Ajoke Sobanjo-ter Meulen, Princess Nothemba (Nono) Simelela, Wiweka Kaszubska, Alwyn Mwinga, Jamie Nishi, Andrew Tuttle, Lisa Goërlitz (from top left to right)

Although gender is increasingly factored into health research, much remains to be done, experts reported at a Tuesday event co-organised by the Geneva Graduate Institute’s Global Health Centre.

But despite growing awareness, health research continues to conceptualize gender in binary terms. Very little research concerns those who identify as LGBTQ+, according to speakers at the event, which was co-sponsored by the Medicines for Malaria Venture, the Global Health Technologies Coalition, Deutsche Stiftung Weltbevölkerung (DSW International), and the International Geneva Global Health Platform. 

Panellists explained how diseases can have vastly different impacts on different genders because of social and economic factors. Women are under-represented in pre-clinical and clinical trial research, leading to limited data on risks and benefits of tested medicines and vaccines. Later impacts of this bias eventually may limit women’s therapeutic options.

Pregnant women are an especially vulnerable category, often left out of clinical trials altogether.  

Involve Communities, Improve Trust

Alwyn Mwinga, CEO, Zambart Project; Zambia DNDi Board Patient Representative said the key to involving more women in research is to improve trust.

Panellists repeatedly stressed the need to work closely with communities while designing solutions, as currently researchers have inadequate consultations with women.

“This element of trust actually underscores the importance of important community research, and this is more impactful,” said Alwyn Mwinga, Zambart Project CEO and Zambia DNDi Board Patient Representative.

She said the take-home message is that pregnant women are willing to participate in research, provided they are given sufficient information to make a considered decision. She added that while more women are included in recent clinical trials, a lot more needs to be done.  

Among the barriers to including more women in clinical trials were onerous paperwork involved in the consent process and cultural issues surrounding consent: if women must refer such decisions to a spouse or parents, this calls into question the process of informed consent. 

Neglected Diseases and Skewed Funding

Bias isn’t limited to gender issues — inequities also mark funding for research into various diseases. Some diseases get more funding than others, and those that concern women the most may be neglected.  

“In 2018 we saw $US 1.7 billion invested across these health issues … and, maybe unsurprisingly, the lion’s share of that — nearly 85% — went to HIV/AIDS,” said Andrew Tuttle, Policy Cures Research research director. Research is lacking about pregnancy-related conditions, and this slows development of drugs and technologies for pregnancy-related conditions.

Poverty-related neglected diseases are another neglected area. “The same disease might have different consequences on different genders or different sexes because of the role of women and girls in society or because of expectations towards different gender roles and so on,” said Lisa Goërlitz, DSW Brussels Office EU Advocacy Unit head.

She said there is almost no data on how these diseases affect LGBTQ+ community members.

Gender dimensions have significant impact on health outcomes depending on stigma and discrimination, as well as different financial and social outcomes.

Ajoke Sobanjo-ter Meulen, lead of Maternal Immunisation, Bill & Melinda Gates Foundation said that maternal immunisation can serve as an example for other health programmes

While stakeholders like manufacturers, policy-makers and communities can make a difference, women have made direct efforts to be included in research.
“Women’s autonomy and agency — I think that played a very important role. The Zika example and Ebola example are very critical here, because in both instances pregnant women demanded to be included in clinical trials, which initially did not happen,” said Ajoke Sobanjo-ter Meulen, maternal immunisation lead at the Bill & Melinda Gates Foundation.

Thanks to these milestones, subsequent outbreaks have seen pregnant women included in earlier stages of research.

The 74th World Health Assembly convenes under the theme: “Ending this pandemic, preventing the next: building together a healthier, safer and fairer world.”

Bold decisions are required to strengthen the World Health Organization and equip it with authority and resources it needs to address glaring shortcomings in pandemic preparedness and response, the 74th World Health Assembly was told on Tuesday.

Recommendations emerging out of a report by the Independent Oversight and Advisory Committee (IOAC) for the WHO Health Emergencies Programme were presented to the Assembly on Tuesday.  While the committee was supposed to focus on the WHO Emergencies response, as such, its criticisms of failings were more focused upon the insufficient lack of global political will to fight the pandemic, a lack of global solidarity and planning.

“Overall, IOAC is satisfied with the achievements made, and impressed by the [WHO] Secretariat as continuous efforts are made to implement the IOAC recommendations,” said IOAC chair Felicity Harvey in her presentation to member states. “And I would also like to recognize that Dr Tedros is committed to implementing our recommendations – and indeed some recommendations issued in this report are already being implemented as we speak. 

Those recommendations include more intensive work with Member States “to improve and clarify risk assessments, corresponding alerts, and empower IHR national focal points to take informed action”. In addition, she said the IOAC report found that WHO should review existing tools for “national and international preparedness,” as well as the use of travel restrictions in the pandemic context.

Other recommendations include strengthening of core WHO technical expertise and revising staffing and related grading processes, including clearer roles and responsibilities for the director-general, regional directors and other senior staff, with respect to emergencies.

However Harvey said the IOAC was also calling upon member states to review whether WHO had the strategic capacity to support country pandemic preparedness and if it had sufficient funding to lead multidimensional and large-scale emergencies like the COVID-19 pandemic.

