The EU has announced a €100 million fund that prioritises humanitarian settings and capacity building of national health authorities in Africa.

The European Union (EU) today pledged €100 million towards a humanitarian fund that will assist with COVID-19 vaccine roll-out in Africa.

The initiative was announced today at a press briefing addressed by Dr John Nkengasong, Director of the Africa CDC and Janez Lenarčič, European Commissioner for Crisis Management.

According to the EU, the new fund will support two complementary dimensions of the vaccination campaigns in Africa. A quarter of the fund will support the roll-out of the vaccination campaigns in African countries. It will also support capacity building of national health authorities and health care workers and will also support the management of information and vaccination coordination platforms.

“It will also address critical logistical gaps, including equipment. This implementation at country and continental level will ensure better and independent monitoring of the roll-out of the COVID-19 vaccination campaigns across Africa, supporting Africa CDC’s ongoing work. From a long-term perspective, it would also seek to reinforce national health systems’ resilience to address future epidemic outbreaks,” the EU said in a statement.

A second tranche of €65 million is set aside to support the roll-out of vaccination campaigns in specific humanitarian settings, notably in conflict and hard-to-reach areas, implemented through needs-specific activities, in close cooperation with various EU humanitarian partners. A further €10 million in reserve will be allocated to any of the two tracks as needed.

Continuous Support for Africa

Africa’s public health stakeholders have repeatedly decried vaccine nationalism of several rich countries including some in Europe that have an oversupply of COVID-19 vaccines for their citizens while groups at most risk in several African countries are yet to get vaccine doses.

But Lenarčič noted that the EU has continued to support Africa and is doing a lot to expand and ensure equitable access to COVID-19 vaccine doses in Africa through the COVAX Facility and several other bilateral and unilateral actions. “Almost half of what is produced in the EU is exported,” he said.

According to him, the EU believes and supports a global approach towards tackling the COVID-19 pandemic.

“The EU has demonstrated its solidarity in many respects with regard to this pandemic, including through its financial contribution to the COVAX facility, and through export of vaccines produced in the EU. Together(with Africa CDC), we will be able to assist members of the African Union in rolling out their vaccination campaigns. This is part of what we see as a global approach,” Lenarčič said.

The EU has not always agreed with the Africa CDC on how best to approach poor access to COVID-19 vaccines in Africa. It opposed calls for intellectual property rights for COVID-19 vaccines to be waived so that more vaccine producers, including some in Africa, are able to be involved in mass production so that sufficient doses are available across the world.

Fund Allocation

John Nkenkasong, Director of the Africa Centres for Disease Control.

Nkenkasong told Health Policy Watch that while the estimate of what each African country will receive through the initiative is not yet available, there are broad indications of the kinds of efforts the fund can support in AU member states.

“The fund is not to get vaccines and distribute them to countries; it is to first aid countries to set up vaccination centres, and the roll-outs mechanism. The breakdown of exactly how much will go to each country is not an issue that we can put on the table now; it will be based on their strategic plans,” he told HPW.

He said every African country now has a vaccination plan and to disburse the fund will require engaging the countries, look at the interface between Africa CDC’s discussions with them, where they are with their vaccination plans and needs they still have.

“Some countries are very capable of doing their own things and they may not need this kind of support. However, some countries would need tremendous support to get to where they have to be, and then the specificity of this program is very important—the humanitarian component is extremely valuable because it has to be tailored to meet those goals of the targeted nature of the funds,” he added.

Image Credits: European Union.

Some studies have suggested that administration to travelers of a rapid COVID test upon arrival may be just as effective as lengthy quarantine requirements, to control the import of COVID-19 cases.

After months of stalemate, WHO looks set to update its guidance on managing COVID-19 infections in the context of international travel – but proof of vaccination should not be required as a condition of entry to any country, emphasized WHO’s International Health Emergency Committee.

This was among the wide-ranging recommendations issued on Monday by the International Health Regulations Emergency Committee, which first declared that the COVID-19 outbreak constituted an International Public Health Emergency (PHEIC), in January of 2020.

