The World Health Assembly in Geneva in May 2018. Next week’s special session will be held virtually – like all sessions since the pandemic began.

As pandemic treaty negotiations kick off again at the World Health Organization (WHO) in Geneva this week, countries face a stark choice. Will they decide to move ahead on a new system that vests an independent entity with greater powers to monitor their own national alert and responses – in the name of faster pandemic response for everyone?

The initiative to create a new pandemic treaty to redress the key weaknesses seen in the global response to COVID-19 is enjoying a flurry of last minute support from countries and global health advocates ahead of a World Health Assembly special session, starting Monday that takes up the issue formally.

“The ongoing chaos of this pandemic only underlines why the world needs an ironclad global agreement to set the rules of the game for pandemic preparedness and response,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in a media briefing in this week’s lead-up to the milestone moment. 

Over 100 countries are now backing the treaty initiative, initially championed by Germany, the  European Union and the United Kingdom but also supported by key countries in Latin America, Asia and Africa, such as Chile, Kenya, Rwanda, Korea and Thailand.  

In a draft decision circulating Sunday evening, the United States and a number of other former treaty skeptics had joined as co-sponsors – including India, Japan and Pakistan.  Their co-sponsorship, along with all 54 member states of the African Group, suggests good prospects for passage of a WHA decision that would kick-start intergovernmental negotiations no latter than 1 March 2022.  China and Russia, however, were noticeably absent as co-sponsors of the draft text.

According to the official WHO version of the draft WHA text, entitled “Our World Together”, an intergovernmental negotiating body would be created and commissioned “to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response.” The negotiations would aim to conclude a draft agreement by May 2024, in time for the 77th World Health Assembly, which would then have to be approved by a two-thirds majority, said the official draft, released on Saturday.

The fact that the United States had signed onto the draft decision to launch negotiations represents a significant softening of its previous opposition, observers said.  Although Washington continues to have qualms about getting behind a new instrument featuring legally binding rules that would provide a carte blanche entry for treaty enforcers to enter sovereign states to investigate and monitor compliance, western diplomats in Geneva told us on Friday.  

Among the aye-sayers, strong public statements of support were registered last week in: a BMJ op-ed by 32 ministers of health; as well as appeals by the former co-chairs of the Independent Panel for Pandemic Preparedness and Response (IPPR); and another ad-hoc Panel for a Global Public Health Convention, to name just a few. 

“There’s now a groundswell of support,” said Dame Barbara Stocking, former head of Oxfam Great Britain and leading voice in the latter, in an interview. She cited three “fundamental problems” with the existing International Health Regulations, drafted nearly two decades ago: 

“There is no compliance mechanism. The IHR was written for all health hazards and not for all pandemics, while the problem with pandemics is that they have exponential growth. You can’t wait and see what happens. And the whole precautionary principle is not there.”

Analogue process in a digital era 

 The Independent Panel, in a report earlier this year, called current alert processes “analogue” measures that aren’t at all fit for purpose in a digital age. Specifically, the IHR regulations: 

  • Don’t explicitly require countries to notify WHO of new and emerging pathogens of concern – unless national health authorities have determined there is “significant risk of international spread” and/or “significant risk of international traffic or trade restrictions.”  Under those vague criteria, China in fact, had no clear obligation to notify WHO of the “novel coronavirus” circulating in Wuhan, when they did in early January 2020;

    The IHR “decision” tool doesn’t actually require country’s to notify WHO about unknown pathogens, until they have been deemed to pose international contagion and travel risks.
  • Lack any clear mechanism for monitoring, reporting or verification of countries’ preparedness and response. In fact, the word “monitoring” only appears two times in the IHR text with respect to monitoring the individual arrivals of individuals or freight at country borders;  
  • Lack clear reference to obligations for pathogen-sharing essential for rapidly developing treatments. Treaty sceptics, however, say the Nagoya Protocol of the Convention on Biodiversity provides a framework for such pathogen sharing along with the sharing of research benefits, such as new vaccines.

Emerging out of the era of the first SARS outbreak in 2002-03,  a more deadly but less contagious virus, the IHR also is highly preoccupied with curbing countries’ excessive use of penalising travel restrictions. 

In contrast, in the SARS-COV2 era, much higher volumes of international travel proved to be one of the most efficient spreaders of a more contagious virus, critics say. Any pandemic treaty or instrument negotiated today would need a more fine-tuned approach – so that critical trade and supply chains remain open – but new viruses or variants are better contained. 

International tourism travel 1950-2020. Travel doubled between 2004 and 2019, before crashing in 2020

The Pandemic Treaty – infringing on sovereignty? 

Former Liberian President Ellen Johnson Sirleaf (left) and Former New Zealand Prime Minister Helen Clark (right), co-chairs of The Independent Panel presented a second report on Monday, 22 November, calling for quick action on a Pandemic Treaty or Convention

Whether the new instrument is called a “treaty” or a framework convention, such as the Framework Convention for Tobacco Control, treaty supporters envision a tough new legal framework to address fault lines laid bare by the current pandemic.  Treaty skeptics say those weaknesses could be addressed by revisions in the existing IHR;  supporters say revisions would not be enough to address more fundamental flaws with the IHRs. 

For example, compliance with the IHR is managed directly by the WHO. Under a new Global Health Treaty, or Framework Convention, monitoring and verification of treaty compliance could be administered at “arms-length” by a Treaty Secretariat – with fewer of the political pressures and concerns that can hobble WHO’s work with countries. 

“WHO has to remain as the normative body and the standard setter,” asserted Stocking, “But WHO also has to be a friend of all of the countries. And it’s very hard to be that friend, and also to do serious monitoring and inspection.” She said the International Atomic Energy Agency offers an example of the kind of independent monitoring function that a treaty could spawn.   

A new global health treaty, or framework convention, moreover, could also be multifaceted, including protocols to address issues of access and equity that the existing IHRs do not even broach, she and other proponents hasten to add. 

Those protocols could also involve the creation of more formalized finance and institutional mechanisms for vaccine and medicines sharing with low-income countries that have been so lacking dudring the current crisis. 

That is the vision of New Zealand’s former Prime Minister, Helen Clark, former co-chair of the Independent Panel (IPPR). Clark and her former co-chair, Liberia’s Ellen Johnson Sirleaf, urged faster action on a pandemic treaty  in new appeal published Monday, six months after their original report.

Despite the many advantages proponents cite, there remain major sticking points. 

Skeptics, including the United States, continue to be highly wary of the same legally-binding  treaty components about which advocates are so enthusiastic. These same monitoring and compliance mechanisms raise complex concerns about the potential ways in which a treaty might infringe on national sovereignty, in matters of public health. 

And reportedly, the US is not alone.  Other major nations, including both American allies like India and Japan, as well as rivals like China and Russia, share similar fears. 

“It’s an issue for lots of countries, democratic countries as well,” said one diplomatic observer, who asked not to be named. “It’s a complex issue.”  

Carrots instead of sticks

The South Sudan Minster of Health, Elizabeth Chuei, gets a COVID vaccine in March 2021 – a month later most deliveries to Africa were halted as a result of an interruption in supplies from India, which faced a surge in cases of the new Delta variant.  To date, less than 5% of sub-Saharan Africans have been vaccinated, and less than 1 in 4 health workers.

