risk of sexual violence and sexist attitudes against and towards them and [of] limited access to justice,” Canada said. “These challenges have only increased during the COVID-19 pandemic, and disabled women and girls continue to fight for their rights for equality and for changes to the system.” The resolution highlighted the role of community health workers in advancing equitable access of persons with disabilities to safe, quality, accessible and inclusive health services. Stress on Community-Based Rehabilitation Among the stakeholders invited to collaborate under the resolution are organisations of persons with disabilities, private sector companies, scholars and teachers. “Community-based rehabilitation is a strategy to improve access to the services to persons living disabilities in middle-and low-income countries through the optimal use of local resources,” said Colombia. Speaking about the @WHO's Global Disability Action Plan, #Colombia says community based rehabilitation can improve access in low and middle income countries for persons with disability. pic.twitter.com/bC3rSk7t9J — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 Civil society organisations have welcomed the resolution. “We welcome that the resolution calls on governments to actively involve people living with disabilities in decision-making and programme design. This will ensure that health systems and responses to health emergencies can better deliver on the needs of the people most affected,” said Nina Renshaw of the NCD Alliance. “As we’ve seen in other fields of global health, such as HIV and TB, meaningful inclusion of lived experience is absolutely fundamental to catalyse overdue progress.” Image Credits: PicPedia. Africa CDC Warns COVID-19 Could Become Endemic; France Pledges Vaccine Support 27/05/2021 Paul Adepoju A Nigerian health workers receives his COVID-19 vaccine. With vaccine deliveries delayed by India’s decision to prioritise local vaccination over export requests, Africa’s leading disease control agency suggested COVID-19 could become endemic. John Nkengasong, director of Africa’s CDC, told reporters on Thursday that Africa needs to immunise population majorities quickly, but the vaccine delays make this unlikely. “With the rate of immunisation in Africa, we are lagging behind in the battle against the pandemic,” Nkengasong said. He asked the global community to consider vaccine access a collective security issue that needs to be addressed everywhere. “If we keep vaccinating at this pace, we are not going to achieve our target. And that will delay our ability to eliminate the virus from our population — and my greatest concern is that we may actually begin to move towards the endemicity of this virus,” he said. WHO Regional Director Echoes Concerns About Eradication At a separate briefing, Matshidiso Moeti, WHO Africa Regional Office director, also said Africa faces challenges that make it unlikely to eradicate the disease anytime soon. She said vaccine delays disproportionately affect African countries, and these point to further poor outcomes for the continent. Dr Matshidiso Moeti, WHO Africa Regional Office director, warned of slow pandemic progress. Moeti discussed WHO research saying Africa needs at least 20 million doses of the Oxford-AstraZeneca vaccine in the next six weeks in order to get second doses to all who received a first dose within the 8-12 week recommended interval between doses. Compared with 1.5 billion vaccine doses already administered globally, Africa has to date administered 28 million doses, or fewer than two per 100 people. “As supplies dry up, dose-sharing is an urgent, critical and short-term solution to ensuring that Africans at the greatest risk of COVID-19 get the much-needed protection,” said Moeti. “Africa needs vaccines now. Any pause in our vaccination campaigns will lead to lost lives and lost hope.” “We are expecting, not only in Africa, but globally, that this is a virus that we are going to live with in the future,” Moeti said in response to a question from Health Policy Watch. “ So instead of talking about quickly eradicating COVID-19, the main objective is to minimise severe illness and deaths from the virus”. She said Africa should continue to develop needed vaccines and therapeutics, and that African health systems must not be overwhelmed by the pandemic waves. She stressed the need for more vaccine access on the continent going into 2021 to “reach that level of vaccination that’s needed to enable African countries to open up and return to a more normal life”. While the threat of endemicity remains, Moeti said, public health stakeholders on the continent are anticipating and hoping very much that COVID-19 will not become endemic in Africa. France, Europe Pledge Support for Africa Vaccine Quest The French government meanwhile, announced a new, and larger, phase of vaccine dose sharing with African countries. Speaking at the WHO briefing briefing, Stéphanie Seydoux, French Ambassador for Global Health, Seydoux said that France would now share half a million doses with six African countries within weeks. France was the first developed country to volunteer to share COVID-19 vaccines from domestic supplies, donating over 31,000 doses to Mauritania, with another 74,400 set for imminent delivery. Stéphanie Seydoux, French Ambassador for Global Health Issues, said Africa should benefit from tools established to fight the pandemic. Seydoux noted that while Africa has largely been spared from the full brunt of the pandemic, the continent and all regions should benefit from tools established to fight COVID-19. She also noted France’s commitment to Africa’s vaccine manufacturing capacity. France also is committed to a European Union plan to provide 100 million COVID-19 vaccine doses for low-income countries by year’s end. The United States has similarly pledged to share 80 million doses with lower-income countries. Lesotho Explains How to Share “Half a Loaf” Lesotho was hoping to receive more than 130,000 COVID-19 vaccine doses through the COVAX facility. Instead, it received about 36,000 doses of Oxford-AstraZeneca vaccine on 3 March. Health Minister Semano Henry Sekatle said the country takes a “half loaf is better than none” approach in vaccination planning. Lesotho Health Minister Semano Henry Sekatle: “Those who have surplus should be kind enough to return the doses”. This approach allowed vaccination of 95% of health workers, he said. He then appealed to vaccine-rich countries to share with those in need: “Those who have surplus should be kind enough to return the doses. It is also quite important that all these countries that are producing these vaccines should seriously consider the liberalisation of the patents,” Sekatle said. Added Nkengasong,“Now [it is] critically urgent for countries sitting on excess doses to redistribute — and redistribute quickly, so that we can put vaccines in the arms of the people. And the people of Africa should understand that these vaccines are safe. He cautioned, however, that as Africa cannot expect to receive very large quantities of vaccines anytime soon, the continent needs to continue focusing on key preventive measures such as masks and social distancing, as well as careful surveillance of hot spots in new cases and improved treatment, including sufficient oxygen supplies to treat seriously ill patients. All of those measures can help prevent health systems from getting overwhelmed. At the same time, he noted that the public needs to do its part too: “By having safe vaccines, you’re ensuring that your neighbour is safe, your loved ones are safe. So I urge everyone that has access to getting vaccinated to quickly do so, so that we can continue to protect ourselves, and protect our loved ones.” WHO Calls For More Investment In Primary Health Care; ‘World Is Far Behind’ in Reaching Universal Health Coverage 27/05/2021 Chandre Prince WHO member states are lagging behing in achieving Universal Health Coverage by 2030, as outlined in the Sustainable Development Goals. While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring Universal Health Coverage (UHC). Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed. WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030. WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work. There, too, countries fall far short of the mark. Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports. “But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.” Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF. UHC is a Right, Not a Privilege US Health and Human Services Secretary Xavier Becerra said UHC is “a right and not a privilege”. US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010 – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization. Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said. “Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra. To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits. “We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.” UHC 2030 steering committee co-chair Justin Koonin UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”. For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers. “If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said. Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.” Somalia Calls for UHC ‘Roadmap’ Somalian Health and Human Services Minister Fawziya Abikar Nur While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”. She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians. Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said. COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame WHO DG Dr Tedros Ghebreyesus called on all member states to strengthen primary health care. Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months. “Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said. Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”. UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness. Image Credits: UNICEF. China Sidesteps COVAX Vaccine Donations; Africa Highlights Pandemic Fallout on Health Systems & Societies 27/05/2021 Paul Adepoju Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing. COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge. But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. “China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna. At #WHA74 #China calls for equitable distribution of vaccines and says it will continue to support it. #China said it would continue bilateral donations but refrained from any commitments to #COVAX. pic.twitter.com/5Lf7XYas6R — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. “The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. “However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms. Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.” Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs). “While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.” Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center. COVID – One Among Many Outbreaks Africa Faces Dr Matshidiso Moeti, WHO Regional Director for Africa. WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases. Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.” The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.” ‘Last Pandemic’ Report Approved The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats. See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind. Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.” “We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said. The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”. Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics. ‘Two-tiered World’ of Vaccinated and Unvaccinated Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand. As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. “Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states. “At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. Said Clark: “The return on investment would be enormous – both for people’s health and for economies.” Image Credits: Paul Adepoju , Paul Adepoju. Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Washington Call to ‘Redouble Efforts’ on SARS-CoV2 Virus Origins Investigation – But Will There be Action at WHA? 27/05/2021 Elaine Ruth Fletcher White House Deputy Press Secretary Karine Jean-Pierre discusses President Joe Biden’s order to the US intelligence community to take a fresh look at the origins of SARS-CoV2 with answers in 90 days. Amidst fresh calls from US President Joe Biden ordering the science and intelligence community to come up with a more detailed account of how the SARS-CoV2 virus emerged – it’s unclear how much action the World Health Assembly will really see on the issue. Language in the the final-agreed draft of a WHA resolution, Strengthening WHO preparedness and response to health emergencies, appears to have been muted to assuage objections by China and other allies- with the removal of any explicit reference to an “investigation” of the virus origins from the text. The reference to “investigation” of the virus origins had been included in an earlier, 20 April version of the text seen by Health Policy Watch, although it was presented there as a phrase that was still up for debate. Countries’ Adherence to ‘National’ as well as ‘International laws’ The resolution, set to be debated on Saturday, also has watered-down language about countries’ obligations to adhere to provisions of the WHO’s international health regulations that mandate transparency and rapid action on emerging pathogens – adding the term, “taking into account national”… as well as international, laws. That loophole, which can checkmate international mandates, has been another big concern for critics of the investigation so far. That, in light of the fact that China has alerady held back on providing valuable data from national blood banks that could have revealed when the virus really began to spread – saying that it would violate national privacy laws. So far, the earliest cases that China acknowledges formally date from December 2019 – although a series of US intelligence leaks, as well as scientific and surveillance reports of increased hospital occupancy, flu cases and even mask purchases earlier that fall or winter, suggest that cases were occurring well before that in China. Earlier circulation of the virus in Wuhan and Hubei province, a major center of trade and business with Europe, would also explain why surveillance reports from Italy and elsewhere in Europe have also found evidence of SARS-CoV2 antibodies in populations dating as early as August or September. Horseshoe bats found in southwestern China’s Yunnan province carry the viruses most similar to SARS-CoV2 – they also were the subject of intense study at the Wuhan Instiute of Virology. “It is absolutely critical that the World Health Assembly mandate a comprehensive investigation into pandemic origins before the 2021 session closes on Monday,” Jamie Metzl, a senior fellow of the US Atlantic Council, told Health Policy Watch on Thursday. “If China should block that process, the only way forward will be for interested countries to work together to set up a parallel investigation process. We must not let China have a verto over whether or not we investigate the worst pandemic in a century which has unnecessarily killed so many millions of people. Metzl was one of the co-authors of a detailed open letter penned by an international group of scientists to the World Health Assembly in late April, urging WHO member states to seize the moment of the upcoming World Health Assembly to adopt a much tougher mandate, with more rigorous scientific measures, to get to the truth of whether the SARS-CoV2 virus first infected humans from a natural source, a wild animal market, or in a laboratory. US Mandates Major Investigation Perhaps out of frustration with Geneva’s inaction, Biden’s administration only this week ordered a major investigation of its own – ordering scientists and intelligence experts to explore with equal vigour the two main pathways by which the virus may have escaped – from a laboratory or via a more natural route. Tune in for a briefing with Principal Deputy Press Secretary Karine Jean-Pierre. https://t.co/omSyVeSo9S — The White House (@WhiteHouse) May 26, 2021 “”Today the president asked the intelligence community to redouble their efforts to collect and analyze information that could bring us closer to a definitive conclusion, and to report back to him in 90 days,” said Principal Deputy Press Secretary Karine Jean-Pierre, speaking at a White House briefing on Wednesday. “Back in early 2020, the President [then Donald Trump] called for the CDC to get access to China to learn about the virus, so we could fight it more effectively- getting to the bottom of the origin in this this pandemic will help us understand how to prepare for the next pandemic,” she added. “As we have done throughout our COVID response, we have been committed to a whole of government effort to ensure we’re doing everything to both understand and end this pandemic and to prevent future pandemics. “This is why the President is asking the US intelligence community, in cooperation with other elements of our government, to redouble efforts to collect and analyze information that can bring the world closer to a definitive conclusion on the origin of the virus and deliver a report to him again in 90 days. It will be another hole of government of effort, as I mentioned, including work by our national labs and other agencies.” With regards to the WHO-led investigation, which even WHO Director General Dr Tedros Adhanom Ghebreyesus had admitted was flawed, Jean-Pierre said: “Importantly, we will continue to pushing for a stronger, multilateral investigation into the origins of the virus in China, and we will continue to press China to participate in a full transparent, evidence based, international investigation with the needed access to get to the bottom of a virus that’s taken more than 3 million lives across the globe. And critically, to share information and lessons that will help us all prevent future pandemics. The White House statement marked the first time since Biden’s election that Washington has taken a direct lead on the thorny and geopolitically charged origins issue. Although Trump’s administration had also launched an investigation into the same questions – that earlier quest was laced, from the start, by the hyperbole and politics around Trump’s overall approach to China and the WHO, leading many to dismiss the lab escape hypothesis a conspiracy theory. However, in the intervening months, as the WHO investigation fumbled, while more shards of evidence emerged elsewhere about the problematic conditions in the Wuhan Virology Institute, its research into horseshoe bats that carry the same coronaviruses most similar to SARS-CoV2, and, most recently, reports that scientists in the virology lab may have fallen ill shortly before the COVID outbreak visibly began in Wuhan. That has led to concerns among more and more mainstream scientists about the holes and omissions around the narrative about the virus emergence – emerging from both China and the WHO-led investigative team. In addition, the speed and ease at which the virus became transmissible in humans, once it emerged, suggested to many that it may not have emerged from a natural, animal-borne route. Said former US Centers for Disease Control Director Robert Redfield, a respected virologist, in a recent CNN interview, I do not believe this somehow came from a bat to a human. Normally when a pathogen goes from a zoonotic source to a human, it takes a while for it to figure out how to become more and more efficient in humans, in human transmission. … so I just don’t think this makes biological sense. ” Image Credits: NIH/David Veesler, University of Washington. WHA Approves Resolution To Scale Up Services For Disabled People 27/05/2021 Disha Shetty Disability services should be incorporated into primary health care programmes at the community level, states a resolution adopted at the 74th WHA. A new resolution adopted on Thursday by the 74th World Health Assembly aims to scale up access to services and treatment for people living with disabilities – using a more “gender-sensitive and inclusive” approach. The resolution co-sponsored by Israel and Australia, calls upon member states to ensure that disability services are incorporated into primary health care programmes at the community level – and that conversely disabled people also have full access to health services. It also calls for special attention to be paid to the “unique vulnerabilities of those who may be living in care and congregated living settings in times of public health emergencies such as COVID-19, and for special protection against infections in particular for at-risk groups,” including more education for health care workers. And, the resolution calls upon WHO to etch out a global research agenda on disabilities, as well as to develop, by the end of 2022, a global report on disabilities, updating estimates on the numbers of disabled people worldwide, from a decade old World Report on Disability (2011). Countries Said Community-based Interventions Are Key Israeli diplomat Nitzan Arny speaks about the resolution on persons with disability led by Israel. One in seven persons worldwide experience some form of disability. The numbers are increasing due to factors such as ageing populations and widespread chronic health conditions. Many countries highlighted the roles community-based interventions can play in improving access – in reactions that warmly supported the initiative overall. The resolution broadly calls for collection of reliable data that allow for disaggregation by disability. It also advocates equal access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. Persons with disabilities face inequality in social, economic, health and political spheres and are more likely to live in poverty than those without disabilities. They are also more likely to have risk factors for noncommunicable diseases and less likely to have access to essential health services. “Nothing about us without us’ is not just a catchphrase. Meaningfully involving persons with disabilities in decision-making processes is a precondition for ensuring disability inclusion,” said Israel’s delegate to the WHA, Nitzan Arny, in presenting the initiative. Australia, the resolution’s co-sponsor said: “We recognize the importance of promoting disability inclusion in the health sector to ensure persons with a disability enjoy the highest sustainable highest attainable standard of health, including access to quality disability inclusive health services, information and education across their lifetimes.” Israel, Australia, the United States, European Union, Kenya, Botswana, the United