That advice seemed to clash head-on with the political winds in many countries, and the travel industry, regarding the adoption of vaccine certificates to reopen travel while containing virus spread and variants. Groups ranging from the International Air Transport Association to the European Commission have proposed the creation of a digital COVID vaccine/recovery certificate to facilitate safer international travel.

The statement also follows months in which WHO has resisted taking a stance in favor of now widely used measures such as pre-flight or post-flight COVID testing  – even though this is now widely practiced around the world – from Europe and North America, to Africa and Asia.

In a press release issued after its seventh meeting on the COVID pandemic, the Committee said that WHO should indeed: “update the WHO December 2020 risk-based guidance for reducing SARS-CoV-2 transmission related to international travel (by air, land, and sea) based on current science and best practices that include clear recommendations for testing approaches and traveler quarantine duration, as appropriate.”

It added that the updated travel guidance should “take into consideration COVID-19 vaccination roll out, immunity conferred by past infection, risk settings, movements of migrants, temporary workers, and purpose of travel (non-essential versus essential),” the Committee stated.

But in an explicit message to member states, the Committee added: “Do not require proof of vaccination as a condition of entry, given the limited (although growing) evidence about the performance of vaccines in reducing transmission and the persistent inequity in the global vaccine distribution. States Parties are strongly encouraged to acknowledge the potential for requirements of proof of vaccination to deepen inequities and promote differential freedom of movement.”

Strict COVID-related controls in travel and COVID testing at airports helped ‘bend the curve’ of the outbreak,in some countries, experts say. But WHO has so far not provided guidance.  
Other Advice – Control Food Safety in Wild Animal Markets to Reduce Pathogen Spillover to Humans

In other recommendations, the Committee also advised WHO and member states to proceed with rapid implementation of recommendations that have emerged from the international expert committee investigating the origins of the SARS-CoV2 virus, including new WHO guidance to temporarily suspend the sales of wild mammals in the so-called “wet animal markets”, where wild animals are held in captivity, and slaughtered on site for customers in many Asian and African cities.

The WHO international expert committee had said that infected wild mammals that were slaughered and sold in Wuhan wet markets were one “very likely” pathway for the introduction of the SARS-CoV2 virus into the city – although other scientists have charged that the theory the virus escaped from a Wuhan virology laboratory investigating coronaviruses should not be discounted either.

According to the Emergency Committee recommendations, WHO should:

  • Encourage research into the genetic evolution of the SARS-CoV-2 virus.
  • Promote One Health approaches to better understand and reduce the risk of spill-over of emerging infections from animal to human populations and from humans to animals, including from domestic animals.
  • Work with partners to develop and disseminate joint risk-based guidance for regulation of wet markets and farms to reduce transmission of novel pathogens from humans to animals and vice-versa.

The Committee also urged WHO to continue its appeals to “global solidarity efforts to increase equitable access to COVID-19 vaccines and ancillary supplies by supporting the COVAX Facility and engaging in technology transfer, where feasible.”  And it said that WHO and member states should strengthen its epidemiological and virologic surveillance as part of a comprehensive strategy to control the development of COVID-19 variants, including member state’s sharing of variant gene sequences and meta-data with WHO and on publicly available platforms.

 

Image Credits: Wikimedia Commons: Nemo.

New COVID-19  cases climbed again globally last week for the eighth week in a row – while only 1% of the 100 million vaccine doses administered last week were in low- and middle-income countries – said senior WHO officials on Monday, citing two key barometers of pandemic policies.

Meanwhile, speaking at a WHO press conference ahead of this week’s planned White House Climate Summit, the teenage climate activist Greta Thunberg called upon global leaders to ensure that front line health workers and other high-risk groups in low- and middle-income countries are vaccinated more rapidly – saying it was morally unacceptable that younger people in affluent countries should be able to access the vaccine ahead of high-risk groups elsewhere.