“The world looks to WHO for guidance, but to serve that purpose WHO must be equipped with the necessary authority and resources to coordinate pandemic prevention and response. “

“IOAC will continue to hold WHO accountable, but Member States and partners must play their part as well, to help the Organization fulfil its role in protecting the health of populations across the world,” Harvey said. “Global health is truly a shared responsibility.”

Regarding the recent allegations of sexual harrassment and exploitation among WHO staff in the Democratic Republic of the Congo, the IOAC said it was concerned about the fact-finding process’s slow progress.

Two media recent reports have detailed allegations by women who said male aid workers responding to the Ebola crisis in the eastern DRC offered them jobs in exchange for sex.  In one report, a woman working as a nurse’s aide in northeastern Congo alleged she was offered a job from a WHO doctor at double her salary in exchange for sex. 

“We urge WHO to immediately implement preventive and response measures in areas that are potentially high-risk for sexual exploitation and abuse. The IOAC recommends that WHO conduct a cross-Organization review of the current tools, structures, processes and coordination mechanisms to prevent, mitigate and manage all potential risks linked to emergency operations for both staff and communities,” Harvey said.

‘WHO Strengthened Its Leadership Position’

IOAC chair Dr Felicity Harvey

Though the report exposes failings in pandemic preparedness and response, Harvey said the commitee found numerous examples of “global solidarity and collaboration, together with remarkable progress in research and development”.

“Despite the challenges faced, the report concludes that WHO has maintained, and indeed strengthened, its leadership position in the global response throughout the pandemic,” she said.

The IOAC also voiced support for WHO Director-General Dr Tedros Ghebreyesus, the public face of WHO efforts since the SARS-CoV-2 virus emerged in the Chinese city of Wuhan in late 2019. It said it was “deeply concerned by the high level of toxicity and incivility on social media against WHO and its personnel”.

“The Committee strongly condemns personal attacks against the Director-General and WHO staff members, and recommends that WHO build capacity to deploy proactive countermeasures against misinformation and social media attacks, and further invests in risk communication as an essential component of epidemic management.”

Reaction to Three Critical Reports

The report is one of three documents critically reviewing the global pandemic response – and the document most focused on WHO’s own emergency performance. The other two reviews were undertaken by the Independent Panel for Pandemic Preparedness and Response (IPPR) and the International Health Regulations Review Committee (IHRC). The Independent Panel report focused broadly on the failures of the global community and member states, although also with reference to WHO’s strengths and shortcomings.  The third report focused on the limitations of the current International Health Regulations, which comprise the legal framework governing emergency response. 

A number of member states welcomed the recommendations by the three reports and called for their immediate implementation.

South Africa said “business as usual can’t be an option anymore.” Meanwhile, the United States said it was ready to work with all WHA member states to translate recommendations into concrete change and tangible improvements.

Canada urged member states to “build coordinated, cohesive and efficient systems to respond to various recommendations to ensure actions don’t unintentionally result in further fragmentation, new structures or a fallout”, while Denmark called for further collaboration to safeguard critical societal functions. 

Mexico voiced its concern over the speed at which decisions are being implemented. Russia was also critical, saying not all conclusions and recommendations made by the commissions were “fully in line with an accurate analysis of the COVID-19 pandemic”.

Portugal, speaking on behalf of the European Union and its member states, urged the WHO to facilitate discussions among experts on all recommendations made by different commissions and report back to member states.

Image Credits: World Health Assembly.

Public health measures, including physical distancing, mask wearing, and hand hygiene, will continue to be necessary as the world is still in the “deepest part of this pandemic,” according to WHO officials.

The number of pandemic-related cases and deaths have rapidly accelerated in the first four months of 2021, said WHO officials on the second day of the 74th World Health Assembly – and despite sharp declines seen in almost every region over the four weeks, the situation remains “fragile.”

The “highly unstable” global epidemiological situation, combined with the slow global vaccine rollout, requires continued enforcement of public health measures worldwide, said Mike Ryan, WHO Executive Director of Health Emergencies. 

As of Tuesday, 167 million cases and 3.47 million deaths have been recorded since the beginning of the pandemic, although these figures are likely under-representative, according to WHO.

Cases have doubled since late December, and 2021 so far has seen a death toll of 1.6 million, compared to 1.82 million in all of last year.

Peaks in cases in all WHO regions were seen in late 2020 and into the first four months of 2021, fueled by increased social mixing, relaxation of public health measures, emergence of more transmissible SARS-CoV2 variants, and inequitable vaccine distribution. 

The rise in cases has burdened health systems, with ICUs operating at capacity and a shortage of beds, oxygen and therapeutics. 

“Recent weeks have shown an overall decline in reported cases, but the global situation remains fragile and volatile, with significant outbreaks in countries across all regions of the world,” said Ryan.

The global number of new weekly COVID-19 cases since the beginning of the pandemic, separated by WHO region.

According to the WHO COVID dashboard, sharp declines were reported in the past two weeks. As of May 17, new cases weekly appeared to have declined to 4.19 million globally – as compared to a peak of 5.69 million at the all-time pandemic peak on April 26.

This past week has seen the number of new cases drop further to roughly one million, according to WHO figures. However, the data may be incomplete as of May 24.