So while some treaty advocates stress the need for the tougher compliance measures – other close observers emphasize how any new legal framework, to be politically successful, will need strong incentives that engage voluntary compliance.   

“It’s nice to conceive of an international law enforcement agency for virologists, that can go anywhere in the world, visa ready, get all the data and investigate. But that’s not the way the world works,” observed one analyst. 

“Boxing in countries usually isn’t helpful in achieving cooperation. So how do you structure something that incentivizes countries to cooperate? 

“Everyone likes to focus on the sticks, but there should be carrots as well.”

Incentives will be particularly important to low-income countries in developing regions facing rapid deforestation, urbanization and food systems change – where most of the world’s new pathogens have historically emerged. 

There are mounting fears in some countries that they could share pathogens or information about emerging risks, only to be punished rather than rewarded. That, in fact, is precisely what South Africa experienced this week after sharing information about a new SARS-CoV2 variant of concern, Omicron (B.1.1.529) – only to see the United Kingdom, the European Union and Israel immediately halt flights and bar entry to citizens from the same southern African countries that had reported on the virus variant. 

Next stop – UN General Assembly Summit

Tijjani Muhammad-Bande, President of the seventy-fourth session of the United Nations General Assembly in September. Asked to convene a Pandemic Summit before the end of the year.

Precisely in response to such concerns, there is also building momentum for a summit to be convened by the  UN General Assembly soon after the WHA session. There, world leaders would be called upon to adopt a wider political declaration and roadmap for beating down COVID and preventing future pandemics. 

That roadmap would include, presumably, steps to ensure more sustainable financing for low- and middle-income countries’ pandemic preparedness and vaccine access. 

On the table are ambitious proposals for a $10 billion a year preparedness fund and a $100 billion emergency response fund. 

Although if the recent series of G-20 Summits, as well as the Glasgow Climate Conference, offer any example, wrestling actual delivery of the funds from the same rich countries that support the pandemic treaty initiative, may not be an easy feat.  

Bottom up approaches may be better – some say 

Civil society critics say more vaccines and medicines production needs to be anchored in the global south.  On story of success is Incepta Pharmaceuticals in Bangladesh. Employing nearly 10,000 people at 17 sites, Incepta produces vaccines for cholera, influenza, measles, rubella, and Hepatitis B among others.

That is one of the reasons why civil society critics such as Carlos Correa, director of the Geneva-based South Centre, continue to maintain that the whole pandemic treaty endeavour is likely to be a futile exercise.  

Speaking at an event hosted Wednesday by the Geneva Global Health Hub (G2H2), Correa advocated more of a “bottom-up” approach that would focus on building countries’ health systems – and developing more regional vaccine and manufacturing capacity. 

That approach could be financed by offering LMICs more generous debt relief and greater access to IMF special drawing rights, he and others have added.

Agreement on a pandemic waiver on Intellectual Property related to COVID medicines and vaccines, being debated at the World Trade Organization, would meanwhile provide an effective legal framework for stimulating more regional production of needed vaccines and medicines, he and other civil society critics of the treaty maintain.       

Despite the doubts, WHA special session will likely green light next steps on treaty negotiations 

For the moment, however, trade representatives from the global North and South remain deadlocked over the IP waiver proposal.  And now, next week’s WTO Ministerial Conference (MC12), which had been scheduled to meet face-to-face in Geneva, has now been indefinitely postponed as a result of new Swiss travel restrictions announced over the weekend, barring entry to travelers from over a dozen countries in the wake of South Africa’s discovery of the Omicron variant.

As the WHA special session was planned from the start as a hybrid session, it was largely unaffected by the emergency Swiss travel rules. Monday’s opening saw a few dozen countries attending in person at WHO headquarters, while others were online virtually. Meanwhile, the global panic triggered by Omicron will only add more impetus to the Director General’s appeal to world leaders to band together around a pandemic treaty.

So despite the hesitations and hiccups, it’s expected that the three-day virtual WHA session (29 November -1 December), will yield at least a green light for beginning intergovernmental negotiations on a treaty instrument, based on the draft decision, and behind that, a detailed report by a WHA Member State Working Group that has been meeting over the past several months.  

Whether Sunday’s draft is the final one, however, remains to be seen.  Like most WHA agreements,  the aim is to reach a consensus. And that means coming up with a text that China and Russia would not vote against – even if they abstain or express reservations. 

“Something that goes up will be already pre-negotiated.  That doesn’t mean they will have full agreement, but they want to continue the negotiations.”

Stocking, too, expects a pre-drafted WHA decision to begin “intergovernmental negotiations” will be approved. As for how those talks will proceed after the three-day session? Figuring that out will be no easy feat, she admits:

“How do you do it? They will have to work out the modalities of doing negotiations with 194 countries.”

-Updated 28.11.2022

Image Credits: Photo: WHO/Antoine Tardy, Statista 2021, @TheIndPanel, UNICEF, UN Photo/Eskinder Debebe, Incepta.

Civil society groups hold global demonstrations outside embassies of the United States, United Kingdom, Australia, Canada, Brazil, and other countries which oppose a temporary WTO patent waiver on COVID-19 health products.

Human rights lawyers have threatened legal action against the governments of Canada, Germany, Norway and the United Kingdom if they fail to support a waiver of the Trade-Related Intellectual Property Rights (TRIPs) Agreement in relation to COVID-19 healthcare products.

The waiver will be discussed at the 12th Ministerial Conference of the World Trade Organization (WTO) next week .  

A group of human rights advocates — the European Centre for Constitutional and Human Rights (Germany), Professor Andenæs QC at the University of Oslo (Norway), and a coalition of organizations in Canada —On Thursday announced prospective domestic lawsuits in their respective countries should their governments fail to support the waiver of intellectual property over COVID healthcare technologies proposed by South Africa and India at the WTO last year in response to the pandemic.

Meantime, Global Justice Now and Just Fair have written a letter of concern to the UK government setting out why the failure to support the waiver contravenes international human rights law, according to a statement released on Thursday by the UK-based social justice organisation, Global Justice Now,

India and South Africa proposed the waiver last October, and it now has the support of over 100 low and middle-income countries while 60 countries have agreed to co-sponsor the waiver proposal. 

Legal letters warn governments

Letters drafted to governments by lawyers on behalf of organisations such as Global Justice Now and Just Fair highlight the global disparities in access to COVID-19 vaccine and therapeutics, and highlight governments’ obligations under international human rights law to take “steps within their power to ensure the human rights to life, health, equality, and benefit from scientific progress”.

The letters also stress that countries have legal duties with respect to international cooperation, good-faith implementation of treaty obligations, along with access to justice.

On 24 November, the majority of the European Parliament voted for the European Union to support a temporary TRIPS waiver for COVID-19 vaccines. Although even the US has lent its support to the waiver for the vaccines, Japan, the UK, Canada, and some EU member states like Norway and Germany have opposed the proposal 

An urgent letter to Canada’s Minister of International Trade (traduction) signed by multiple organizations and human rights experts warned that if Canada fails to support the TRIPS waiver, this decision could be challenged in domestic courts as a failure to implement Canada’s human rights obligations in good faith, through international cooperation.