“We have the tools we need to correct this great imbalance that exists around the world today in the fight against COVID-19, just with the climate crisis, Thunberg said. “Those who are the most vulnerable need to be prioritized in global problems require global solutions… But so far, on average, one in four people in high-income countries have received the coronavirus vaccine, compared with just one in 500 in low and middle-income countries,” she said.

Thunberg, whose foundation announced a 100,000 Euro donation to the WHO co-sponsored COVAX initiative, added: “It is completely unethical that high-income countries are vaccinating young and healthy people, if that happens at the expense of people in risk groups, and on the front lines in low- and middle-income countries.”

Regarding the upcoming climate summit, the pandemic has highlighted how health and climate are inextricably intertwined with deforestation and environmental degradation that causes climate change and the spillover of animal-borne diseases into human populations, Thunberg stressed.

“In the future, we will most likely experience more frequent and more devastating pandemics unless we drastically changed the way our ways and the way we treat nature,” she said.

“Today, up to 75% of all emerging diseases come from animals. As we are cutting down forests and destroying habitats, we are creating the ideal conditions for diseases to spill over from one animal to another, and then to us. And we can no longer separate the health crisis from the ecological crisis, and we cannot separate the ecological crisis from the climate crisis. It’s all interlinked.”

Youth Climate Activist Greta Thunberg speaking at WHO press conference

COVID Infections Also Increasing Among Younger People at ‘Alarming’ Rate 

Meanwhile, COVID cases were increasing among younger people aged 25-29 at an “alarming rate” Tedros said, possibly as a result of the propagation of more transmissible SARS-CoV2 variants as well as increased social mixing among younger adults. That mixing, added WHO COVID-19 lead Maria Van Kerkhove, is not only due to more socializing and pandemic fatigue, but also for work and religious reasons following the Easter holidays and Ramadan.

More than 5.2 million new cases were reported just last week, the largest so far, and the world also topped the record of 3 million deaths.  “It took nine months to reach 1 million [deaths], four months to reach 2 million and just 3 months to reach 3 million deaths. Big numbers can make us numb. But each one of these lives lost is a tragedy for families, communities and nations,” Tedros said.

COVAX Facility Facing Immediate Supply Problems Related to India Case Surge

WHO’s Bruce Aylward

The COVAX facility had, as of Monday, distributed just over 38.7 million vaccine doses in low- and middle-income countries, noted WHO senior advisor Bruce Aylward.

“The whole vaccine supply situation remains precarious, and the challenge still because of such competing demands for these doses remains a very difficult one to manage,” said Aylward.

The surge in COVAX cases in India has put constraints on COVAX access to vaccines produced by the Serum Institute of India (SII) – one of the main COVAX vaccine suppliers to date, he explained For the time being, SII has had to redirect much of its recent production to domestic cases. COVAX remains short on donations of other alternative vaccines, as well as funds to make strategic purchases.

“It all it all comes back again also to the COVAX facility having the resources it needs so that it can put the contracts in place, upfront to make sure the supplies are there, not just the supplies in terms of the vaccines, but… syringes and the other supplies, including … cold chain equipment, and sometimes very specialized cold chain equipment to get these products to people,” said Aylward.

While the African Union and the World Trade Organization last week held major conferences on the topic of expanding vaccine manufacturing in the short term the focus needs to be on the redistribution of doses being produced right now, Aylward stressed.

“The challenge is how we’re actually using the doses that are being made.  Last week, while those conferences were taking place, 100 million more doses of vaccines were administered around the world. And the issue is where they’re being administered – because … 99 million doses of vaccines last week went into high, upper middle income and some lower-middle-income countries but only 1% went to the lowest income countries.”

Aylward and other WHO officials lauded recent gestures by countries such as Sweden and Norway to donate excess vaccines that they don’t plan to use – urging other high-income countries that are currently hoarding vaccines to follow suit.

“If we have a lot more weeks, where 99% of the vaccines go to a set of countries that already have most of the vaccine, we’re not going to get out of this crisis as rapidly and efficiently and with as least, you know lives lost as possible,” Aylward noted.