Despite the high numbers of deaths cumulatively – amounting to 3.5 million deaths so far reported to WHO and possibly far more in terms of unreported deaths – overall mortality rates also have declined over time. Ryan attributed that to earlier clinical care, effective use of oxygen and the steroid dexamethasone, and the fact that more health systems have gained experience in treating COVID cases, including during surges.  

The proportion of critically ill COVID-19 patients that died declined from nearly 40% early in the pandemic to approximately 16%.  

Public Health Measures Remain Essential to Curb Transmission

Although countries have learned from a year of experiences with containing the virus, contact tracing, and treating severely ill patients, the world remains “in the deepest part of this pandemic,” Ryan said. 

“Current estimates suggest that over 80% of our communities need to have immunity to stop or interrupt transmission. However, data from serologic studies around the world indicate that no countries have acquired this level of natural immunity. A substantial proportion of the world’s population remains susceptible to infection,” Ryan said. 

While COVID-19 vaccines could close the immunity gap, their distribution continues to be uneven and unfair. Some 83% of the 1.6 billion doses administered globally have been used in high- and upper-middle-income countries, which account for just half the world’s population. 

The difference in the number of doses administered per 100 people between high-income and low-income countries is more than 75-fold.

Now, however, countries that have conducted rapid an intensive vaccination campaigns – such as Israel, the United Kingdom and the United States – are seeing the rollout begin to slow – as all of those wishing to be vaccinated have done so.

Approximately 62.9% of Israel’s population have received at least one dose, but the country’s daily vaccines administered per 100 people dropped from 2.14 in late January to 0.05 in late May. 

Those countries have also seen very sharp declines in cases. However Ryan cautioned against over-optimism about what vaccines could achieve more broadly in light of the slower vaccine rollouts going on elsewhere – and the ongoing dearth of vaccines in many low- and middle-income countries.

As a result, “it is unlikely that many communities will achieve the very high levels of herd immunity required to control transmission anytime soon,” said Ryan. 

Public health measures that are the mainstay in controlling transmission will thus continue to be critically important for months to come. These include physical distancing, mask wearing, hand washing, robust testing, contact tracing, quarantining, and clinical care of cases. 

“We must stay the course while striving to increase vaccination coverage,” Ryan said. “Continuing to suppress viral transmission and dissemination is vital everywhere, regardless of vaccination rates – and is all the more critical given that the SARS-CoV2 virus continues to evolve.”

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

Currently, four variants of concern and six variants of interest are being monitored and examined for links to heightened transmissibility, more severe disease, and reduced vaccine efficacy. 

Evidence suggests that the available vaccines remain effective against the variants of concern, and that public health measures are able to control the variants’ spread. 

Short-term priorities include implementation of effective public health measures and enhanced national, regional and global surveillance and monitoring. Over the medium term, production and equitable distribution of vaccines, therapeutics and diagnostics need to be scaled up, and health systems’ resilience and capacities should be strengthened.

WHO Pandemic Initiatives Facing Funding Shortage

The Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to speed up the development and distribution of diagnostics, therapeutics and vaccines, faces a US$18.5 billion financing gap. 

The ACT Accelerator is poised to deliver over two billion vaccine doses, 900 million rapid tests, and 100 million treatment courses in the coming year if funding challenges are overcome, said Dr Bruce Aylward, Accelerator lead and senior advisor to the director general. 

The diagnostics, vaccines and therapeutics delivered by the ACT Accelerator over the past year.

The COVAX Facility, one pillar of ACT-A, has shipped 72 million doses to 123 countries; 32 of those countries were only able to start their vaccination campaigns due to COVAX. 

“There’s no question that COVAX works. The challenge is getting the vaccines into the facility through the cooperation and support of countries and companies to be able to address the increasing inequity in distribution,” Aylward said. 

The equity gap extends beyond vaccines to tests and treatments, with high-income countries conducting 125 times more tests per day than low-income countries. 

“If you can’t see the virus, you can’t manage your outbreak, and you can’t understand the gravity of the situation – until it’s too late and you’re faced with catastrophic consequences,” Aylward said. 

Low- and middle-income countries, including India and Brazil most recently, have an oxygen shortage of 3.3 million cylinders per day currently needed to treat COVID-19 patients. 

“Inequities are prolonging the impact and duration of the pandemic,” said Ryan. “Urgent action is required not only to address inequitable access to health care and to vaccines, but to ensure that countries have the capacity to translate vaccines into vaccination, diagnostics into effective surveillance, and therapeutics into treatment.”

Nearly US$14.6 billion has been pledged to ACT-A, but the funding gap will have to be closed to carry out procurement and equitable rollout of critical tools. 

“Without that financing, we are unable to manage the response, roll out the vaccines, ensure we are testing, keep health care workers safe with PPE [personal protective equipment], and treat those with severe disease with oxygen and steroids,” Aylward said. “With financing alone, we cannot access doses because the vast majority are contracted through the end of this year.” 

Dr Bruce Aylward, Senior Advisor to the WHO Director General and lead for the ACT Accelerator.

Integrating and Financing WHO’s Pandemic Plan is Next Step in Closing Equity Gap

Fully funding and integrating WHO’s COVID-19 Strategic Preparedness and Response Plan for 2021, which was launched in February, within ACT-A will be crucial for the delivery of COVID products, stressed Aylward.