It stated that such a decision could also be challenged as a violation of rights to life, security of the person and equality in the Canadian Charter of Rights and Freedoms “because of its effect on the life and health of vulnerable groups in Canada, including women, the elderly, persons with disabilities, Indigenous Peoples, Black people, other racialized persons, and persons experiencing poverty”.

When it comes to the EU, Germany is one of the members that has opposed the waiver. Miriam Saage-Maaß of the European Centre for Constitutional and Human Rights, said that it was important for Germany to live up to its extra-territorial human rights obligations and do everything within its power to enable equitable access to the most effective COVID-19 vaccines.

“Germany can no longer defend a position that enforces vaccine apartheid and which unnecessarily prolongs the pandemic situation worldwide,” she said. 

Meanwhile, Professor Mads Andenæs QC at the University of Oslo said, “Court action against the Norwegian government is to commence, challenging the inadequate responses by the government to comply with its obligations under international and European human rights law and the Norwegian constitution.”

Norway has failed to support the waiver, and Norwegian Ambassador Dagfinn Sørli currently chairs the WTO TRIPS Council.

Addressing the UK, Nick Dearden of Global Justice Now said: “Throughout this pandemic, the UK government has put the interests of big pharmaceutical businesses ahead of the need to save lives around the world and defeat this pandemic.

“The epitome of this approach is that they have effectively blocked, repeatedly, the one measure the vast majority of the world has demanded – the waiver of intellectual property rules at the WTO. We hope our action today will send a clear message: they need to stop blocking action at the WTO.”

These letters are part of a broader set of legal strategies being pursued by human rights networks to achieve equitable global access to COVID-19 healthcare technologies. 

Image Credits: Tadeau Andre/MSF .

A new variant with significant mutations has been identified.

CAPE TOWN – A new COVID-19 variant with a “very unusual constellation of mutations” – currently referred to as B.1.1.529 – has been identified in southern Africa, South Africa’s Health Ministry announced on Thursday.

On Friday, WHO dubbed the variant “Omicron”, adding it to its list of variants of concern – even as the European Union, the United Kingdom, the United States and Israel slapped a new round of restrictions on incoming travelers from South Africa and other southern African countries where it has been identified. 

The variant has over 30 mutations in spike protein, the site usually targetted by COVID-19 vaccines, according to Professor Tulio de Oliveira, Director of South Africa’s Centre for Epidemic Response and Innovation. 

“The mutation profile is predicted to give significant immune evasion and enhanced transmissibility, and urgent work has already started to understand its full significance,” said De Oliveira.

Some of the mutations are associated with resistance to neutralizing antibodies (and therapeutic monoclonal antibodies from vaccines), more efficient cell entry and the evasion of innate immunity, which could enhance transmissibility, as well as increased infectivity, De Oliveira told a health ministry media briefing on Thursday.

“The full significance remains uncertain,” said De Oliveira, but added that experts tracking the variant would have more information “very soon”.

South African officials are meeting with the World Health Organization (WHO) on Friday to brief it about the development.

The first case of this variant was identified in Botswana while a man who arrived in Hong Kong from South Africa recently also had the variant.

Rapid spread

“Twenty-two positive cases of variant B.1.1.529 have been recorded in [South Africa] following genomic sequencing collaborations between the National Institute for Communicable Diseases (NICD) and private laboratories,” the NICD reported.

“Although the data is limited, our experts are working overtime with all the established surveillance systems to understand the new variant and what the potential implications could be,” said Professor Adrian Puren, NICD Acting Executive Director.

“Developments are occurring at a rapid pace and the public has our assurance that we will keep them up to date.”

Cases in South Africa have been low until two weeks ago when an outbreak traced to a student gathering in Gauteng province was identified as a super-spreader. 

Detected cases and percent testing positive are both increasing quickly, particularly in the north of South Africa, according to the NICD.

“Epidemiological data suggest a sustained increase in COVID-19 incidence across Gauteng, possibly fueled by cluster outbreaks,” said De Oliveira.

“The new variant has been detected in multiple samples from across Gauteng, and public and private testing laboratories in Gauteng have noticed a significant and rapid increase in detection of variant (which can be identified via a PCR proxy), and is now increasing in other provinces.”

High alert

Dr Michelle Groome, Head of the Division of Public Health Surveillance and Response at the NICD, said that provincial health authorities remain on high alert and are prioritising the sequencing of COVID-19 positive samples. 

She stresses that regardless of the emergence of new COVID-19 variants, the importance of non-pharmaceutical interventions remains unchanged and the public are urged to be responsible. 

“This means that individuals should get vaccinated, wear masks, practice healthy hand hygiene, maintain social distancing, and gather in well-ventilated spaces,” said Groome.

 

 

Many children with tuberculosis don’t get TB treatment because of challenges with diagnosis and reporting.

Every day, more than 650 children around the world die from tuberculosis – largely because they have never had the chance to be diagnosed and treated. 

In the wake of the COVID-19 pandemic, children have fallen behind on almost every score – from access to schooling and nutrition to mental health and basic health services.  But nowhere are those gaps more urgently in need of being addressed, than in the case of the world’s most deadly infectious disease. 

In commemoration of World Children’s Day 2021, observed 20 November, Health Policy Watch interviewed Dr Lucica Ditiu, executive director of the Stop TB Partnership, about how seriously children are lagging behind in TB diagnosis and treatment – and what can be done about it.   

Health Policy Watch: According to this year’s Global TB report, only 41% of the estimated 3.5 million children living with TB have been diagnosed and treated (2018-2020), and only 11% of those children with drug-resistant TB. What are the major factors driving the disturbing lack of children’s access to treatment?   

Lucica Ditiu: The children of today are paying the bill for the negligence of the past – for TB programmes being underfunded, as well as a lack of attention to children as a vulnerable group. Children, in the vast majority, get infected by adults and, usually, do not transmit the disease. So when you see a lot of children with TB, it means that there are a lot of adults passing it on. It’s a very good indicator of a very weak programme. 

The biggest problem is to find and diagnose the children with TB. One is about access. To find the children you need to ensure that their parents and families have access to the health system, and that is not secure. This is why the Universal Health Coverage Sustainable Development Goal (SDG)  is very good. And the number of  children with TB diagnosed and treated can be an indicator of how far along we are in reaching UHC.  

The other problem is one of diagnostic tools. We do not have good enough TB diagnosis tools for adults.  A lot of diagnosis still relies on clinical examination and sputum smear microscopy, exactly like 100 years ago.  With children is even more difficult – as children don’t produce sputum when they cough. So they are more difficult to diagnose. 

HPW: What about new TB tools like GeneXpert, which provides a rapid molecular diagnosis?

Ditiu: Even GeneXpert and other rapid molecular tests rely on sputum, which children don’t produce.  So you have to make do with X-rays, clinical approaches, or very extreme procedures like gastric aspirate, where a nasogastric tube is inserted through the nose to extract and diagnose TB based on gastric fluids. It is a very unpleasant and aggressive procedure. The child has to be intubated under anaesthesia.

That means we need more advanced diagnostic tools for children. There are different groups, supported by STOP TB and our partners – such as UNITAID, and the Global Fund, looking at alternatives.  One of the most advanced tools involves diagnosing TB in the stool of  children, and there is very good progress on that. 

There are other groups looking at other types of diagnosis, based on DNA, based on blood, based even on cough. 