Meanwhile, WHO’s Chief Scientist Soumya Swaminathan said that there remains considerable global vaccine “fill and finish” capacity that has not yet been harnessed by pharma producers capable of making larger quantities of active vaccine ingredients.  She said that a new COVID Vaccine Manufacturing Task Force, co-sponsored by WHO, COVAX, and other partners, is looking at opportunities to quickly address bottlenecks and ramp up the production of more vaccine supplies.

WHO Chief Scientist Soumya Swaminathan

“We know that there is a lot of unused fill and finish capacity globally, and therefore we need manufacturers who have the capacity to make a bulk [active vaccine ingredient] product, to link them with existing fill and finish capacities in facilities around the world,” Swaminathan said.

The Task Force is trying to help link suppliers of critical vaccine ingredients and raw materials to manufacturers, and ensure that export bans “don’t interfere with the process of vaccine manufacturing”. A longer-term goal would be to actually build more manufacturing capacity, particularly in low- and middle-income countries through technology transfer arrangements, she added.

In a thinly veiled appeal to Moderna and Pfizer, Swaminathan said that WHO is calling upon “owners of technology, particularly mRNA technology, to come forward to work with us, to share that technology, that know-how, and experience with recipient companies that will be selected according to a set of criteria that we are developing, and that will ensure not only supplies for this pandemic, but will also help with future regional health security for regions which currently do not have any vaccine manufacturing capacity.  And this obviously can be extended to vaccines for many other infectious diseases.”

On Friday, WHO issued a call for expressions of interest from small and mid-sized pharma firms, as well as from “owners of technology and intellectual property rights” to mRNA vaccines –  to support the creation of a COVID-19 mRNA vaccine technology transfer hubs, particularly in low- and middle-income countries.

“The intention is for these hubs to enable the establishment of production process at an industrial or semi-industrial level permitting training and provision of all necessary standard operating procedures for production and quality control. It is essential that the technology used is either free of intellectual property constraints in LMICs, or that such rights are made available to the technology hub and the future recipients of the technology through non-exclusive licenses to produce, export and distribute the COVID-19 vaccine in LMICs, including through the COVAX facility,” stated the WHO call.

It added that it was seeking expressions of interest from:

  1. Small/middle-sized (public or private) manufacturers of medical products (drugs, vaccines or drug substances) preferably, but not exclusively, in LMICs, which could host a COVID-19 mRNA hub and:
    • Assemble the technology up to good manufacturing practices-grade pilot lots for clinical trials;
    • Transfer the appropriate know-how and technology to existing or new manufacturers in LMICs to enable them to develop and produce COVID-19 mRNA vaccines;
  2. Owners (public or private) of technology and/or intellectual property rights. These may be academic institutions, pharmaceutical companies, non-governmental organizations, or any other entity willing to contribute these to a technology transfer hub, under the auspices of WHO, to enable the production of mRNA-based COVID-19 vaccines in LMICs.

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Africa, Ghana

Six weeks after receiving 1.7 million doses of the AstraZeneca COVID-19 vaccine from COVAX, the Democratic Republic of Congo (DRC) finally started to vaccinate people on Monday.

The delay followed concerns about the safety of the vaccine amid reports about possible links between the vaccine and blood clotting.

In a bid to build public confidence, Health Minister Eteni Longondo became one of the first people to receive the vaccine at Kinshasa University’s medical school. The European Union’s Ambassador to the DRC, Jean-Marc Chataigner, and UN Humanitarian Affairs Coordinator David McLachlan-Karr were also vaccinated.

The rollout was initially due to start on 15 March.

Interior Minister Gilbert Kankonde said last week that the country’s medical experts were satisfied that the vaccine posed no danger to citizens.

“The vaccination will be voluntary and priority will be given to healthcare personnel, vulnerable people, those with chronic illnesses and all those who are greatly exposed while carrying out their work,” Kankonde said.

The country of more than 80 million people has received 1.7 million doses of AstraZeneca through COVAX, a World Health Organization-backed effort to procure and distribute inoculations to poor countries. In addition, India has also donated 50,000 doses to the country.