The Strategic Preparedness and Response Plan translates the knowledge from the global response to the pandemic in 2020 into strategic actions and guides coordinated measures. The Plan for 2021 is requesting US$1.96 billion to fund WHO’s efforts to end the acute phase of the pandemic. 

“If we want to expand now from the product development work, which has been so successful, to in-country delivery work, there has to be a strong WHO coordinating capacity,” said Aylward.

“We have the tools, [now] we got to have the capacity to support in-country uptake and use,” Aylward added.

The Plan currently has a funding shortfall of over 70%, which leaves “the organization in real and imminent danger of being unable to sustain core functions for urgent priorities,” said Ryan. 

More than 90% of the US$576.1 million received by WHO have been earmarked and just 8% of the funding is flexible. 

“This underfunding and earmarking of funds risks paralyzing WHO’s ability to provide rapid and flexible support to countries and is already having consequences for current operations,” said Ryan.

Some member states supported and joined the call for more flexible funding at a World Health Assembly session on Tuesday.

“We urge the member countries to consider predictable, sustainable and unearmarked financing to enable WHO to deliver on the functions entrusted to it under the International Health Regulations 2005,” said Shanchita Haque, Bangladesh’s delegate.

Shanchita Haque, Deputy Permanent Representative at the Permanent Mission of the People’s Republic of Bangladesh to the United Nations.

“Sweden remains a strong supporter of unearmarked funding to WHO and calls on member states to take responsibility,” said Sweden’s delegate. “We cannot expect WHO to deliver extensively without the means to do so.”

Member States Called Upon to Donate Doses 

The sharing of doses will be a crucial part of WHO Director General Dr Tedros Adhanom Ghebreyesus’ plan to vaccinate a quarter of a billion more people in the next four months, which he laid out in his opening remarks at the World Health Assembly. 

“Today I am calling on Member States to support a massive push to vaccinate at least 10% of the population of every country by September, and a ‘drive to December’ to achieve our goal of vaccinating at least 30% by the end of the year,” said Tedros on Monday.

Some 10 countries have recently announced plans to share over 150 million doses, but more will be needed in May and June to reach the goal by September, Aylward said. 

Image Credits: Flickr: IMF Photo/Joaquin Sarmiento, WHO.

Healthcare workers in Nigeria fight to maintain vaccination services during the COVID-19 pandemic.

 

Key World Health Organization (WHO) member states agreed to postpone a potentially polarising discussion on a ‘pandemic treaty’ until November, according to a World Health Assembly ‘draft decision’ published Tuesday.

The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – specifies that a special WHA session should be “dedicated to considering the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response”.

This special WHA would establish “an intergovernmental process” to draft and negotiate this instrument, “taking into account the report of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies”. 

Previously, the US had advocated for a high-level ministerial meeting to consider the possibility of an international instrument or treaty.

Late Tuesday afternoon, Germany delivered a statement on behalf of 59 countries that now support the  special session of the WHA in November to discuss a possible pandemic treaty.

“In our view, a pandemic treaty under the roof of the WHO is the preferred way forward to strengthen the multilateral health architecture,” said Germany in the statement.

Mike Ryan, WHO Health Emergencies Programme Executive Director, appealed Tuesday for “the highest-level political commitment” to address the organisation’s weaknesses in the face of pandemics. 

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

Reciting a lengthy list of epidemics that had ended with unmet promises to fix global responses, Ryan said, “If I had a dollar for every recommendation made in this space, I would have a completely funded programme.”

“My personal view is that we need a political treaty that makes the highest-level commitment to the principles of global health security — and then we can get on with building the blocks on this foundation,” Ryan told a lunchtime briefing on pandemic preparedness.

Since November the European Union has advocated a pandemic treaty similar to the Framework Convention on Tobacco Control, but has faced opposition from the US, Russia and Brazil. (The tobacco convention provides signatories with evidence-based tobacco control strategies that they are obliged to implement, albeit incrementally.)

Russia’s WHA representative told Tuesday’s plenary that there was no need for additional requirements beyond the International Health Regulations, as these are binding global regulations to prevent the spread of disease.

US public utterances have been vague, although an earlier Health Policy Watch report indicated the US was trying to stall discussions by proposing various diplomatic measures such as a high-level ministerial meeting to consider setting up an “international instrument”.

US Health and Human Services Secretary Xavier Becerra

Addressing Tuesday’s plenary, US Health and Human Services Secretary Xavier Becerra called for “urgent action this year to strengthen health security and pandemic preparedness” by “improving global triggers.” 

Measures should include a “sustainable global health security financing mechanism” and developing “surge capacity” for global manufacturing of personal protective equipment, vaccines, therapeutics and diagnostics, said Becerra.

However, comments from various US officials during the Assembly indicate that the country is concerned about the financial responsibilities attached to any legal framework, which might be difficult to get domestic support for.

EU Upbeat About Pandemic Treaty

Meanwhile, the EU delegations to the United Nations in Geneva were positive about the draft decision.

“Ahead of the World Health Assembly, the EU and a group of countries from across all WHO regions built a large coalition to ensure that WHA74 would pave the way for establishing a process for a Framework Convention on Pandemic Preparedness and Response,” according to a statement from the EU delegations.