But in general, for TB, even though it’s one of the oldest known diseases, we still don’t have a point-of-care diagnostic, that people can self test at home. Diagnosis still requires heavy involvement of the health system and therefore access to diagnosis is a huge bottleneck.

HPW: What are the particular hotspots for children’s TB? 

Ditiu: The  largest numbers of TB-infected children are living in Asia, including India, Bangladesh, Indonesia, and Pakistan. 

In Africa, conversely, there are a lot of children with TB and HIV co-infections. And that is where the clinical progression of the disease is more accentuated. So if we look at high numbers, they are in Asia. If we look at the complicated forms, it’s more in Africa. 

In Eastern Europe and Russia, meanwhile, we see more of the drug-resistant TB forms among children. These are forms that cannot be easily treated in the usual six-month treatment regimes.  

Multi-drug resistant TB (MDR-TB) in children is also hugely underestimated. It’s very difficult to diagnose and treat – although if the child has a parent with drug-resistant TB, you can assume that he or she has drug-resistant forms too. It’s disastrous for children. The estimates are at least 30 000 children fall ill with drug-resistant TB every year, but the diagnosis and treatment coverage is very low. Only 12 200 children have been treated over the last three years (2018- 2020)! Whereas we estimate that there are around 200,000 children worldwide with MDR-TB. This is a huge and dramatic gap.

Last year was the first year that WHO made estimates of children with MDR-TB.  But we need WHO to lead on improving these estimates, including asking countries to notify and report upon children with drug-resistant TB by country.

For MDR-TB, the treatment is at least one year instead of six months.  We have specific oral formulations for the treatment of  children with TB. And we have everything needed for a full oral regimen for children. Fortunately, 85% of countries have dropped the injectable treatments for MDR-TB, which have horrible side effects, including deafness. We still have some countries in which injectables are still used in children and we must immediately change that.  But the big problem is to identify the children. 

HPW: In terms of HIV/TB coinfection, why are children left out?  We have noted that children’s access to HIV treatment also lags far behind that of adults, with less than 40% of children 0-14 getting ARVs in 25 sub-Saharan African countries reviewed in 2020. One would think that if more HIV-infected children were being treated, they could also be screened for TB? 

Ditiu:  For TB, the biggest challenge is still identifying the children who are TB co-infected. Once they are diagnosed, treating them is not such a big problem.  For HIV, the problem is access to treatment. 

Why are children left behind? It could be partially attributable to the stigma of co-infection and I think it’s all about access, a matter of the weakest link in the chain. But indeed it’s a bit puzzling because the amount of resources for HIV treatment of children is very high. Hundreds of millions of dollars are available for diagnosis and treatment. What I can say is that, on the positive side, preventive TB treatment is recommended for people living with HIV.  And in the African region, people living with HIV are for the most part receiving preventative TB treatment, including children

But I think access to services is essential for TB and HIV. In the last two years, what we have seen as a result of the pandemic, is that people that are most vulnerable and have any barrier to access services – poverty, distance, gender, religion, color  – have had even more problems in accessing services.

HPW: What is Stop TB doing to address these access barriers that you’re describing?  

Ditiu: Our focus is on removing barriers for people to access diagnosis, treatment and care for TB. Some 80% of our budget of $20 million a year is distributed in various small grants to governments and civil society to pilot and test new ways to reach, diagnose and treat TB-infected people. 

For children, through our Global Drug Facility work funded by Japan and USAID,  we pushed for the introduction of new children formulations for the treatment of drug-resistant TB, with specific doses and a great taste. This effort has supported the treatment of children with drug-resistant TB in more than 60 countries, but it also made people think more about drug-resistant TB in children.  

We also are the leading organization in ensuring that social justice, discrimination, stigma, gender disparities, and human rights are being properly addressed in TB programmes. Through our Challenge Facility for Civil Society granting mechanism, uniquely in the TB world, we provide grants only to local, grassroots organizations for their work on TB response. 

Supported mainly by USAID, with some funding from the Global Fund, we managed to grant around $6-7 million annually to these civil society and community organizations from TB high- burden countries.

Our other granting mechanism – TB-REACH, which is an initiative funded by Canada and several other donors – provides since 2010 support to any organization, from government to faith-based, that is able to show they can find people infected with TB and get them diagnosed and treated, using local solutions. It basically funds local solutions using innovative solutions as well as new tools to remove barriers to access to early diagnosis and treatment and we grant around $15-20 million each year.

With the support of TB REACH  and other teams in Stop TB, we are also testing new tools and innovations, for instance, to support people with TB with treatment adherence. For instance,  there are digital tools to ensure that when a TB-infected person opens his or her pillbox, a signal is sent to the portable phone of the health care worker who therefore will know that he or she took the treatment.  

We also have a team that identifies and supports new developers and start-ups in the TB space.  

Finally, under the STOP TB Partnership there are 9 different working groups, including the Working group for Childhood TB, led by Dr Farhana Amanulla, a Pakistani physician, who is one of the leading paediatric TB experts in the world. We try all of us to raise the awareness about children in TB as for a long time TB in children was not recognized. 

 

HPW: How did the COVID pandemic impact efforts to expand the detection and treatment of childhood TB? 

Ditiu: COVID had a very devastating impact on TB generally. Since TB and COVID are both airborne diseases, the TB hospitals, dispensaries, health posts and laboratories, were really refocused to COVID so TB hospital beds were really completely blocked off. There was zero occupancy in some cases for TB.   

In the countries that were thinking beyond COVID, however, there were more positive angles. They were able to do more. There were places where they did bi-directional testing – one leading example of this is India. You’d have someone coming in with symptoms of cough, weakness, you test for COVID but if there are indications that it could be TB, you would also do a TB test. 

Also, in terms of community outreach, people who traditionally did TB outreach were co-opted to do COVID, but in the smarter places they continued doing TB work as well. India did very well with this, and so did South Africa. 

Now, Indonesia is putting this in place as well as the Philippines, Costa Rica, India, Indonesia, and the Philippines, where TB outreach workers have been going door-to-door searching for both TB and COVID and offering support.  

In India, there was a TB hotline that embraced COVID diagnosis and treatment as well as  Tb. You maximize what you have already in place. 

But the moment you just switch off, and just do COVID, not TB, that’s the moment we all lose.. So integration, creating platforms that ensure you have access to easier diagnosis and treatment, that is the key. 

HPW: That kind of integration is the gold standard for universal healthcare but it’s often very difficult to achieve. The health sector likes to work in silos.  So how do you push for integration?  

Ditiu: What we need to be doing is reimagining TB care and, in fact, healthcare. We need to be doing it closer to our door, with community health workers and mobile units that come to your home and diagnosing several diseases at once in multi-diagnosis platforms.  For instance, thanks to a grant from Canada, the USA and now the the UK government, our TB REACH team will look into the integration of diagnostic testing to show it works, that it is cost-efficient and so on.  

HPW: Unfortunately current trends seem to indicate movement in the wrong direction – for TB at least – with fewer people overall being diagnosed and treated in 2020 than before the pandemic began. 

Ditiu: It’s very dramatic what we see, and I think it will continue. Even though, of the people who die of TB, HIV and malaria, 60% die of TB, the TB response gets only 18% of Global Fund money, whereas HIV gets 50%, and malaria 32%. That is from a budget of $4 billion a year. 