Kingdom, Japan, Mexico and a dozen other countries co-sponsored the resolution. Today during #WHA74 the assembly adopted 🇮🇱 #Israel led resolution on persons living with #disabilities 🎥 pic.twitter.com/BootPAvNNr — Nitzan Arny 🎗 (@NitzanArny) May 27, 2021 Meanwhile, the resolution gives new impetus for action, particularly in light of the fact that WHO’s current Global Disability Action Plan 2014–2021 is set to expire this year. New Zealand, however, said it supports extending the Global Disability Action Plan because “This would demonstrate continued international commitment to this goal, and provide guidance for how this can be achieved.” New Zealand is committed to improve health outcomes for persons with disabilities, the country tells #WHA74 @WHO. It also supports extending WHO's Global Disability Action Plan. pic.twitter.com/l6etILNoyD — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 COVID’s Impacts on Persons With Disabilities The pandemic has harmed people with disabilities in various ways, yet few member states collect data that are disaggregated by disability. Women and girls living with disabilities face particular challenges. “Women, young women and girls who are disabled have a high risk of being marginalized and seriously discriminated against. That reduces their economic and social status, it increases the risk of sexual violence and sexist attitudes against and towards them and [of] limited access to justice,” Canada said. “These challenges have only increased during the COVID-19 pandemic, and disabled women and girls continue to fight for their rights for equality and for changes to the system.” The resolution highlighted the role of community health workers in advancing equitable access of persons with disabilities to safe, quality, accessible and inclusive health services. Stress on Community-Based Rehabilitation Among the stakeholders invited to collaborate under the resolution are organisations of persons with disabilities, private sector companies, scholars and teachers. “Community-based rehabilitation is a strategy to improve access to the services to persons living disabilities in middle-and low-income countries through the optimal use of local resources,” said Colombia. Speaking about the @WHO's Global Disability Action Plan, #Colombia says community based rehabilitation can improve access in low and middle income countries for persons with disability. pic.twitter.com/bC3rSk7t9J — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 Civil society organisations have welcomed the resolution. “We welcome that the resolution calls on governments to actively involve people living with disabilities in decision-making and programme design. This will ensure that health systems and responses to health emergencies can better deliver on the needs of the people most affected,” said Nina Renshaw of the NCD Alliance. “As we’ve seen in other fields of global health, such as HIV and TB, meaningful inclusion of lived experience is absolutely fundamental to catalyse overdue progress.” Image Credits: PicPedia. Africa CDC Warns COVID-19 Could Become Endemic; France Pledges Vaccine Support 27/05/2021 Paul Adepoju A Nigerian health workers receives his COVID-19 vaccine. With vaccine deliveries delayed by India’s decision to prioritise local vaccination over export requests, Africa’s leading disease control agency suggested COVID-19 could become endemic. John Nkengasong, director of Africa’s CDC, told reporters on Thursday that Africa needs to immunise population majorities quickly, but the vaccine delays make this unlikely. “With the rate of immunisation in Africa, we are lagging behind in the battle against the pandemic,” Nkengasong said. He asked the global community to consider vaccine access a collective security issue that needs to be addressed everywhere. “If we keep vaccinating at this pace, we are not going to achieve our target. And that will delay our ability to eliminate the virus from our population — and my greatest concern is that we may actually begin to move towards the endemicity of this virus,” he said. WHO Regional Director Echoes Concerns About Eradication At a separate briefing, Matshidiso Moeti, WHO Africa Regional Office director, also said Africa faces challenges that make it unlikely to eradicate the disease anytime soon. She said vaccine delays disproportionately affect African countries, and these point to further poor outcomes for the continent. Dr Matshidiso Moeti, WHO Africa Regional Office director, warned of slow pandemic progress. Moeti discussed WHO research saying Africa needs at least 20 million doses of the Oxford-AstraZeneca vaccine in the next six weeks in order to get second doses to all who received a first dose within the 8-12 week recommended interval between doses. Compared with 1.5 billion vaccine doses already administered globally, Africa has to date administered 28 million doses, or fewer than two per 100 people. “As supplies dry up, dose-sharing is an urgent, critical and short-term solution to ensuring that Africans at the greatest risk of COVID-19 get the much-needed protection,” said Moeti. “Africa needs vaccines now. Any pause in our vaccination campaigns will lead to lost lives and lost hope.” “We are expecting, not only in Africa, but globally, that this is a virus that we are going to live with in the future,” Moeti said in response to a question from Health Policy Watch. “ So instead of talking about quickly eradicating COVID-19, the main objective is to minimise severe illness and deaths from the virus”. She said Africa should continue to develop needed vaccines and therapeutics, and that African health systems must not be overwhelmed by the pandemic waves. She stressed the need for more vaccine access on the continent going into 2021 to “reach that level of vaccination that’s needed to enable African countries to open up and return to a more normal life”. While the threat of endemicity remains, Moeti said, public health stakeholders on the continent are anticipating and hoping very much that COVID-19 will not become endemic in Africa. France, Europe Pledge Support for Africa Vaccine Quest The French government meanwhile, announced a new, and larger, phase of vaccine dose sharing with African countries. Speaking at the WHO briefing briefing, Stéphanie Seydoux, French Ambassador for Global Health, Seydoux said that France would now share half a million doses with six African countries within weeks. France was the first developed country to volunteer to share COVID-19 vaccines from domestic supplies, donating over 31,000 doses to Mauritania, with another 74,400 set for imminent delivery. Stéphanie Seydoux, French Ambassador for Global Health Issues, said Africa should benefit from tools established to fight the pandemic. Seydoux noted that while Africa has largely been spared from the full brunt of the pandemic, the continent and all regions should benefit from tools established to fight COVID-19. She also noted France’s commitment to Africa’s vaccine manufacturing capacity. France also is committed to a European Union plan to provide 100 million COVID-19 vaccine doses for low-income countries by year’s end. The United States has similarly pledged to share 80 million doses with lower-income countries. Lesotho Explains How to Share “Half a Loaf” Lesotho was hoping to receive more than 130,000 COVID-19 vaccine doses through the COVAX facility. Instead, it received about 36,000 doses of Oxford-AstraZeneca vaccine on 3 March. Health Minister Semano Henry Sekatle said the country takes a “half loaf is better than none” approach in vaccination planning. Lesotho Health Minister Semano Henry Sekatle: “Those who have surplus should be kind enough to return the doses”. This approach allowed vaccination of 95% of health workers, he said. He then appealed to vaccine-rich countries to share with those in need: “Those who have surplus should be kind enough to return the doses. It is also quite important that all these countries that are producing these vaccines should seriously consider the liberalisation of the patents,” Sekatle said. Added Nkengasong,“Now [it is] critically urgent for countries sitting on excess doses to redistribute — and redistribute quickly, so that we can put vaccines in the arms of the people. And the people of Africa should understand that these vaccines are safe. He cautioned, however, that as Africa cannot expect to receive very large quantities of vaccines anytime soon, the continent needs to continue focusing on key preventive measures such as masks and social distancing, as well as careful surveillance of hot spots in new cases and improved treatment, including sufficient oxygen supplies to treat seriously ill patients. All of those measures can help prevent health systems from getting overwhelmed. At the same time, he noted that the public needs to do its part too: “By having safe vaccines, you’re ensuring that your neighbour is safe, your loved ones are safe. So I urge everyone that has access to getting vaccinated to quickly do so, so that we can continue to protect ourselves, and protect our loved ones.” WHO Calls For More Investment In Primary Health Care; ‘World Is Far Behind’ in Reaching Universal Health Coverage 27/05/2021 Chandre Prince WHO member states are lagging behing in achieving Universal Health Coverage by 2030, as outlined in the Sustainable Development Goals. While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring Universal Health Coverage (UHC). Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed. WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030. WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work. There, too, countries fall far short of the mark. Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports. “But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.” Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF. UHC is a Right, Not a Privilege US Health and Human Services Secretary Xavier Becerra said UHC is “a right and not a privilege”. US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010 – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization. Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said. “Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra. To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits. “We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.” UHC 2030 steering committee co-chair Justin Koonin UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”. For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers. “If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said. Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.” Somalia Calls for UHC ‘Roadmap’ Somalian Health and Human Services Minister Fawziya Abikar Nur While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”. She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians. Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said. COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame WHO DG Dr Tedros Ghebreyesus called on all member states to strengthen primary health care. Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months. “Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said. Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”. UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness. Image Credits: UNICEF. China Sidesteps COVAX Vaccine Donations; Africa Highlights Pandemic Fallout on Health Systems & Societies 27/05/2021 Paul Adepoju Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing. COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge. But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. “China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna. At #WHA74 #China calls for equitable distribution of vaccines and says it will continue to support it. #China said it would continue bilateral donations but refrained from any commitments to #COVAX. pic.twitter.com/5Lf7XYas6R — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. “The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. “However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms. Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.” Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs). “While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.” Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center. COVID – One Among Many Outbreaks Africa Faces Dr Matshidiso Moeti, WHO Regional Director for Africa. WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases. Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.” The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.” ‘Last Pandemic’ Report Approved The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats. See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind. Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.” “We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said. The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”. Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics. ‘Two-tiered World’ of Vaccinated and Unvaccinated Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand. As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. “Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states. “At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. Said Clark: “The return on investment would be enormous – both for people’s health and for economies.” Image Credits: Paul Adepoju , Paul Adepoju. Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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WHA Approves Resolution To Scale Up Services For Disabled People 27/05/2021 Disha Shetty Disability services should be incorporated into primary health care programmes at the community level, states a resolution adopted at the 74th WHA. A new resolution adopted on Thursday by the 74th World Health Assembly aims to scale up access to services and treatment for people living with disabilities – using a more “gender-sensitive and inclusive” approach. The resolution co-sponsored by Israel and Australia, calls upon member states to ensure that disability services are incorporated into primary health care programmes at the community level – and that conversely disabled people also have full access to health services. It also calls for special attention to be paid to the “unique vulnerabilities of those who may be living in care and congregated living settings in times of public health emergencies such as COVID-19, and for special protection against infections in particular for at-risk groups,” including more education for health care workers. And, the resolution calls upon WHO to etch out a global research agenda on disabilities, as well as to develop, by the end of 2022, a global report on disabilities, updating estimates on the numbers of disabled people worldwide, from a decade old World Report on Disability (2011). Countries Said Community-based Interventions Are Key Israeli diplomat Nitzan Arny speaks about the resolution on persons with disability led by Israel. One in seven persons worldwide experience some form of disability. The numbers are increasing due to factors such as ageing populations and widespread chronic health conditions. Many countries highlighted the roles community-based interventions can play in improving access – in reactions that warmly supported the initiative overall. The resolution broadly calls for collection of reliable data that allow for disaggregation by disability. It also advocates equal access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. Persons with disabilities face inequality in social, economic, health and political spheres and are more likely to live in poverty than those without disabilities. They are also more likely to have risk factors for noncommunicable diseases and less likely to have access to essential health services. “Nothing about us without us’ is not just a catchphrase. Meaningfully involving persons with disabilities in decision-making processes is a precondition for ensuring disability inclusion,” said Israel’s delegate to the WHA, Nitzan Arny, in presenting the initiative. Australia, the resolution’s co-sponsor said: “We recognize the importance of promoting disability inclusion in the health sector to ensure persons with a disability enjoy the highest sustainable highest attainable standard of health, including access to quality disability inclusive health services, information and education across their lifetimes.” Israel, Australia, the United States, European Union, Kenya, Botswana, the United Kingdom, Japan, Mexico and a dozen other countries co-sponsored the resolution. Today during #WHA74 the assembly adopted 🇮🇱 #Israel led resolution on persons living with #disabilities 🎥 pic.twitter.com/BootPAvNNr — Nitzan Arny 🎗 (@NitzanArny) May 27, 2021 Meanwhile, the resolution gives new impetus for action, particularly in light of the fact that WHO’s current Global Disability Action Plan 2014–2021 is set to expire this year. New Zealand, however, said it supports extending the Global Disability Action Plan because “This would demonstrate continued international commitment to this goal, and provide guidance for how this can be achieved.” New Zealand is committed to improve health outcomes for persons with disabilities, the country tells #WHA74 @WHO. It also supports extending WHO's Global Disability Action Plan. pic.twitter.com/l6etILNoyD — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 COVID’s Impacts on Persons With Disabilities The pandemic has harmed people with disabilities in various ways, yet few member states collect data that are disaggregated by disability. Women and girls living with disabilities face particular challenges. “Women, young women and girls who are disabled have a high risk of being marginalized and seriously discriminated against. That reduces their economic and social status, it increases the risk of sexual violence and sexist attitudes against and towards them and [of] limited access to justice,” Canada said. “These challenges have only increased during the COVID-19 pandemic, and disabled women and girls continue to fight for their rights for equality and for changes to the system.” The resolution highlighted the role of community health workers in advancing equitable access of persons with disabilities to safe, quality, accessible and inclusive health services. Stress on Community-Based Rehabilitation Among the stakeholders invited to collaborate under the resolution are organisations of persons with disabilities, private sector companies, scholars and teachers. “Community-based rehabilitation is a strategy to improve access to the services to persons living disabilities in middle-and low-income countries through the optimal use of local resources,” said Colombia. Speaking about the @WHO's Global Disability Action Plan, #Colombia says community based rehabilitation can improve access in low and middle income countries for persons with disability. pic.twitter.com/bC3rSk7t9J — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 27, 2021 Civil society organisations have welcomed the resolution. “We welcome that the resolution calls on governments to actively involve people living with disabilities in decision-making and programme design. This will ensure that health systems and responses to health emergencies can better deliver on the needs of the people most affected,” said Nina Renshaw of the NCD Alliance. “As we’ve seen in other fields of global health, such as HIV and TB, meaningful inclusion of lived experience is absolutely fundamental to catalyse overdue progress.” Image Credits: PicPedia. Africa CDC Warns COVID-19 Could Become Endemic; France Pledges Vaccine Support 27/05/2021 Paul Adepoju A Nigerian health workers receives his COVID-19 vaccine. With vaccine deliveries delayed by India’s decision to prioritise local vaccination over export requests, Africa’s leading disease control agency suggested COVID-19 could become endemic. John Nkengasong, director of Africa’s CDC, told reporters on Thursday that Africa needs to immunise population majorities quickly, but the vaccine delays make this unlikely. “With the rate of immunisation in Africa, we are lagging behind in the battle against the pandemic,” Nkengasong said. He asked the global community to consider vaccine access a collective security issue that needs to be addressed everywhere. “If we keep vaccinating at this pace, we are not going to achieve our target. And that will delay our ability to eliminate the virus from our population — and my greatest concern is that we may actually begin to move towards the endemicity of this virus,” he said. WHO Regional Director Echoes Concerns About Eradication At a separate briefing, Matshidiso Moeti, WHO Africa Regional Office director, also said Africa faces challenges that make it unlikely to eradicate the disease anytime soon. She said vaccine delays disproportionately affect African countries, and these point to further poor outcomes for the continent. Dr Matshidiso Moeti, WHO Africa Regional Office director, warned of slow pandemic progress. Moeti discussed WHO research saying Africa needs at least 20 million doses of the Oxford-AstraZeneca vaccine in the next six weeks in order to get second doses to all who received a first dose within the 8-12 week recommended interval between doses. Compared with 1.5 billion vaccine doses already administered globally, Africa has to date administered 28 million doses, or fewer than two per 100 people. “As supplies dry up, dose-sharing is an urgent, critical and short-term solution to ensuring that Africans at the greatest risk of COVID-19 get the much-needed protection,” said Moeti. “Africa needs vaccines now. Any pause in our vaccination campaigns will lead to lost lives and lost hope.” “We are expecting, not only in Africa, but globally, that this is a virus that we are going to live with in the future,” Moeti said in response to a question from Health Policy Watch. “ So instead of talking about quickly eradicating COVID-19, the main objective is to minimise severe illness and deaths from the virus”. She said Africa should continue to develop needed vaccines and therapeutics, and that African health systems must not be overwhelmed by the pandemic waves. She stressed the need for more vaccine access on the continent going into 2021 to “reach that level of vaccination that’s needed to enable African countries to open up and return to a more normal life”. While the threat of endemicity remains, Moeti said, public health stakeholders on the continent are anticipating and hoping very much that COVID-19 will not become endemic in Africa. France, Europe Pledge Support for Africa Vaccine Quest The French government meanwhile, announced a new, and larger, phase of vaccine dose sharing with African countries. Speaking at the WHO briefing briefing, Stéphanie Seydoux, French Ambassador for Global Health, Seydoux said that