“The decision to be adopted today by the Assembly will set up a special session of the WHA in November 2021 to focus on this one issue with a view to starting the formal negotiation process immediately thereafter.”

Also Tuesday, Charles Michel, President of the European Council, reiterated the EU’s call for an international treaty to “foster a comprehensive approach to better predict, prevent and respond to pandemics, strengthen global capacity and resilience to ensure fair access to medical solutions, and bolster international alert systems that are sharing … cutting-edge medical research.”

Three Perspectives on WHO Inadequacies

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

Three key reports – from the Independent Oversight and Advisory Committee (IAOC), the Independent Panel for Pandemic Preparedness and Response (IPPR), and the International Health Regulations Review Committee (IHRC) – have laid bare various WHO failures in the face of COVID-19.

The IPPR presented its report to the WHA on Tuesday. This team was led by former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Sirleaf. Clark told Tuesday’s technical briefing the panel “has recommended the adoption of a pandemic framework convention within six months, using powers under Article 19 of the WHO constitution”. 

“We see the convention as being complementary to the International Health Regulations,” Clark said. “We think its negotiation should be facilitated by the WHO, with involvement at the highest levels of that negotiation of governments, scientific experts and civil society.”

This convention would fill gaps in the current legal framework, clarify the responsibilities of states and international organisations, reinforce states’ pandemic-related measures and support WHO’s empowerment, she said. 

It also would set up principles and mechanisms for financing preparedness and early response, and for the “global public goods of vaccines, therapeutics, diagnostics, and essential supplies and technology transfer.”

More pointedly, Clark noted that “WHO needs to have unfettered access to the sites of an outbreak, and it shouldn’t need to go through a negotiated process to get there.”

IHR review co-chair Lucille Blumberg said her committee also supports a pandemic treaty to address regulatory gaps that “mostly concern detection, assessment, and alert provisions, as well as preparedness for core capacities. … There are other elements required for a comprehensive global architecture for emergency preparedness and response which seem to fall outside of the IHR. 

“This has made us consider there may be benefits in agreeing on a global legal mechanism that would outline such provisions while supporting and complementing IHR implementation — and this could be done through a pandemic treaty,” Blumberg said.

Image Credits: Twitter: @WHOAFRO, WHO.

Front line healthcare workers at Thailand Bamrasnaradura Infectious Disease Institute faced workforce shortages and had limited access to personal protective equipment as violence against healthcare workers worsened globally.

An unprecedented number of healthcare workers were seriously assaulted last year, even as health workers risked their lives on the front lines of the COVID-19 response. 

Over 412 COVID-related attacks on health workers, including kidnappings and murders, occurred between January and December 2020, experts reported at a World Health Assembly side event. The session Monday was co-organized by the Global Health Center; the Safeguarding Health in Conflict Coalition; the Swiss Confederation; and the Government of Spain. 

Panelists said that as most countries went into lockdown last year, public frustration, anger and anxiety fuelled violence against health workers worldwide. 

Violence against health care in the context of the COVID-19 pandemic in 2020. Reported COVID-19-related violence (in green) peaked in the early weeks of the pandemic and has since fallen.

The majority of perpetrators of pandemic-triggered violence were patients and their family members, or local community members. In 59% of cases, violence was triggered by opposition to COVID diagnostic testing or a decision to hospitalize a patient, said a “Threats and Violence against Health Care during the COVID-19 Pandemic” report by Insecurity Insight.

Healthcare workers faced abuse while traveling to and from work in 30% of cases. In 11% of incidents, health workers were threatened or injured for speaking out against challenges they experienced at work, including protests over the lack of personal protective equipment and masks. 

“Sadly, these violations in dozens of countries and situations of conflict are the new normal. And this normal is not acceptable,” said Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights. 

Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights.

“It is especially unconscionable during the time of a global health crisis, the COVID-19 pandemic, which compounds the situation of devastation from attacks on health in war and other situations of conflict,” Sirkin added

While generally there were fewer assaults in 2020 compared to previous years, the nature of the events became more severe, with an increase in the number of health workers killed and kidnapped. 

Assaults on Health in Conflict Situations

Beyond COVID-related attacks, deeply-entrenched patterns of violence against health workers in conflict-ridden countries also continued. 

This included attacks on health workers and destruction of health facilities associated with the ongoing conflicts in Libya and Yemen – which continued despite the UN Secretary’s call for a ceasefire due to the pandemic. 

The Central African Republic, plagued by armed conflict, social unrest and political instability, also has seen a high proportion of health facilities destroyed or rendered non-functional.

“Killings, assault, kidnapping, verbal threats and overt acts of intimidation against healthcare workers are commonplace,” said Minister of Health Pierre Somse. 

Pierre Somse, Minister of Health of the Central African Republic.

He said that in the country, the number of attacks against healthcare workers rose 79% from October 2020 to February 2021.

The Central African Republic has one of the world’s lowest physician-to-patient ratios and among the highest rates of maternal and infant mortality. 

In one district in the Central African Republic with high levels of violence against health personnel, tuberculosis vaccination rates also dropped to 45%, as compared to the national average of 81%. 

“Conflict and violence against healthcare workers is worsening inequality and inequities in access to health services,” said Somse. “Addressing all forms of violence against healthcare workers in conflict settings is an urgency. It is needed today more than ever, as we confront COVID-19.”