So, in terms of financing for TB, while we are desperate, people on the ground are even more desperate, so we need to find a reason for hope.  

We push, in all of our discussions, the need for additional resources as well as for more integration. We are not always welcomed with love as TB is not high on any important agenda of  key stakeholders. It’s like when you run after a possible partner and know that this is the future, but we are not always embraced.  But we don’t give up, because we have to end TB by 2030.

Dr Lucica Ditiu

Dr Lucica Ditiu is a Romanian physician and public health expert who has served as Executive Director of the Stop TB Partnership since May 2011. Dr Ditiu has devoted her career to supporting people affected by TB, especially those who are the most vulnerable, stigmatized and living in impoverished communities. Prior to taking over her current role, she worked in the WHO and UN systems at every level – national, subregional, regional, and global.

She eschews inflexible rules, hierarchy, and formal meetings. Under her watch, the Stop TB Partnership has evolved into a lean, accountable, innovative, and progressive operation that continuously challenges the status quo. Dr Ditiu is relentless in pushing for the inclusion of all people affected by TB in the programs and activities of the Stop TB Partnership. Her motto stems from the lyrics of a Romanian band: “The day you give up is the day you die.” 

 

Image Credits: University of Cape Town Lung Institute.

Patients seeking essential health services during COVID-19 pandemic in Jangamakote Village, India.

There is “broad consensus” on the need for a “binding pact” to address the threat of pandemics, said World Health Organization (WHO) Director-General on Wednesday – a few days before the World Health Assembly special session devoted exclusively to discussing what many refer to as a pandemic treaty.

“The ongoing chaos of this pandemic only underlines why the world needs an ironclad global agreement to set the rules of the game for pandemic preparedness and response,” Tedros told the media at the WHO’s COVID-19 briefing in Geneva.

“This will be the subject of next week’s special session of the World Health Assembly. The world has treaties to manage other threats. Surely countries can agree on the need for a binding pact on the threats of pandemics?” added Tedros, who described the special session as a unique opportunity to develop a generational agreement.

 “I’m encouraged that there is now a broad consensus for the need for such an instrument. We will not achieve everything at the special session. But I hope it will serve as the launching pad for the development of an international agreement,” concluded Tedros.

Not everyone wants a Treaty

However, at the same time in another part of the city, civil society critics expressed concerns that a new Pandemic Treaty would fail to bring about the more fundamental changes that they say are needed in global finance and manufacturing mechanisms – so as to really improve the access of low- and middle-income countries to pandemic-related medicines and vaccines.  

Not only that, but critics fear that many low-income countries, still focused on fighting a pandemic, lack the human resources required to advance their interests in negotiations over a new Pandemic Treaty. 

The creation of such a new instrument could further fragment global health decision-making, removing certain responsibilities and powers from the direct control of the World Health Organization, said others in a panel discussion sponsored by the Geneva Global Health Hub (G2H2). 

The discussion focused on a new G2H2 report that reflected upon countries’ and civil society views about the treaty, entitled, “The Politics of a WHO Pandemic Treaty in a Disenchanted World.” 

Rather than focusing on a treaty, stakeholders should look more closely at debt relief and other economic measures that could strengthen health systems in developing countries, which are hobbled by years of internationally-imposed austerity, said Carlos Correa, director of the Geneva-based South Centre.  Without stronger, more durable health systems, countries will remain ill-equipped to battle disease threats, regardless of treaty provisions, he said.  

More regionally-based R&D and production of vaccines and medicines, stimulated by a World Trade Organization waiver on Intellectual Property restrictions to stimulate more sharing of pharma know-how is also critical, said Nicoletta Dentico, one of the paper’s co-authors.  

But she expressed fears that the drawn-out negotiations over the legal language on a treaty would obscure the need for needed reforms to trade and economic arrangements that deeply affected health.  

It is  “not coincidental” that critical WTO waiver discussions are taking place next week, at the same time as the World Health Assembly (WHA) meets on the pandemic treaty, Dentico added, expressing fears that the WHA negotiations would divert attention from the WTO talks, currently deadlocked by European opposition to the waiver initiative. 

The report highlighted a number of factors influencing various interest groups’ support for a pandemic treaty, including developing countries wanting a seat at the negotiating table.

At the same time, Dr Suerie Moon, co-director of the Global Health Centre of the Geneva Graduate Institute, put forward a more positive spin on the Pandemic Treaty proposal.

She compared it to a “potluck dinner” where everyone might bring their own “dish” to the table.  What remains to be seen, however, is if the “tastes will blend together and the wine will match the meal.”

Moon added that while the report adds valuable civil society perspectives to the debate, the two dozen key informat interviews upon which the research was based seemed to reflect too much of a “Eurocentric” viewpoint – and could have benefitted from more inputs from countries in the global South.

Image Credits: Flickr – Trinity Care Foundation.

Dr Tedros

Although the World Health Organization (WHO) continues to condemn COVID-19 vaccine boosters in the face of global vaccine inequity, a top official conceded that they looked increasingly likely in future.

“The first priority everywhere has got to be reaching the unvaccinated, most highly vulnerable populations,” stressed Dr Bruce Aylward, special advisor to the WHO Director-General.

 But he conceded: “Eventually we will need to get the boosters to sustain immunity. It looks more and more likely, but at this point, there’s still an awful lot of unvaccinated people out there”.

“This is not just a phenomenon of low-income countries,” stressed Aylward. “In much of  Europe, where we’re seeing the current outbreak, much of that is being driven by the unvaccinated of course, and many of the people ending up in ICUs and who are dying are unvaccinated folks.”

Last Friday, the US made boosters available to all adults ahead of Thursday’s Thanksgiving holiday, while a number of European countries are also offering boosters to all adults. A few months back, Israel curbed its fourth wave through a combination of boosters and reaching the unvaccinated.

Don’t Vaccinate Kids Yet

The WHO also cautioned against wealthy countries vaccinating children ahead of vulnerable populations in other countries.

“As a matter of global equity, as long as many parts of the world are facing extreme vaccine shortages, countries that have achieved high vaccine coverage in their high-risk populations should prioritize global sharing of COVID-19 vaccines through the COVAX facility before proceeding to vaccination of children and adolescents who are at low risk for severe disease,” urged the WHO in a statement released on Wednesday.

Instead, it urged “attaining high coverage of primary series – and booster doses as needed based on evidence of waning and optimizing vaccination impact – in highest risk subgroups, such as older adults” before vaccinating children.

Europe’s ‘false sense of security’

With Europe accounting for over 60% of new global COVID-19 cases this week, the WHO warned that vaccinations had given some countries “a false sense of security”, urging a return to masks, social distancing and avoiding crowds – alongside vaccinating the unvaccinated.

“In many countries and communities, we’re concerned about a false sense of security that vaccines have ended the pandemic and that people who are vaccinated do not need to take any other precautions. Vaccines save lives, but they do not fully prevent transmission,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Wednesday.

Pointing out that vaccines only gave around 40% protection against the Delta variant, Tedros urged even the vaccinated to take precautions to avoid infection.

Dr Mike Ryan, executive director of Health Emergencies, said that social mixing in Europe had returned to “pre-pandemic levels”.