The vast central African country has officially registered 28,956 cases of COVID-19, with 745 deaths, since the start of the pandemic last year.

Kankonde added that the country would also ease its curfew, currently between 9pm to 5am, to 10pm – 4am in provinces with low caseloads.

According to official statistics, the 80-million strong country has only recorded 28,665 infections and 745 deaths.

In early April, UN peacekeepers from the Southern Sector at Democratic Republic of Congo received their first dose of COVID-19 vaccine from a donation from the Indian government. Other UN agency staff members are expected to start being vaccinated from today.

 

Image Credits: WHO.

A new study has found that there is a higher risk of blood clots from COVID-19 than vaccines.

The risk of developing a rare brain blood clot is eight to ten times higher in people infected with COVID-19 than those who get a vaccine, a new study has found.

The study by Oxford University last week reported that the risk of the rare blood clotting known as cerebral venous thrombosis (CVT) following COVID-19 infection is around 100 times greater than normal, several times higher than it is post-vaccination or following influenza.

The study follows investigations into links between the AstraZeneca vaccine and rare blood clots and also looked at those who had a Pfizer or Moderna vaccine. According to the study, four people in one million people experience CVT after getting the Pfizer or Moderna vaccine, versus five in one million people for the AstraZeneca vaccine. In comparison, 39 in one million patients who get COVID-19 develop CVT.

Rollouts of AstraZeneca’s vaccine have been halted or limited in many countries, based on concerns about blood clots.

Led by Professor Paul Harrison and Dr Maxime Taquet from Oxford University’s Department of Psychiatry and the NIHR Oxford Health Biomedical Research Centre, the study examined the health records of 81 million people in the US, looking at the number of CVT cases diagnosed in the two weeks following a diagnosis of COVID-19 and the number of cases occurring in the two weeks after people had their first coronavirus vaccine.

They then compared these to calculated incidences of CVT following influenza, and the background level in the general population. The risk of a CVT from COVID-19 is about 10 times greater than the mRNA and eight times greater than the AstraZeneca vaccine. In addition, 80% of people who developed the clots survived.

Reassuring Findings

Based on US data, the Oxford research team said people being vaccinated should be reassured by the findings.
The study has not been through a final review and is still a work-in-progress, but the researchers say it must be “interpreted cautiously because it is difficult to calculate with certainty how common CVTs are in the general population, partly because of just how rare they are”.

According to Harrison: “We’ve reached two important conclusions. Firstly, COVID-19 markedly increases the risk of CVT, adding to the list of blood clotting problems this infection causes. Secondly, the COVID-19 risk is higher than we see with the current vaccines, even for those under 30; something that should be taken into account when considering the balances between risks and benefits for vaccination”.

Prof Beverley Hunt of Thrombosis UK told BBC news that the mechanisms behind people getting clots after COVID-19 and those experiencing clots after vaccines were likely to be different.

“Patients who are hospitalised with COVID-19 have very pro-thrombotic (sticky) changes in their blood, which persist after they have been discharged. This will lead to an increased rate of blood clots.
“The mechanism for the very rare blood clots and low platelet counts seen after the AstraZeneca vaccine is different. It is associated with an immune response.”

People are “likely” to need a third dose of the coronavirus vaccine within 12 months of getting the first two doses of the Pfizer-BioNTech vaccine, Pfizer CEO Albert Bourla said during a recent interview.

The third booster jab could be necessary “somewhere between six and 12 months” after the second one and possibly even annually, Pfizer CEO Albert Bourla told CNBC television during a recording broadcast on 15 April.

“A likely scenario is that there will be likely a need for a third dose, somewhere between six and 12 months and then from there, there will be an annual revaccination, but all of that needs to be confirmed. And again, the variants will play a key role,” he told a CNBC reporter.

Bourla said that the Pfizer-BioNTech vaccine has proved to provide immunity for six months.

Variants “will play a key role” in how regularly people will need to have their COVID immunity topped up as time goes on – in a similar way to how flu vaccines are updated and re-administered year on year.