Trends in Violence Against Health Workers for 2021 

Over the past five years, a health facility in a conflict zone was destroyed or severely damaged every other day, on average. Every two days a health worker was kidnapped or injured, and every three days a health worker was killed. At least 600 health workers were killed and over 1000 health facilities were damaged. This violence was concentrated in Syria, Nigeria, Afghanistan and the Democratic Republic of Congo. 

“Where does this leave us for this year? I’m afraid the picture doesn’t look good,” said Christina Wille, Director of Insecurity Insight, a Geneva-based NGO. “I’m afraid we’ll probably be here next year again with a report that has a few little positive notes to report.”

In 2021, increasing attacks on healthcare workers were witnessed and reported in Tigray, Gaza, and in Myanmar. In Myanmar, there were over 500 arrest warrants issued against healthcare workers since the coup in February.

Barely a day has gone by without violence against health workers being reported in Myanmar. Some 19 health facilities were damaged in Gaza over the past two weeks, including its main COVID-19 laboratory. 

“It seems that whenever there’s violence, it’s accompanied by violence against healthcare,” said Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition. 

Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition.

The violence is sometimes the collateral damage associated with larger strategic objectives. Other times it is an end in itself, as in Afghanistan, where the Taliban forces closures of health facilities in order to exert their leverage over health services. Health workers are sometimes punished for providing care to enemy combatants, although occasionally the violence is a result of recklessness, said Rubenstein.

Actions Needed by States, the UN and WHO

This month marks five years since the United Nations Security Council adopted a resolution against attacks on health workers in situations of armed conflict. On this anniversary, little progress has been made on implementing the resolution and reducing violence. 

“A few states have demonstrated their commitments and followed through on them, but these unfortunately are exceptions,” said Rubenstein.

The resolution was prompted by the 2015 US bombing of the Kunduz Trauma Center in Afghanistan, operated by Médecins sans Frontières, which killed 42 patients and health-care workers. 

An operating room in the Kunduz Trauma Center in Afghanistan, operated by Médecins Sans Frontières, that was destroyed in a US airstrike in 2015.

“In the darkness of the night, my hospital was on fire and I was hearing the screams of patients, caretakers, and staff for help. No one could help them. And all of them, the ones who had been trapped inside, died,” said Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

“I have seen terrible consequences of attacks on healthcare: patients and medical personnel directly killed and injured, and essential in life saving medical services lost for current and future patients,” said Nasim.

Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

Calling for Five Concrete Steps by Global Community

“After five years of inaction, the international community must take a much more vigorous stance,” said Rubenstein.  He laid out five concrete steps to be taken by the international community:

  • A special representative of the UN Secretary General should be appointed to monitor and report on the compliance of states with the resolution;
  • Political leaders must demand that ministers of defense get involved in reforming operational procedures and protecting healthcare;
  • WHO should convene health ministers to address the issue of violence against health workers at the ongoing 74th World Health Assembly;
  • WHO must take action to address the underreporting of data collected on violence against healthcare;
  • States and the UN must stop taking actions that undermine protection and legitimize violence against healthcare.

Multiple times over the past five years, the Security Council has blocked referrals to the International Criminal Court. In response, the General Assembly should establish new tribunals to prosecute perpetrators. 

Additionally, member states that sell arms to perpetrators of violence against healthcare must start adhering to laws prohibiting such sales. 

“These five steps take commitment and political will,” said Rubenstein. “We don’t want to meet in another five years and have the same discussion.”

“We all have a role to play in preventing these terrible events, which continuously reduce and impair the capacity of the impact of healthcare systems around the world,” said Maciej Polkowski, Head of the Health Care in Danger Initiative at the International Committee of the Red Cross. 

“The very least we can ask is that people stop attacking medical facilities and healthcare workers who are trying to save human lives,” said Nasim. “It must stop.”

Image Credits: Global Health Center, UN Women Asia and the Pacific.

Receiving a shot of insulin to help control diabetes.

A draft resolution on expanding prevention and treatment for diabetes now appears set for approval at this week’s World Health Assembly – after a number of European countries, as well as the US, removed their opposition to language mandating the World Health Organization to develop targets for expanded diabetes treatment – as well as measures encouraging greater price transparency in the insulin market. 

The resolution awaiting formal approval asks the WHO Director General to assess “the feasibility and potential value of establishing a web-based tool to share information relevant to the transparency of markets for diabetes medicines, including insulin, oral hypoglycaemic agents and related health products, including information on investments, incentives, and subsidies.”

The resolution also asks the Director General to make: “recommendations for the prevention and management of obesity over the life course, including considering the potential development of targets in this regard, and to submit these recommendations to the Seventy-fifth World Health Assembly for its consideration in 2022.”

The draft resolution’s overall goals include promoting “access to diagnostics and quality, safe, effective, affordable and essential medicines, including insulin, oral hypoglycaemic agents and other diabetes-related medicines and health technologies for all people living with diabetes, in accordance with national context and priorities.” 

The resolution’s language also recognises “the importance of international cooperation in support of national, regional, and global plans … including to increase access to treatment such as insulin.” 