Maria Van Kerkhove, WHO COVID-19 Technical Lead

WHO technical lead on COVID-19, Dr Maria Van Kerkhove, said it was essential to cut transmission rates to avoid the development of new variants and to protect people from “long COVID”.

“The more the virus circulates, the more opportunities it has to change. We have the Delta variant, which is the most transmissible SARS-COV2 virus we’ve seen to date ,and Delta is evolving as well,” warned Van Kerkhove.

“We have decent genomic sequencing around the world, but we don’t have eyes and ears in all countries in terms of what is circulating and how these viruses are changing.,” she added.

The WHO was looking through future scenarios to try to predict how much more the virus will change and if there was the potential for “future immune escape” which could weaken vaccines, she added.

The WHO was also concerned about “long COVID, this post-COVID condition that we are only beginning to learn about” that affected all parts of the body, she added.

“We’re working with partners around the world to understand what in fact it is, how long these longer-lasting symptoms remain in some individuals, why these symptoms affect all parts of the body. We don’t even have good estimates of how many people will suffer from long COVID,” said Van Kerkhove.

“So until we know, it is prudent to drive transmission down as much as we can with simple measures that we know work. These proven public health and social measures that we mention don’t mean lockdown. They mean physical distancing, they may mean wearing masks, they mean avoiding crowds, investing in ventilation where we live where we study where we work.”

 

Image Credits: WHO.

sputnik
Sputnik V Vaccine

Russia’s Sputnik V COVID-19 vaccine demonstrates an 80% efficacy six to eight months after the second dose – a higher efficacy than officially published mRNA vaccines, announced the Russian Direct Investment Fund (RDIF) in a press briefing on Wednesday.

The efficacy data is based on “real-world data from the Ministry of Health of the Republic of San Marino”, according to the RDIF and has not yet been published.

This has led the Sputnik team to assert that adenoviral vaccines such as Sputnik V provide for longer efficacy than mRNA ones, such as the Pfizer and Moderna, “due to longer antibody and T-cell response”.

The Pfizer-BioNTech vaccine, while 90% effective against COVID-19 hospitalizations for all variants including Delta, had declining efficacy, falling from 88% within one month after receiving two doses to 47% after six months. 

Sputnik V efficacy is significantly higher than Pfizer vaccine after 6-8 months

Sputnik’s efficacy data from 18,600 fully vaccinated people found efficacy was at 80%  in the six to eight months after a second jab, while the hospitalization rate with COVID infection was only 0.75 per 1,000 people during the entire mass vaccination campaign in the country from February to November 2021.

Over 70% of the adult population of San Marino have been vaccinated with Sputnik V. 

Vaccine cocktails, the future of COVID vaccines 

Kirill Dmitriev, CEO of the Russian Direct Investment Fund.

Going forward, RDIF CEO Kirill Dmitriev proposed vaccine combinations as a possible solution to COVID-19, including a potential combination with their one-shot vaccine, Sputnik Light, and mRNA vaccines.  

“We believe the future of vaccines is about cocktails. It’s about combining different vaccines to help prolong immunity.”

He added: “We are pro-boosters, but we believe the combination of vaccines should be explored much more.”

Sputnik Light has shown 70% efficacy against the Delta variant and is being promoted as a booster for non-Russian vaccines. 

As a vaccine cocktail, Sputnik V combines two adenoviruses – human adenovirus serotype 26 and human adenovirus serotype 5.

Sputnik V success in Argentina 

Dmitriev pointed that Argentina, which uses Sputnik and other vaccines, had a remarkable 35% decline in cases over the last four months. 

Russia will lift its ban on flights to Argentina, as well as Bangladesh, Brazil, Mongolia, and Costa Rica, from 1 December, as a result of the declining cases. 

The Sputnik team will be publishing additional data on long-term vaccine response from different countries, including those in Latin America, which Dmitriev noted was “very important” in showcasing the efficacy and safety of the vaccine. 

“It’s very important that this data is not coming just from Russia. We have an abundance of data on Sputnik, on more than 100 million people who were vaccinated outside of Russia, and that allows us to speak on the safety and efficacy of our vaccine – as one of the safest and one of the most efficient.” 

WHO Emergency Listing Approval expected by end of year, despite setbacks

Sputnik V is expected to be approved by the World Health Organization for emergency use listing (EUL) by the end of the year, according to Dmitriev.

“We are working with WHO but Sputnik is already saving tens of hundreds of millions of lives around the world,” he said.

Sputnik V is currently approved for use in 71 countries, with a total population of four billion people, and is the “second-largest vaccine in the world by numbers of registration from different countries.”

RDIF applied for EUL back in February but the process has been dogged by problems, including WHO inspectors flagging a number of concerns when visiting manufacturing sites in Russia, including control of aseptic operation and filling. Russia had also postponed planned inspections of the Sputnik manufacturing sites back in October.

COVID cases decline in Russia, but surge in rest of Europe

Russia has far fewer new COVID cases than most of Europe.

While Russia’s coronavirus death toll still hovers near all-time highs, the number of new infections continues to decline, in contrast to the rising surge occurring in many other countries in Europe. 

The state coronavirus task force reported 35,681 new confirmed cases, reflecting a steady downward trend since early November when the daily numbers topped 41,000. 

This is despite the country’s low vaccination rate – only 37.46% of the population is fully vaccinated.

A more expressed drop in COVID-19 cases is expected if the country continues to follow precautionary measures, infection disease specialist Yevgeny Timakov told Russian news agency TASS. 

“Stabilization process will take about a month, followed by the decline in the disease rate if there is control over infections sources at least in terms of wearing masks. Then everything will be normal and we will celebrate the New Year smoothly,” the expert said.

In comparison, the rest of Europe is currently experiencing a surge in COVID infections, with several countries reporting record-high infection rates, prompting governments to introduce full and partial lockdowns, as well as mandatory vaccinations.

Dmitriev attributed the spike in Europe’s cases to the decrease in efficacy of the mRNA vaccines, which a large percentage of Europe is vaccinated with, and called the rise in cases “alarming”.

“There shouldn’t be a breakout in cases. We believe that all vaccines are important and they protect from severe infections and hospitalizations, and yet, the number of cases that we see in Europe is really alarming,” he said.

Image Credits: Sputnikvaccine/Twitter.

Older highly drug-resistant TB treatment (above) compared with new BPaL regimen (below).

In the face of the COVID-19 pandemic, tuberculosis mortality has started to increase for the first time in a decade. In 2020 alone, more than 1.5 million people died from TB. Every year, about half a million people develop a drug-resistant form of TB (DR-TB).

The vast majority of people with TB live in low- and middle-income countries, where access to tests and treatments for all diseases is often challenging. This lack of access means more than a third of all TB infections go unreported.

The problem is even more acute among those with drug-resistant forms of the disease. Since 2020, due in part to the impact of the COVID-19 pandemic on global TB control programs, the situation has been getting worse, not better. Less than 60% of DR-TB patients treated were cured in 2020.

Doctors reviewing a patient’s medication in a rural TB clinic in South Sudan.

Antimicrobial awareness

World Antimicrobial Awareness Week 2021 is drawing increased attention to the global health, financial, and security impacts of growing resistance to drugs the world has long relied on to treat many infectious diseases.

This is therefore a timely moment to examine the threats, progress, and needs relating to drug-resistant tuberculosis (TB) – the single largest cause of death from resistant infections.