“But protection goes down by time. It is extremely important to suppress the pool of people that can be susceptible to the virus,” Bourla said. 

Earlier this month, Pfizer said its COVID-19 vaccine was more than 91% effective at protecting against the coronavirus and more than 95% effective against severe disease up to six months after the second dose.

Beyond the study of 12,000 vaccinated people, exactly how long immunity lasts with two doses “remains to be seen”, Bourla said. Researchers say more data is needed to determine whether protection lasts after six months. 

In February, Pfizer and BioNTech said they were testing a third booster dose of their COVID-19 vaccine to better understand the immune response against new variants of the virus.

Nadhim Zahawi, the UK’s Minister for Business & Industry and COVID Vaccine Deployment, has said that his country’s top four priority groups could be invited for a third booster dose as soon as September.

The over-80s, clinically extremely vulnerable, health and social care staff and care home workers were the first to be vaccinated against coronavirus in December and the first weeks of this year.

They were offered the Pfizer-BioNTech or the Oxford-AstraZeneca jab, but Zahawi says he expects eight different vaccines to be available later in the year.

In the US, health officials are already preparing for booster doses to be issued between nine and 12 months after people are fully vaccinated.

This would mean a third dose for people who have received the Pfizer or Moderna jabs and a second dose for the Johnson & Johnson single-shot vaccine. 

Bourla’s comments come after Johnson & Johnson CEO Alex Gorsky told CNBC in February that people may need to get vaccinated against COVID-19 annually.

 

 

 

 

 

 

 

Image Credits: Flickr – World Economic Forum.

Polluted air in New Delhi

NEW DELHI, India – Delhi State aims to fight air pollution as a “mass movement” with public participation,  according to Environment Minister Gopal Rai – but a recent conference he called with experts on the issue concluded with no firm commitments.

Rai convened the two-day virtual conference with air pollution experts and clean air advocates to brainstorm ideas for a “long-term action plan to tackle pollution” ahead of north India’s seasonal winter peaks.

New Delhi is the most polluted city in the world and on certain days citizens are exposed to such poor air quality that it is the equivalent of smoking 40-50 cigarettes per day.

“The government will focus on changing the mindset and behaviour of people,” Rai told the meeting. “Within the constraints of the pandemic and restrictions on mass mobilisation, we need to create a mass movement. Our three-pronged approach needs to focus on policy, technology and making the environment a mass concern,” he said. 

Although the government has taken some steps, including an electric vehicle policy (aiming for a quarter of new vehicles licensed to be electric by 2024) and introducing bio-decomposers to curb stubble burning, Rai admitted these were not enough.

Delhi state Environment Minister Gopal Rai

“A plan is needed that can work through the year, and in the coming days we will come up with an action plan to further better Delhi’s air quality index. Nobody knows until when the pandemic will rage, and it’s not feasible to wait that long. We would like your suggestions to create a viable and effective plan for the city,” he said. 

“While we have identified hotspots, it is still challenging to measure the timing, the rate, source and impact of pollution. The Delhi government is working at a technological level to find appropriate tools to measure these indicators which would in turn help us devise the correct policy,” he explained.

However, no commitments were made at the meeting, and experts pointed out that a similar meeting had been called in February 2020, which yielded little in terms of actual pollution control.

Lots of Ideas, But No Follow Through

There is no dearth of ideas on how to control pollution – from banning the manufacture of firecrackers to installing filters in the chimney stacks of industrial units to reduce emissions or mandating norms for fuel and engines. But none is popular because commercial interests are harmed, and defensive lobbies are pushing back in courts.

In October last year, the Delhi government had announced a “war on pollution,” with great fanfare, led from a war room personally commanded by Chief Minister Arvind Kejariwal. 

His arsenal comprised a seven-point action plan that included:  tracking the city’s hotspots; launching a ‘green Delhi’ mobile app to address open air burning complaints; and repairing the city’s potholed roads to control dust. 