France would now share half a million doses with six African countries within weeks. France was the first developed country to volunteer to share COVID-19 vaccines from domestic supplies, donating over 31,000 doses to Mauritania, with another 74,400 set for imminent delivery. Stéphanie Seydoux, French Ambassador for Global Health Issues, said Africa should benefit from tools established to fight the pandemic. Seydoux noted that while Africa has largely been spared from the full brunt of the pandemic, the continent and all regions should benefit from tools established to fight COVID-19. She also noted France’s commitment to Africa’s vaccine manufacturing capacity. France also is committed to a European Union plan to provide 100 million COVID-19 vaccine doses for low-income countries by year’s end. The United States has similarly pledged to share 80 million doses with lower-income countries. Lesotho Explains How to Share “Half a Loaf” Lesotho was hoping to receive more than 130,000 COVID-19 vaccine doses through the COVAX facility. Instead, it received about 36,000 doses of Oxford-AstraZeneca vaccine on 3 March. Health Minister Semano Henry Sekatle said the country takes a “half loaf is better than none” approach in vaccination planning. Lesotho Health Minister Semano Henry Sekatle: “Those who have surplus should be kind enough to return the doses”. This approach allowed vaccination of 95% of health workers, he said. He then appealed to vaccine-rich countries to share with those in need: “Those who have surplus should be kind enough to return the doses. It is also quite important that all these countries that are producing these vaccines should seriously consider the liberalisation of the patents,” Sekatle said. Added Nkengasong,“Now [it is] critically urgent for countries sitting on excess doses to redistribute — and redistribute quickly, so that we can put vaccines in the arms of the people. And the people of Africa should understand that these vaccines are safe. He cautioned, however, that as Africa cannot expect to receive very large quantities of vaccines anytime soon, the continent needs to continue focusing on key preventive measures such as masks and social distancing, as well as careful surveillance of hot spots in new cases and improved treatment, including sufficient oxygen supplies to treat seriously ill patients. All of those measures can help prevent health systems from getting overwhelmed. At the same time, he noted that the public needs to do its part too: “By having safe vaccines, you’re ensuring that your neighbour is safe, your loved ones are safe. So I urge everyone that has access to getting vaccinated to quickly do so, so that we can continue to protect ourselves, and protect our loved ones.” WHO Calls For More Investment In Primary Health Care; ‘World Is Far Behind’ in Reaching Universal Health Coverage 27/05/2021 Chandre Prince WHO member states are lagging behing in achieving Universal Health Coverage by 2030, as outlined in the Sustainable Development Goals. While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring Universal Health Coverage (UHC). Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed. WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030. WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work. There, too, countries fall far short of the mark. Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports. “But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.” Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF. UHC is a Right, Not a Privilege US Health and Human Services Secretary Xavier Becerra said UHC is “a right and not a privilege”. US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010 – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization. Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said. “Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra. To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits. “We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.” UHC 2030 steering committee co-chair Justin Koonin UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”. For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers. “If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said. Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.” Somalia Calls for UHC ‘Roadmap’ Somalian Health and Human Services Minister Fawziya Abikar Nur While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”. She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians. Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said. COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame WHO DG Dr Tedros Ghebreyesus called on all member states to strengthen primary health care. Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months. “Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said. Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”. UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness. Image Credits: UNICEF. China Sidesteps COVAX Vaccine Donations; Africa Highlights Pandemic Fallout on Health Systems & Societies 27/05/2021 Paul Adepoju Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing. COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge. But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. “China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna. At #WHA74 #China calls for equitable distribution of vaccines and says it will continue to support it. #China said it would continue bilateral donations but refrained from any commitments to #COVAX. pic.twitter.com/5Lf7XYas6R — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. “The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. “However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms. Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.” Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs). “While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.” Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center. COVID – One Among Many Outbreaks Africa Faces Dr Matshidiso Moeti, WHO Regional Director for Africa. WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases. Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.” The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.” ‘Last Pandemic’ Report Approved The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats. See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind. Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.” “We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said. The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”. Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics. ‘Two-tiered World’ of Vaccinated and Unvaccinated Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand. As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. “Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states. “At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. Said Clark: “The return on investment would be enormous – both for people’s health and for economies.” Image Credits: Paul Adepoju , Paul Adepoju. Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Africa CDC Warns COVID-19 Could Become Endemic; France Pledges Vaccine Support 27/05/2021 Paul Adepoju A Nigerian health workers receives his COVID-19 vaccine. With vaccine deliveries delayed by India’s decision to prioritise local vaccination over export requests, Africa’s leading disease control agency suggested COVID-19 could become endemic. John Nkengasong, director of Africa’s CDC, told reporters on Thursday that Africa needs to immunise population majorities quickly, but the vaccine delays make this unlikely. “With the rate of immunisation in Africa, we are lagging behind in the battle against the pandemic,” Nkengasong said. He asked the global community to consider vaccine access a collective security issue that needs to be addressed everywhere. “If we keep vaccinating at this pace, we are not going to achieve our target. And that will delay our ability to eliminate the virus from our population — and my greatest concern is that we may actually begin to move towards the endemicity of this virus,” he said. WHO Regional Director Echoes Concerns About Eradication At a separate briefing, Matshidiso Moeti, WHO Africa Regional Office director, also said Africa faces challenges that make it unlikely to eradicate the disease anytime soon. She said vaccine delays disproportionately affect African countries, and these point to further poor outcomes for the continent. Dr Matshidiso Moeti, WHO Africa Regional Office director, warned of slow pandemic progress. Moeti discussed WHO research saying Africa needs at least 20 million doses of the Oxford-AstraZeneca vaccine in the next six weeks in order to get second doses to all who received a first dose within the 8-12 week recommended interval between doses. Compared with 1.5 billion vaccine doses already administered globally, Africa has to date administered 28 million doses, or fewer than two per 100 people. “As supplies dry up, dose-sharing is an urgent, critical and short-term solution to ensuring that Africans at the greatest risk of COVID-19 get the much-needed protection,” said Moeti. “Africa needs vaccines now. Any pause in our vaccination campaigns will lead to lost lives and lost hope.” “We are expecting, not only in Africa, but globally, that this is a virus that we are going to live with in the future,” Moeti said in response to a question from Health Policy Watch. “ So instead of talking about quickly eradicating COVID-19, the main objective is to minimise severe illness and deaths from the virus”. She said Africa should continue to develop needed vaccines and therapeutics, and that African health systems must not be overwhelmed by the pandemic waves. She stressed the need for more vaccine access on the continent going into 2021 to “reach that level of vaccination that’s needed to enable African countries to open up and return to a more normal life”. While the threat of endemicity remains, Moeti said, public health stakeholders on the continent are anticipating and hoping very much that COVID-19 will not become endemic in Africa. France, Europe Pledge Support for Africa Vaccine Quest The French government meanwhile, announced a new, and larger, phase of vaccine dose sharing with African countries. Speaking at the WHO briefing briefing, Stéphanie Seydoux, French Ambassador for Global Health, Seydoux said that France would now share half a million doses with six African countries within weeks. France was the first developed country to volunteer to share COVID-19 vaccines from domestic supplies, donating over 31,000 doses to Mauritania, with another 74,400 set for imminent delivery. Stéphanie Seydoux, French Ambassador for Global Health Issues, said Africa should benefit from tools established to fight the pandemic. Seydoux noted that while Africa has largely been spared from the full brunt of the pandemic, the continent and all regions should benefit from tools established to fight COVID-19. She also noted France’s commitment to Africa’s vaccine manufacturing capacity. France also is committed to a European Union plan to provide 100 million COVID-19 vaccine doses for low-income countries by year’s end. The United States has similarly pledged to share 80 million doses with lower-income countries. Lesotho Explains How to Share “Half a Loaf” Lesotho was hoping to receive more than 130,000 COVID-19 vaccine doses through the COVAX