The inadequacy of tools to effectively diagnose and treat DR-TB has led to this diagnosis and treatment gap, but recent advances could turn the tide. However, we need to protect these advances long enough for them to have a meaningful impact on the fight against TB.

New drugs need to be used appropriately, matched against the bacterial strains that are susceptible to them. New diagnostics can confirm this match. But using the new drugs to treat the wrong strains will inevitably lead to more infections becoming resistant to the new drugs, and the overall threat of drug resistance will continue to increase.

In the fight against DR-TB, time is of the essence. Slower diagnosis and treatment times increase the risk, giving the bacteria more time to become resistant. Increasing access to rapid testing and shorter drug regimens for DR-TB allows for patients to be tested and treated faster, increasing the prospects that patients would complete treatment.

Gold-standard molecular diagnosis can now be made when patients meet with their doctors. A new testing platform from an Indian manufacturer—endorsed by the World Health Organization in 2020 and available today in more than 50 countries—can provide both the initial diagnosis of TB and the detection of rifampicin resistance.

Next-generation tests for multi-drug resistant and extensively drug-resistant forms of the disease approved earlier this year mean clinicians can now generate rapid and accurate drug-resistance profiles, allowing doctors to start patients on better, targeted treatments. A pipeline of new, affordable point-of-care tools for both TB infection as well as drug resistance testing could be made possible with only a small fraction of the investments currently devoted to COVID-19.

Advances in treatment

Site initiation and training for MolBio TrueNAT HCV assay multi-center performance evaluation at St. Paul Hospital, Addis Ababa, Ethiopia.

On the treatment front, therapy for DR-TB had long been characterized by extremely lengthy drug regimens rife with debilitating side effects, such as hearing loss and kidney failure.

Those suffering from highly drug-resistant disease were routinely subject to therapy lasting 18-months or longer, with poor cure rates despite up to 14,000 pills. The financial and human resource cost of administering such therapies has restricted patient access to these treatments in low-income settings.

Recent advances in therapy for highly drug-resistant TB include a six-month, three-drug regimen with a cure rate of approximately 90% and a significantly lower price tag. It is now being procured by more than 30 countries – a promising start to widespread adoption.

Testing and treating are inextricably linked as pillars of fighting AMR. The right diagnosis does not matter if the treatment is intolerable and ineffective. And the best possible treatment only works if it is administered to a patient who actually has the disease for which it is intended.

Crisis of neglect

TB and COVID-19 are both respiratory diseases, with patients often presenting with a cough. But one is bacterial, requiring several specific antibiotics, and the other viral, requiring a different set of therapeutics, the first of which is only now being presented to regulatory authorities.

The important point is that we must be able to distinguish between different causes of the same symptoms and do it quickly. “Just in case” – or uninformed – antimicrobial use for a range of diseases in the absence of a definitive diagnosis drives resistance and puts our hard-won antibiotics at risk.

The ongoing battle against DR-TB is being waged by researchers and clinicians whose labs are starved for resources, and health systems striving to overcome a crisis enabled by decades of neglecting TB. In 2020, the death toll from TB globally was second only to COVID-19 among infectious diseases. And for TB, this death toll has happened for decades if not centuries and, without action, will continue unabated.

AMR has long been considered in global health circles as a silent threat, lacking urgency, resources, and focus. Yet DR-TB is a potent reminder that AMR is quickly getting louder and will become catastrophic if inaction continues.

As we shine a light this week on AMR, it’s important to remember a fact clearly illustrated by the COVID-19 pandemic: tackling a global health threat is a choice. It’s not science, but financial commitments and political will that are the greatest barriers to overcoming deadly infectious diseases.

Mel Spigelman
Bill Rodriguez
Mel Spigelman, MD, is the president and CEO of TB Alliance, a product development partnership dedicated to discovering and delivering better and faster TB cures. 
Bill Rodriguez, MD, is Chief Executive Officer of FIND, the global alliance for diagnostics. He has extensive experience serving as advisor to the World Health Organization and national governments on global HIV, Tuberculosis, Ebola, and COVID-19.

 

 

 

Image Credits: Dato Koridze , WHO/John Rae Photography, Ryan Ruiz/ FIND.

Austrian police tackle anti-lockdown protesters in Vienna over the weekend.

Other European countries may follow the example of Austria, which entered a nationwide lockdown on Monday, as COVID-19 cases continue to surge across the region.

New COVID-19 cases increased by over 3,5 million in a single week, and deaths by over 50,000, according to the latest report from the European Centre for Disease Prevention and Control (ECDC). 

German health minister Jens Spahn grimly warned on Monday that, by the end of winter, Germans could either be “vaccinated, recovered or dead”. ICU beds in the country are under pressure as Germany recorded 45,326 new daily cases on Tuesday and 309 new deaths, according to the Robert Koch Institute. 

As civil protests mounted and debate raged across Europe over COVID certificates and vaccine mandates, WHO’s headquarters remained largely silent about exactly what policies countries should follow, saying primarily that countries should pursue a “risk-based approach.”   

However, WHO’s European Regional Director Hans Kluge has been more assertive on both, saying that along with more mask wearing, requiring a COVID pass for entry to entertainment or workplaces “is not a restriction of liberty, rather it is a tool to keep our individual freedom.” 

“In order to live with this virus and continue our daily lives, we need to take a ‘vaccine plus’ approach,” said Kluge in a statement on Tuesday.

“This means getting the standard doses of vaccine, taking a booster if offered, as well as incorporating preventive measures into our normal routines,” said Kluge. Only 48% of Europeans report wearing a mask indoors

Kluge also appealed to citizens to “do everything we can by getting vaccinated and taking personal protective measures, to avoid the last resort of lockdowns and school closures”.

“We know through bitter experience that these have extensive economic consequences and a pervasive negative impact on mental health, facilitate interpersonal violence and are detrimental to children’s well-being and learning,” he added.

After that, outright vaccine mandates should be a “last resort” but that a “legal and societal debate would be “very timely,” Kluge said in a weekend interview with the BBC.   

The WHO expects “high or extreme stress” on hospital beds in 25 countries, and “high or extreme stress” in intensive care units (ICU) in 49 out of 53 countries between now and 1 March 2022.

In the absence of urgent action, WHO’s sprawling European region, which extends from the United Kingdom to Russia and the Central Asian republics of the former Soviet Union, could see another 500,000 deaths by March, Kluge warned. 

Austria sets out the toughest vaccine mandates seen so far in Europe 


Austria’s 20-day lockdown – which has closed all but essential businesses and largely confined people to their homes – is necessary to safeguard the country’s public health system, according to Chancellor Alexander Schallenberg.

Describing the measure as “drastic”, Schallenberg said that the lockdown was the only way out of the current crisis.

Austria also intends to introduce mandatory vaccinations on 1 February, which Schallenberg told the CNN was necessary as around 33% of Austrians – almost two million people – were still unvaccinated despite a year of intensive vaccination campaigns. He said there were a number of reasons, including mistrust of science, and political campaigning against vaccinations, including by the Freedom Party, one of the three biggest parties in the country’s parliament. 

Schallenberg said those who refused to get vaccinated would face an “administrative fine”, although the amount has not yet been set, and that there is a precedent for this in other countries such as France and Italy in regard to certain groups of people, as well as compulsory smallpox vaccine mandates in the 1940s.