His most powerful weapon at the time was a cheap and simple rapid compost brew, Pusa Decomposer, that Kejriwal had hoped would inspire farmers in surrounding rural states to turn their crop waste into valuable fertilizer rather than burning it. 

Rai told the conference that teams from the adjoining states of Punjab and Haryana had visited a government decomposer pilot, but didn’t offer more details or any commitments made by them to adopt the decomposer.

Unexpected Revival of Air Quality Management Body

The experts suggested taking a proactive, year-round and an airshed approach to reducing air pollution, working collaboratively with neighboring states; creating walking and cycling paths, improving public transport, managing garbage better, choosing cleaner fuel, encouraging electric vehicles for transport and delivery, and enforcing existing pollution control laws. 

The meeting follows an unexpected move by the federal government to approve the re-promulgation of an ordinance to set up a statutory body to manage air quality in India’s polluted National Capital Region, which includes Delhi, and adjoining areas of the Indo-Gangetic plain, which includes Punjab, Haryana, Rajasthan and Uttar Pradesh. Significantly, the new ordinance envisages an expanded statutory body that will include the interests of the farming, industry and construction sectors.

The ordinance was first promulgated last October at the peak of north India’s annual ‘airpocalypse’, before being inexplicably allowed to lapse last month, when air quality was beginning to improve slightly. 

But a recent meeting of federal ministers and their bureaucrat counterparts approved the re-promulgation of the ordinance, and the government is expected to introduce it as a Bill in the monsoon session of Parliament, according to environment secretary RP Gupta.

There has been no official word on this development but Solicitor General Tushar Mehta, who represents the government in the courts applied to court to place the ordinance on record, which was accepted by the court. 

Once the ordinance is re-promulgated and enacted by presidential decree, the commission is expected to be reconstituted with most of the original members. Although there is no official notification as yet, the original members are expecting to be retained, according to government sources who declined to be named.

The erstwhile 18-member Commission on Air Quality Management (CAQM) had been headed by M.M. Kutty, a former bureaucrat who had once headed the ministry of petroleum and natural gas. The other members included Arvind Nautiyal, a joint secretary in the environment ministry, KJ Ramesh, former head of the India Meteorological Department and Ashish Dhawan of the Air Pollution Action Group as an NGO representative.

Key stakeholders including the health, agriculture, rural development and labour ministries, had been left out. 

Sources told Health Policy Watch that the government let the ordinance lapse because the CAQM’s ability to prosecute polluters meant it could impose stringent penalties on farmers for burning crop stubble.

“The farmers’ protests have become a very sensitive topic,” the source said.

Until March, the CAQM was functioning out of a temporary space in the office of the Indian Oil Corporation, and meeting every two to three weeks to outline and discuss its strategy. It had started working on a pilot project on estimating hyper-local pollution using curb-side laser measurements of vehicular pollution.

“The committee had made decent progress,” a source said, noting that if a brand new committee is constituted, this progress would be lost. 

“The only concern we had was around funding. It is still not clear where the funds will be allocated from,” another person close to the committee said. 

They added however that they expect the commission to retain its statutory powers, including those empowering it to impose strict penalties on polluters. These penalties include a jail term of up to five years as well as fines.

The unexpected, and unexplained, dissolution and, now, re-promulgation has taken atmospheric scientists and clean-air advocates by surprise. “#CAQM on the way back; for real or just another charade?” Bhavreen Kandhari, a clean air activist, tweeted.

“The CAQM is a major improvement over the EPCA. The devil is in the details, what is the fund allocation, how large will be the secretariat, how will it be able to carry out punishment and fines, etc. – all this need to be known,” Dr Laveesh Bhandari, economist and director of the Indicus Foundation, said. “It is these details that will decide whether this initiative will be effective.”

 

Image Credits: Neil Palmer.

The city of Chicago in the United States used innovative ways to help fight the COVID-19 pandemic.

A real-time COVID-19 data dashboard, celebrities and athletes sharing information about COVID-19 and vaccine hesitancy, rapid response task teams and public communications campaigns have formed part of response strategies to help two major cities fight the pandemic.