Norway Pushed for Even Stronger Language – But Supported ‘Compromise’

Checking blood sugar levels in Kenya for control of diabetes

Obtaining WHA approval for a strong resolution on diabetes – a condition that goes massively undetected and untreated around the world – has been a focus of activity among civil society groups, low- and middle-income countries – as well as some high-income countries such as Norway.

Sources said that Norway had pushed for even stronger language on a price-reporting mechanism, but that what was achieved was a “good compromise.”

Speaking at the WHA’s opening session on Monday, Tonje Borch, senior advisor in Norway’s Minister of Health, expressed strong support for the resolution, suggesting that Norway would like to go even further: “we also strongly support a global price reporting mechanism for insulin – there is clearly a need for more transparency and lower prices will save lives.

“Prices of many new medicines are high, and secret. Lack of transparency is undermining public trust in our health systems. In the case of the Covid-19 vaccines, we have seen that increased transparency is possible and positive. The pandemic encourages us to reflect on the business models and collaborations that have emerged during the pandemic. To achieve the goal of increased transparency, we need to collaborate, both with national health authorities, international organizations and industry. We have a momentum. Now is the time,” Borch said.

In follow-up remarks to Health Policy Watch, Norway’s Minister of International Development, Dag-Inge Ulstein said: “This resolution is important for Norway, since we know that large-scale global efforts to combat diabetes as well as the other NCDs could save millions of lives, contribute to healthier populations and economic growth. This is crucial for achieving the sustainable development goals. This is in line with Norway’s strategy for combating NCDs as a part of our development policy, which was launched in 2019.”

“The high price of insulin today is one of the main reasons for the high death toll of diabetes. We strongly support a global price reporting mechanism for insulin – there clearly is a need for more transparency,” Ulstein added. 

“Such a mechanism would hopefully contribute to bringing the prices down. We are aware that the retail price may be as high as ten times the production costs (“net prices”). In Norway, people with diabetes can live well with their disease, since they have access to affordable insulin. This may not be the case for a poor family in Malawi, having a child with diabetes Type 1 and not being able to provide life-saving insulin. Or having to choose between life-saving insulin for one child or food for the other.”

Civil Society Made Strong Push For Resolution’s Approval 

Dr Helen Bygrave, Médecins Sans Frontières’ (MSF) Access Campaign’s chronic diseases advisor, said she was delighted to see countries like Canada, Brazil and Chile join 19 others in supporting the resolution, which is being led by the Russian Federation. 

“Importantly, the resolution calls for establishing a database to improve the transparency around the price of diabetes medicines, including insulin,” said Bygrave. 

“Insulin is one of the most expensive products in diabetes care, and there is an urgent need to expand access to affordable insulin through price transparency, as well as supporting the harmonisation of regulatory requirements for quality-assured insulins, including biosimilars,” she said.

Currently 420 million people are living with diabetes worldwide. This number is estimated to rise to 578 million by the end of this decade.

An estimated nine million people with type 1 diabetes require insulin to survive and around 60 million people with type 2 diabetes require insulin to manage their condition. Globally, about half of those needing insulin have irregular or no access to it. 

Developed and developing countries differ greatly in diabetes resources available to their populations. As four out of five adults with diabetes live in low-and middle-income countries, these inequalities have huge public health impacts. 

In sub-Saharan Africa, the life expectancy of a child with type 1 diabetes can be as low as one year due to the lack of access to the drug.

Even in developed countries like the United States, high insulin costs mean that many who need the drug don’t get it. 

Three companies — Novo Nordisk, Sanofi, and Eli Lilly — control more than 90% of the global insulin market – a monopoly that leads to unaffordable prices for diabetics in many countries – including even some in high-income countries. The remaining share of the global insulin market is split among approximately seven other insulin manufacturers.

MSF has said that insulin often is not available in public health facilities or private pharmacies in many of the 70 countries worldwide, in which the organisation is active.

To make matters worse, in April 2020, at the peak of the first wave of the COVID-19 pandemic, several countries in Europe also banned the export of insulin fearing that lockdowns would lead to increased insulin demand and shortages, and also possibly disrupting supply chains in other areas. 

People living with diabetes also have a higher risk of becoming severely ill or dying from COVID-19, and are thus among those most impacted by the COVID-19 pandemic. 

Need for targets

Nina Renshaw, policy and advocacy director of the NCD Alliance, also hailed the resolution as evidence of significant progress. 

“It has been through lengthy negotiations for quite a while,” she said. While she said the resolution’s mandate for WHO to develop targets on combating diabetes, don’t specifically mandate the development of a target on access to insulin, she hopes this will change: 

“It is a step along the way in the conversation. We would hope there are ambitious targets around insulin developed in time.”

MSF’s Bygrave also criticized the lack of targets for insulin access as such, saying her organisation would like to see more explicit targets related to global diabetes goals.

“We should be moving towards the more actionable 90-90-90 approach for diagnosis, treatment and control, as outlined in WHO’s Global Diabetes Compact,” she said.  The Compact, launched by WHO and the Government of Canada at a Global Diabetes Summit in April 2021, set broad global goals for addressing the diabetes problem worldwide – but it lacked the official stamp that a WHA resolution endorsed by all 194 member states would provide.  Launch of the Compact coincided with the 100th anniversary of the discovery of insulin.   

 

 

 

 

 

Image Credits: WHO.