facility. Instead, it received about 36,000 doses of Oxford-AstraZeneca vaccine on 3 March. Health Minister Semano Henry Sekatle said the country takes a “half loaf is better than none” approach in vaccination planning. Lesotho Health Minister Semano Henry Sekatle: “Those who have surplus should be kind enough to return the doses”. This approach allowed vaccination of 95% of health workers, he said. He then appealed to vaccine-rich countries to share with those in need: “Those who have surplus should be kind enough to return the doses. It is also quite important that all these countries that are producing these vaccines should seriously consider the liberalisation of the patents,” Sekatle said. Added Nkengasong,“Now [it is] critically urgent for countries sitting on excess doses to redistribute — and redistribute quickly, so that we can put vaccines in the arms of the people. And the people of Africa should understand that these vaccines are safe. He cautioned, however, that as Africa cannot expect to receive very large quantities of vaccines anytime soon, the continent needs to continue focusing on key preventive measures such as masks and social distancing, as well as careful surveillance of hot spots in new cases and improved treatment, including sufficient oxygen supplies to treat seriously ill patients. All of those measures can help prevent health systems from getting overwhelmed. At the same time, he noted that the public needs to do its part too: “By having safe vaccines, you’re ensuring that your neighbour is safe, your loved ones are safe. So I urge everyone that has access to getting vaccinated to quickly do so, so that we can continue to protect ourselves, and protect our loved ones.” WHO Calls For More Investment In Primary Health Care; ‘World Is Far Behind’ in Reaching Universal Health Coverage 27/05/2021 Chandre Prince WHO member states are lagging behing in achieving Universal Health Coverage by 2030, as outlined in the Sustainable Development Goals. While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring Universal Health Coverage (UHC). Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed. WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030. WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work. There, too, countries fall far short of the mark. Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports. “But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.” Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF. UHC is a Right, Not a Privilege US Health and Human Services Secretary Xavier Becerra said UHC is “a right and not a privilege”. US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010 – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization. Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said. “Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra. To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits. “We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.” UHC 2030 steering committee co-chair Justin Koonin UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”. For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers. “If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said. Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.” Somalia Calls for UHC ‘Roadmap’ Somalian Health and Human Services Minister Fawziya Abikar Nur While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”. She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians. Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said. COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame WHO DG Dr Tedros Ghebreyesus called on all member states to strengthen primary health care. Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months. “Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said. Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”. UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness. Image Credits: UNICEF. China Sidesteps COVAX Vaccine Donations; Africa Highlights Pandemic Fallout on Health Systems & Societies 27/05/2021 Paul Adepoju Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing. COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge. But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. “China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna. At #WHA74 #China calls for equitable distribution of vaccines and says it will continue to support it. #China said it would continue bilateral donations but refrained from any commitments to #COVAX. pic.twitter.com/5Lf7XYas6R — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. “The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. “However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms. Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.” Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs). “While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.” Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center. COVID – One Among Many Outbreaks Africa Faces Dr Matshidiso Moeti, WHO Regional Director for Africa. WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases. Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.” The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.” ‘Last Pandemic’ Report Approved The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats. See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind. Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.” “We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said. The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”. Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics. ‘Two-tiered World’ of Vaccinated and Unvaccinated Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand. As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. “Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states. “At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. Said Clark: “The return on investment would be enormous – both for people’s health and for economies.” Image Credits: Paul Adepoju , Paul Adepoju. Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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WHO Calls For More Investment In Primary Health Care; ‘World Is Far Behind’ in Reaching Universal Health Coverage 27/05/2021 Chandre Prince WHO member states are lagging behing in achieving Universal Health Coverage by 2030, as outlined in the Sustainable Development Goals. While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring Universal Health Coverage (UHC). Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed. WHO Director-General Dr Tedros Ghebreyesus said member states are lagging in achieving the 2019 UN General Assembly’s goal of achieving Universal Health Coverage for everyone in the world by 2030. WHO has meanwhile set its own ambitious institutional target of ensuring that 1 billion more people get access to UHC by 2023 – as part of the Organizations “Triple Billion Targets” for its own five-year programme of work. There, too, countries fall far short of the mark. Since the year 2000, average levels of service coverage have improved, but only an additional 290 million people have gained access to high-quality health care, Tedros noted, citing UHC global monitoring reports. “But that leaves a shortfall of 710 million against our target to see 1 billion more people benefiting from universal health coverage,” said Tedros. “The world is far behind.” Among countries and organisations that shared initiatives and progress at the session were the United States, Somalia, Australia, WHO’s African Region and UNICEF. UHC is a Right, Not a Privilege US Health and Human Services Secretary Xavier Becerra said UHC is “a right and not a privilege”. US Health and Human Services Secretary Xavier Becerra, also appearing at the session, said UHC is “a right and not a privilege”. Becerra is leading US efforts to strengthen access to preventive and health care services among US citizens and residents. This is in a country which lacked any mandate for universal health coverage until the passage of the Affordable Care Act in 2010 – which political conservatives tried, but failed, to dismantle under the administration of former President Donald Trump. Further, Becerra said, such coverage must be based on strong and resilient systems that address the health needs of women, children and adolescents, including but not limited to sexual and reproductive health services and immunization. Through the American Recovery Plan, the Biden administration has made the largest US investment in health care since the Affordable Care Act’s passage in 2010, Becerra said. “Our government has been able to reduce health care costs throughout the country. We’ve been able to expand affordable access to health insurance, and to ensure that health care truly is a right, not a privilege. In the United States, we are moving in this direction — and we believe this is the first time I could recall the President of the United States saying health care should be a right — not a privilege,” said Becerra. To ensure access to health services, the US also expanded medical aid programs for lower-income earners and reduced the health insurance costs for some households by raising tax credits. “We are moving closer to true universal health care… While we are not completely there … we are certainly making a major investment through the American Recovery Plan,” Becerra said. “The President has bold plans moving forward to increase that access to coverage.” UHC 2030 steering committee co-chair Justin Koonin UHC 2030 steering committee co-chair Justin Koonin said that although Australia has a strong health care system, this does not mean that “everyone does access health services in the same way”. For example, he said the LGBTQ community, particularly transgender and gender diverse people, did not have access to services like cervical screening due to legislative and policy barriers. “If you want communities to access health services, you need to create demand. And to create demand, you need to speak the language of those communities, and provide services and services that are culturally appropriate,” Koonin said. Primary health care can be improved by driving accountability and promoting social participation, he said. “We seek to ensure that health policy processes are responsive to people’s needs — and in particular the needs of the most vulnerable and marginalized.” Somalia Calls for UHC ‘Roadmap’ Somalian Health and Human Services Minister Fawziya Abikar Nur While the US and Australia noted progress, Somalian Health and Human Services Minister Fawziya Abikar Nur said her country faces various challenges that hamper primary health care, including frequent natural disasters, safety concerns and economic constraints. Still, she said, Somalia has adopted PHC as the “core of sustainable development, health security and universal health”. She said many Somalians have difficulties accessing basic health services and that health insurance in Somalia is limited to private plans. Nur called for a roadmap for UHC development to ensure that private health care services reach all Somalians. Nur said the country has “deliberately prioritised” maternal and neonatal health care interventions because these areas have high rates of death and disease burden. And because providing care of good quality to the majority of its population is paramount, Somalia will soon launch its first “investment case” arguing for