Cases in Austria, Netherlands and Belgium are currently among the highest in Europe – reaching or exceeding 1,400 new infections a day. However, Slovakia has the highest case rate per 100,000 people, while Slovenia and Czechia are also struggling.

Statistic: Incidence of coronavirus (COVID-19) cases in the past seven days in Europe as of November 22, 2021, by country (per 100,000 population) | Statista
Find more statistics at Statista

Vaccine rates below EU average in Switzerland, Poland and elsewhere 

Switzerland and Poland, in contrast, are seeing only about half as many new cases a day. But with vaccination rates in countries like Switzerland and Poland even lower than those in Austria, health authorities there are also bracing for increases in the months ahead.   


Even so, large protests against COVID-19 vaccine passes, lockdowns and vaccine mandates were held over the past weekend in at least seven European countries including Austria, Germany, Italy and France. 

They are also potentially super-spreader events as few protestors wore masks.  

Protests in the Netherlands and Brussels turned violent with protestors overturning and setting police vehicles afire, while police barricaded protestors and fired water cannons in response. 

ECDC  warns of ‘high and rapidly increasing’ case rate

The European Centers for Disease Control (ECDC) has described the current phase of pandemic as being characterised by “a high and rapidly increasing overall case notification rate and a slowly increasing death rate”, with countries with the lowest vaccination rates worst affected.

Twenty of the 29 EU countries reporting data on hospital and ICU admissions or occupancy reported increases by mid-November, according to the ECDC.

Latvia has been under lockdown since late October. In the first two weeks of November, Latvia’s COVID-19 mortality rate increased to 268.6 deaths per one million population, the third-highest in the European Union (EU) and the European Economic Area (EEA) after Romania and Bulgaria. Romania and Bulgaria also have the lowest vaccination rates in the region, at 38% and 25% respectively.

Path out of restrictions lies in high vaccination rate 

Meanwhile, a new discussion paper published by the Centre for Economic Policy Research suggests that, once a country has reached a high threshold of vaccinations, their effect on mortality is sufficient that governments do not have to adopt hard lockdown measures.

The economists tested whether the UK experience, which has a vaccination rate of 83,5% to 89,8% (two doses) across its four counties, and where deaths have remained low despite a surge in new infections and few social controls, could apply in other countries. 


By examining data from 208 other countries from early 2020 to this month, the economists – from the universities of Southern California and Tel Aviv, the Asian Development Bank and the Internals Monetary Fund – concluded that “in the presence of a sufficiently high share of inoculated individuals, governments can shade down containment measures, even as infections are still rampant, without significant adverse effects on mortality”.

The impact of vaccinations on mortality was so significant that the economists were confident that lockdown measures could be dialled down despite finding that vaccines’ impact on new infections was “insignificant”. 

Israel’s experience – booster campaign & learning from mistakes 

The paper also described how Israel’s attempts to remove its “COVID-19 pass” restrictions for entry to restaurants and other venues too early on led to surging caseloads over the summer – which peaked at world-record rates of new infections per capita in early September – or nearly 10,000 cases a day in a country of nine million people”.  

The country later reversed course, reimposing COVID-19 pass restrictions, mask mandates in closed spaces, and limits on venues, while launching a massive booster campaign.  

While “daily mortality was initially zero,” hospitalizations and also deaths increased by mid-September, as well,  “before receding to around seven daily deaths at the end of October”, according to the paper.

“The decrease in new infections since the mid-September peak is probably due to a vigorous booster campaign that raised total vaccinations to 180 per hundred individuals”, the paper argues.

That, along with the preferential treatment of vaccinated individuals in public events as well as continued restrictions on  international travel, probably played a lesser role in dimming the infection’s fires, they argue:

“Be that as it may, this opens the door for the hope that, following a sufficiently potent accumulation of vaccinations, infections are likely to recede as well.” 

Image Credits: CNN.

Spanish Minister of Science and Innovation Diana Morant at the announcement of the license.

The first non-exclusive license for a COVID-19 health tool – a serological antibody test that checks for the presence of anti-SARS-CoV-2 antibodies – has been finalised by the World Health Organization’s (WHO) COVID-19 Technology Access Pool (C-TAP) and the Medicines Patent Pool (MPP).  

The license, announced on Tuesday in partnership with the Spanish National Research Council (CSIC), will facilitate the rapid manufacture and commercialization of CSIC’s COVID-19 serological test worldwide. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus commended the CSIC, a public research institute, for “offering worldwide access to their technology and know-how.” 

“This is the kind of open and transparent licence we need to move the needle on access during and after the pandemic. I urge developers of COVID-19 vaccines, treatments and diagnostics to follow this example and turn the tide on the pandemic and on the devastating global inequity this pandemic has spotlighted.”

MPP Executive Director Charles Gore hailed CSIC for sharing its test, noting that there has been “too much selfish behaviour” during the pandemic.

Gore added that, as MPP had recently concluded a deal to licence and distribute two anti-viral treatments for COVID-19 with Merck and Pfizer, “the importance of diagnostic testing has increased ten-fold”.

Launched in 2020 by the WHO Director-General and the President of Costa Rica, C-TAP aims to pool technologies to boost manufacturing capacity and expand access to COVID-19 health products.   

Test is easy to use and royalty-free for LMICs 

The test is relatively simple and suitable for basic laboratory infrastructure, and if being offered royalty-free to low- and middle-income countries to promote equitable access to COVID-19 tools.

“This licence is a testament to what we can achieve when putting people at the centre of our global and multilateral efforts,” said Carlos Alvarado Quesada, President of Costa Rica, the founding country of C-TAP.  

“It shows that solidarity and equitable access can be achieved and that it is worthwhile continuing to support the principles of transparency, inclusiveness and non-exclusivity that the C-TAP defends.”

In July, WHO called on pharma companies developing therapeutic options for those with severe COVID-19 to waive exclusivity rights or issue transparent, non-exclusive licensing agreements, such as the one finalized with CSIC, in an effort to address ongoing global vaccine inequity. 

In order to sell the tests in low- and middle-income countries, companies producing the technology will need to supplement this manufacturing with performance data in the European population. 

CSIC president Rosa Menendez noted how this type of technology, and all COVID-19 technologies in particular, need solutions that reach all countries, especially those most vulnerable. 

“In this sense, we would like this action by CSIC, of taking part in the international initiatives of MPP and WHO, to become an example and a reference for other research organizations in the world,” she said.

The technology currently has four different serological tests, of which one has the potential to distinguish the immune response of COVID-19 infected individuals from vaccinated individuals. 

Health Action International (HAI) Senior Policy Adviser, Jaume Vidal, described the agreement as “a milestone for global health and a major step toward achieving more equitable access to health technologies”.

“The first product ever to be licensed to C-TAP is an example of public return on public investment in action. It is also evidence of the political will necessary to address protracted issues currently affecting the global response to the pandemic, such as limited manufacturing capabilities or obstacles to technology transfer,” said Vidal.

“The Spanish government is leading by example,” added Vidal. “Not only are they pushing for non-exclusive licensing through the Medicines Patent Pool (MPP) of a critical health technology and committing funding to C-TAP, but have also come out in support of the TRIPS waiver proposal currently under discussion at World Trade Organisation (WTO).”