Keva Bain of the Bahamas and WHO Director General Tedros Adhanom Ghebreyesus

Strengthening the World Health Organization’s pandemic response is a key focus of the 74th World Health Assembly, which started on Monday – and WHO Director General Dr Tedros Adhanom Ghebreyesus has already secured agreements with powerful European member states to do just that.

WHA discussion on a report from the Independent Panel on Pandemic Preparedness is expected on Tuesday., which details the slow, antiquated pandemic response mechanisms of the under-resourced global body. 

To bolster international pandemic surveillance, Switzerland will provide a biosafety laboratory in Spiez for a WHO BioHub Facility. This laboratory will share pathogens with global laboratories and other partners, according to a WHO announcement Monday.

“The facility will serve as a centre for the safe receipt, sequencing, storage and preparation of biological materials for distribution to other laboratories, in order to inform risk assessments and sustain global preparedness against these pathogens,” the announcement said.

Swiss Health Minister Alain Berset addressed the WHA opening session, expressing support for “predictable, independent funding” for the WHO and a pandemic treaty to “enhance and strengthen the role of the WHO, and also to ensure better implementation of the International Health Regulations.”

Meanwhile, French President Emmanuel Macron announced that a WHO Academy to train health workers would open its doors in Lyon in 2023. Macron also stressed the importance of ensuring that the WHO’s funding  was “more sustainable, more predictable, and less dependent on several big donors”.

In addition, said Macron, WHO needs “rapid response missions” with access to all territories to investigate pathogens that might lead to a pandemic. This follows unhappiness with how long it took China to admit a WHO-led team into Wuhan to research the origin of SARS-CoV2.

German Chancellor Angela Merkel expressed her country’s support for a pandemic treaty as well as a Global Health Threats Council to monitor member states’ adherence to international health regulations. Earlier this month, Germany and the WHO announced the establishment of a global hub in Berlin to gather data on pandemics and epidemic intelligence.

German Chancellor Angela Merkel

Push to Vaccinate 10% by September

When Tedros addressed the assembly, he was characteristically frank: “There is no diplomatic way to say it: a small group of countries that make and buy the majority of the world’s vaccines control the fate of the rest of the world.

“The number of doses administered globally so far would have been enough to cover all health workers and older people, if they had been distributed equitably,” he added. “We could have been in a much better situation.”

He then appealed to all member states to “support a massive push to vaccinate at least 10% of the population of every country by September, and a drive to achieve our goal of vaccinating at least 30% by the end of the year.” 

United Nations Secretary-General Antonio Guterres described the COVID-19 pandemic as bringing a  “tsunami of suffering.” He noted the costs of 4 million lives, 500 million jobs and trillions of dollars in economic and industrial impacts.

Guterres reiterated his call made at Friday’s G20 Global Health Summit for a task force that “brings together all countries with vaccine production capacity, WHO, ACT Accelerator, its partners and essential financial institutions able to deal with the pharmaceutical companies”.

The aim, Gutteres added, would be to double global vaccine production by exploring “all options — from voluntary licences and technology transfers to patent pooling and flexibility for intellectual property rights”.

South African president Cyril Ramaphosa, who also co-chairs the ACT Accelerator, decried the “huge divide in the provision of COVID-19 vaccines… [M]illions of people in wealthier nations have been vaccinated while billions of people in poorer countries still wait & are vulnerable to infection.”

Ramaphosa also expressed support for a global health council to collaborate with WHO to support regional and national pandemic response mechanisms.

Appeal for Travel Restrictions to be Eased

Meanwhile, Prime Minister of Antigua and Barbuda Gaston Brown stressed how difficult it was for small island states that suffered massive economic losses to buy vaccines through COVAX because they were deemed middle-income countries. Brown appealed for access to COVAX vaccines to be relaxed, and for travel restrictions and access to be eased.

Reiterating Spain’s commitment to sharing vaccines with Latin American countries, the country’s Prime Minister, Pedro Sanchez, proposed a public-private partnership between airlines, governments and international organisations to facilitate vaccine distribution.

Dechen Wangmo, Minister of Health of Bhutan

Dechen Wangmo, Minister of Health of Bhutan, was elected president of the WHA, which is the main governing body of the WHO, and will steer the complex discussions until the assembly ends next Tuesday. 

Over 70 health issues are on the agenda, from COVID-19 response and preparedness to mental health; patient safety; non-communicable diseases; antimicrobial resistance; health workforces; laboratory biosafety; violence against women, girls and children; finances; and the health-related 2030 Sustainable Development Goals.

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

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

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

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

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

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

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

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

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

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

Observers perplexed by US stance 

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

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

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

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

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

Text Supported By Pandemic Treaty Proponents   

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

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

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

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

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

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

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

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

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

OP 1. DECIDES 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Broad in Scope 

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

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

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

Evergreen, Elastic Vaccine Manufacturing Capacity – Keys to Practical Success

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

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

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

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

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

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

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

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

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

More Transparency Needed

Jamie Love, Director of Knowledge Ecology International

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

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

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

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

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

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

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

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

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

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

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

Scotland’s Fight Against Alcohol Abuse

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

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

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

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

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

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

Stop Incentivising Unhealthy Commodities

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

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

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

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

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

Public Health Policies Save Lives

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

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

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

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

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

Image Credits: rawpixel/unsplash.