more investments in the health sector. This will help the country to mobilise both domestic and external resources to deliver primary health care, Nur said. COVID-19 Has Disrupted Primary Health Care, But It’s Not to Blame WHO DG Dr Tedros Ghebreyesus called on all member states to strengthen primary health care. Dr Tedros said years of disinvestment and underinvestment have resulted in major shortcomings in delivering primary health care. During COVID, A WHO survey found that a majority of countries are experiencing disruptions of at least 25% of many essential health services. The director-general also noted signs of recovery, with the number of countries reporting disruptions to 70% or more of services decreasing from 24% to 8% in the past six months. “Although the pandemic has been a setback in our collective efforts to progress toward this universal health coverage, it has also shown why it’s so important, and why we must pursue it with even more determination,” he said. Tedros said WHO is drawing from lessons learnt from the pandemic and is working with all member states to “strengthen primary health care, increase equitable access to services and reduce out-of-pocket spending”. UNICEF Deputy Executive Director Omar Abdi agreed that while the pandemic has disrupted, and compromised, essential health systems around the world, it could not be singled out as the only factor. “COVID is not to blame. In many countries and regions, systems have also collapsed because of inadequate investments over several decades,” Abdi said. Abdi said UNICEF saw the setback as an opportunity to build back better: “To not only respond to COVID-19, but to help national authorities build stronger and more resilient primary health care services that can reach all people, including the most vulnerable. … Next week, UNICEF will present a new strategic plan … [that] will include a renewed emphasis on helping countries achieve universal health coverage for children and women by strengthening primary health care in four key areas.” Abdu said this would include addressing inequities, promoting integrated care, and ensuring that health systems address issues such as water, sanitation and social protection. He said UNICEF’s new strategic plan will advocate for better national and global emergency preparedness. Image Credits: UNICEF. China Sidesteps COVAX Vaccine Donations; Africa Highlights Pandemic Fallout on Health Systems & Societies 27/05/2021 Paul Adepoju Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing. COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge. But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. “China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna. At #WHA74 #China calls for equitable distribution of vaccines and says it will continue to support it. #China said it would continue bilateral donations but refrained from any commitments to #COVAX. pic.twitter.com/5Lf7XYas6R — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. “The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. “However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms. Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.” Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs). “While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.” Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center. COVID – One Among Many Outbreaks Africa Faces Dr Matshidiso Moeti, WHO Regional Director for Africa. WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases. Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.” The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.” ‘Last Pandemic’ Report Approved The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats. See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind. Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.” “We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said. The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”. Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics. ‘Two-tiered World’ of Vaccinated and Unvaccinated Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand. As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. “Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states. “At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. Said Clark: “The return on investment would be enormous – both for people’s health and for economies.” Image Credits: Paul Adepoju , Paul Adepoju. Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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China Sidesteps COVAX Vaccine Donations; Africa Highlights Pandemic Fallout on Health Systems & Societies 27/05/2021 Paul Adepoju Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing. COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge. But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. “China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna. At #WHA74 #China calls for equitable distribution of vaccines and says it will continue to support it. #China said it would continue bilateral donations but refrained from any commitments to #COVAX. pic.twitter.com/5Lf7XYas6R — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. “The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. “However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms. Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.” Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs). “While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.” Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center. COVID – One Among Many Outbreaks Africa Faces Dr Matshidiso Moeti, WHO Regional Director for Africa. WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases. Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.” The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.” ‘Last Pandemic’ Report Approved The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats. See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind. Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.” “We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said. The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”. Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics. ‘Two-tiered World’ of Vaccinated and Unvaccinated Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand. As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. “Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states. “At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. Said Clark: “The return on investment would be enormous – both for people’s health and for economies.” Image Credits: Paul Adepoju , Paul Adepoju. Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination 26/05/2021 Raisa Santos World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre. And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID. “Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. Travel Measures Must Be Implemented at a Granular Level Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan. She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.” Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” Karen Grepin, University of Hong Kong These measures have been a critical component of national infectious disease response, Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.” Almost every country in the world has travel measures in place, but those measures are highly inconsistent. And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the pandemic is beaten back. Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations Diego Silva, University of Sydney University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.” Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on international travel issues: “It’s not enough to act again in a unilateral manner.” Potential Gap in IHR Compliance and Policy Implementation Catherine Worsnop, University of Maryland Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. “Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic. “We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva. Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Israeli – Palestinian Conflict Blocks Full Day At World Health Assembly 26/05/2021 Elaine Ruth Fletcher Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states. Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. WHO Regional Director for EMRO Ahmed Al Muntari The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services. The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report. The resolution, anchored upon the report, called mainly for the provision of more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip. However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory. This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters. In Israel,13 people, including two children, died. In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly. That motion passed without a word of opposition from the WHA plenary on Wednesday. Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. #WHA74 deferred to the @UN a decision on whether to credential the deposed #Myanmar civilian government of Aung San Suu Kyi or the new #militaryjunta after @WHO received documents from two different delegations. 👉Health Policy Watch https://t.co/HcWfsHW4MK pic.twitter.com/x59fhulMD9 — Health Policy Watch – Global Health News Reporting (@HealthPolicyW) May 26, 2021 Objections by Israel and Allies to “Standalone Item” Have Amplified The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the WHA resolution accompanying the report on health conditions. That constitutes Israeli pushback over the extra attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote. A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote. As the United Kingdom stated: “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed. “We supported the report, and the associated decision be considered alongside other WHO assistive programs. “We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza – and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. “However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories. And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way. Palestine & Syria Retort – What is New? Syrian delegate to the WHA Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: “It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. “What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.” Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text…. which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.” The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services – as well as a pathway to citizenship. “This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.” Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva “Let’s stop the politicization of this forum, by deleting this from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” Image Credits: www.laprensalatina.com. Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Transparency International Calls On World Health Assembly To Investigate Disclosures by WHO’s Italian Whistleblower 26/05/2021 Philippe Mottaz Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge EXCLUSIVE: The Geneva Observer has learned that Transparency International and a broad coalition of organizations advocating for a more robust protection mechanism for UN whistleblowers has sent an open letter to the 74th World Health Assembly (WHA) urging WHO Member States to call for an independent review of the disclosures made by former WHO researcher Dr Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy’s response to the COVID-19 pandemic in May 2020. Dated Wednesday (May 26), the letter also demands the WHO reform “its whistleblowing mechanisms and ensure the independence of its justice system for future whistleblowers.” The report, “An Unprecedented Challenge: Italy’s first response to Covid-19,” was published a little over a year ago on WHO’s European Regional website, then withdrawn after a few hours and never republished, even though it had been approved by the organisation’s scientific committee. To this day, WHO maintains that the report was prematurely published and withdrawn because it contained “factual inaccuracies,” an assertion contradicted by documents gathered by Italian prosecutors in Bergamo investigating why Italy’s pandemic plan had not been updated since 2006. Transparency International Letter Sent to WHA President Transparency International’s strongly worded open letter was sent to the President of this year’s WHA, Bhutan’s Health Minister Dasho Dechen Wangmo. In addition to Transparency International, the open letter is supported by the Whistleblowing International Network (WIN), the Government Accountability Project (GAP,) and more than 30 anti-corruption, public health, and whistleblower protection organizations and individuals. “We are all deeply concerned about the case on public health grounds from two perspectives,” the TI letter states. “First, we are concerned with what appears to be the deliberate suppression of a scientific report of great public interest value at the time it was published and still valuable for ongoing learning. Second, the alleged retaliation against Dr. Zambon for reporting his concerns about the report’s suppression highlights serious failures of WHO’s whistleblowing policy – an essential element of any institution’s good governance.” WHO’s Franceso Zambon resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response The coalition’s demand comes as civil society has been warning that freedom of expression and the public right to quality information was essential during a pandemic and, as the open letter states, “that those who expose harms, abuses and wrongdoings should be protected.” Guerra Pressured Zambon to State that Italy’s Pandemic Plan had been Updated Documents obtained by The GIO reveal that on May 11, 2021, two days before the report was posted online, Dr. Ranieri Guerra, then WHO Assistant Director General in charge of Special Projects, seconded to the Italian Ministry of Health, pressured Francesco Zambon, the WHO’s Venice-based staff official who coordinated the writing of the report with a team of ten experts, to insert language claiming that Italy’s preparedness plan had last been revised in 2016 when in fact it had not been updated since 2006 – something that Zambon refused to do. Former WHO Assistant Director General, Ranieri Guerra Guerra had no formal authority over the publication of the WHO report. Updating Italy’s preparedness plan was, however, supposed to have been his responsibility when serving with the Ministry of Health in Rome prior to being appointed to the WHO by new Director-General Dr. Tedros Adhanom Ghebreyesus in October 2017. “You must immediately correct the text. (…) Don’t mess with me on this one and please no bullshit.(…) Sorry for the tone” Guerra wrote in his email, which he followed with an irate phone call to Zambon. According to knowledgeable sources who spoke to The Geneva Observer under the condition of anonymity, the relationship between the two men – while appearing cordial in some previous exchanges – had become strained from the moment the decision to write the report was made in March. Italian Prosecutors Now Investigating Guerra for Alleged “False Testimony” The exchanges and other documents are, now with the Italian prosecutors who are investigating Guerra for possible “false testimony” regarding his role in Italy’s preparedness planning and the WHO pandemic account. Those same documents suggest that Dr. Tedros’ envoy to Italy was, from the beginning more preoccupied by his own and WHO’s relationship with the Italian government than by the report itself – whose main objective was to share Italy’s experience and lessons learned with the world in the hope that other countries could be better prepared: “Writing such a history is certainly a good idea (…), I am sure it will also please the government,” Guerra wrote to Zambon on March 25. On April 14, in another email, Guerra told Zambon that the researcher had complete latitude to have his team write the report as they see fit. However, he advised Zambon to “provide the [Italian] Health Minister with a more detailed index” of what the report would contain so the “Minister can give his blessing” to this as well as having the funding for writing the report provided by a foreign country. Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016 – the changes were not made. According to documents and confirmed by the sources contacted by The G|O, Zambon and his team accepted that the Italian government should be informed about the writing of the report as a matter of “institutional courtesy” but that the document itself should not be shared in order to protect and maintain the WHO’s credibility and independence. Guerra’s claim insistence that the Italian pandemic plan had been updated was also debunked by a forensic expertise of the metadata of the 2006 plan’s PDF file. That file was – published by the Italian public-broadcaster RAI in December 2020. Guerra was trying to cover up what could be called “a dereliction of duty while he was in charge of prevention at the Italian Health Ministry,” a WHO insider told the Geneva Observer. In his defense, Guerra claims that the final responsibility to update the circa 2006 Italian pandemic plan was not in fact his -, a determination that in the end will be made by Italian justice. Related stories: · The Italian Job: Obfuscation and Influence at the WHO · Senior WHO official under investigation in Italy denies lying to prosecutors · World Health Organization’s Censorship Of Report On Italy’s Pandemic Response Sets Dangerous International Precedent – Critics Say · WHO Playbook For Responses To Media Queries On Suppressed Italian COVID-19 Report – Raises More Questions than Answers Pressure Followed by Intimidation Pressure on Zambon was allegedly followed by intimidation. According to Zambon, who has since resigned from his position in WHO’s Venice office, to the former WHO researcher, Guerra reportedly told him during a phone call on that same day, May 11, that he would have him fired by WHO DG Dr Tedros if he refused to modify the document. The exchange prompted Zambon to immediately report the episode to WHO’s Ethics Office and informed it that he was taking a medical leave of absence due to “a threat email I received” from Assistant DG Guerra. WHO Ethics Office Denies Zambon Whistleblower Protection Several months later, WHO’s Ethics Office responded that Francesco Zambon could not have been a victim of retaliation as he did not have a reporting line to ADG Guerra: “Therefore, ADG Guerra’s alleged comments, while inappropriate, do not constitute retaliation(…)as defined by WHO policy.” The same email to the former researcher states further that: “…you were advised that as there has been no retaliation against you at this stage,” and that “therefore there is no need for protection.” Zambon, isolated professionally and boycotted by his colleagues, subsequently resigned. Guerra, meanwhile, has become a special advisor in the Director General’s office – although according to existing WHO staff rules, he would be obliged to return when he turns 68 in June – beyond which even exceptional extensions of staff positions by the director-general are not supposed to be permitted. WHO, however, did not comment on Guerra’s job status. Transparency International Condemns WHO’s Decision on Zambon Transparency International’s letter strongly condemned WHO’s this decision to deny Zambon protections: “The WHO’s unresponsiveness to Dr. Zambon’s attempts to raise serious public interest issues, and the lack of a timely resolution of his complaints of retaliatory treatment can only have a chilling effect on other WHO staff, as well as those working for similar international bodies, discouraging them from speaking up when it matters. The case also risks fueling serious distrust in WHO and UN systems” the letter reads. (…)” The whistleblowing policies of the United Nations have been a long-standing cause for concern for international whistleblowing protection and anti-corruption and human rights experts. Zambon, in response to the TI letter, told The Geneva Observer and Health Policy Watch: “Over the last months I have been seeing from WHO officials the most bizarre statements on this issue. Either there was a cover-up or else they simply don’t know the full facts. Now that Transparency International spontaneously got this, I wait for an apology from WHO. Now I feel less alone.” Asked to comment, a WHO spokesperson said that the Organization was “currently working on a reply to Transparency International”. The WHO spokesperson acknowledged that in the case of Zambon, a “complaint by him against another WHO staff member was received by WHO in 2020 and is currently under review. But the spokesperson contended that Zambon, who resigned effective 31 March, “is not a whistleblower under WHO policy on whistleblowing; professional conflicts between staff members are handled in line with WHO’s regulatory framework and Zambon has availed himself of the options open to staff members in that respect.” “WHO is cooperating with the Public Prosecutor in Bergamo, following his request for judicial assistance,” the spokesperson added. UN Special Rapporteur’s Recommended UN Agencies Adopt Stronger Whistleblower Protections In 2015, the UN Special Rapporteur on freedom of expression specifically recommended the UN and its agencies” adopt effective policies to enable greater public access to information and to protect whistleblowers.” The open letter also refers to a report by WHO’s External Auditor scheduled to be discussed during WHA74. “We note with keen interest that our concerns and calls for reform have been echoed in the findings of the Report of the External Auditor, published May 17, 2021, and scheduled for discussion on WHA74 preliminary agenda. The Report found a steep increase in the number of complaints of misconduct and retaliation and confirmed this should be a cause for concern for WHO management. Reported breaches of the WHO’s Codes of Ethics and Conflicts of Interest more than doubled, and complaints of retaliation sharply increased from 7 (in 2019) to 19 (in 2020). The CRE received a further 20 complaints. The Report stated that an ‘untenable’ lack of human resources’…[h]ampers the cause of justice’ and the resulting delays are particularly problematic given the large number of cases later found to be substantiated. (…) WHO should enhance its punitive and preventive measures, and urgently reduce delays in investigation and disciplinary action.” Philippe Mottaz / @pmottaz – is the founder and editor-in-chief of the Geneva Observer. Updated with permission from the article first published in The G/O on 26 May, 2021. Image Credits: WHO, An Unprecedented Challenge . Posts navigation Older postsNewer posts