The Partnership for Healthy Cities – supported by Bloomberg Philanthropies, the World Health Organization and Vital Strategies— on Thursday hosted a VitalTalks webinar on how Chicago in the US and Montevideo in Uruguay developed and implemented various systems to prioritise equity in their COVID-19 recovery plans.

In his opening remarks, WHO Director General Dr Tedros Adhanom Ghebreyesus said the virus has exploited and exacerbated underlying inequalities and that cities have borne the brunt of the pandemic.

“But many cities have also shown how the virus can be brought under control,” said Dr Tedros, adding that with “tailored and consistent use of proven public health measures” some cities were able to mitigate the devastating impact of COVID-19 and the inequalities it brought to the fore.

Tedros called on mayors across the world to implement policies to ensure equitable access to vaccines, with priority given to health workers, the elderly and those with health conditions that put them at higher risk. Health was not a luxury,  said Tedros, but a “fundamental human right and the foundation of social, economic, and political stability”.

“As you rebuild, we need to address the underlying inequalities that have left so many communities vulnerable,” he said.

Protecting The Most Vulnerable

Chicago mayor Lori Lightfoot and Intendant Carolina Cosse of Montevideo shared information about how they mounted response campaigns to support high risk populations, protect the lives of those most vulnerable to COVID-19 and the innovative campaigns they launched to communicate and educate residents about new programmes.

 

A year ago, Chicago picked up that its Black residents were dying at seven times the rate of any other population group, forcing authorities to prioritise providing these  residents with tools to protect themselves.

“The progress that we’re now benefiting from is a result of that hard work that started over a year ago. I see this as an opportunity for us to build a really permanent foundational infrastructure to work on community health issues in disparities that we’ve all known about. But now we have an opportunity because of COVID, to really make significant progress and reverse the trends,” said Lightfoot.

Chicago relied heavily on data to ensure that the city prioritised the vaccination of healthcare workers and citizens with comorbidities. Its vaccination drive focused on neighbourhoods that were hardest hit by the pandemic, many predominantly Black and Latinx, and the city is now seeing COVID-19  numbers steadily decreasing in these areas for the first time since the pandemic.

Key to the city’s interventions was “listening to our residents” and forming authentic relationships including forming a racial equity rapid response team, said Lightfoot.

Chicago’s residents are divided equally between white, Black and Latinx people, but in some instances, the life expectancy gap between Black and white was 12 years or more, said Lightfoot.

COVID-19’s deadly toll has hit Black and Latinx Chicagoans hardest, accounting for 71% of all deaths, while those groups make up 66% of the city’s population, according to city data.

No ‘Band Aid’ Solutions

Chicago mayor Lori Lightfoot

One of the challenges that the city faced, Lightfoot said, was that many people of colour did not have adequate access to healthcare and COVID-19 infections were disproportionately affecting Black residents. 

“I said to my team at that time, we need to dig into this. We can’t look away, but we also can’t do temporary Band Aid solutions,” said Lightfoot.

The formation of the racial equity rapid response team saw the city partner with a community health care organisation that had already been working on this issue.

Chicago also relies heavily on a data dashboard which is updated daily to follow and understand the pandemic in real time. The dashboard tracks daily COVID-19 positive rates, deaths, hospitalisations, ICU admissions and the number of people on ventilators across the city. All this information is shared with the public.

Another intervention called “the doctor is in” involves a medical doctor fielding  COVID-19 questions from residents on Facebook Live. At first offered only in English, the service is now available in Spanish.

“We know that the only way that we’re going to calm people’s fears and educate them about the things that they can do to protect themselves is by being 100%, transparent, but meeting them where they are in the moment, using trusted community partners, and that has served us well here in Chicago.”

More still needs to be done, but Lightfoot believes the city has laid a foundation  for addressing “larger systemic health care inequities going forward”.

Montevideo’s Used Existing Health Partnerships

Montevideo drew on its history of working with partners to prevent non-communicable diseases to address the pandemic. 

Cosse said they reinforced existing policies and legislation to help with the fight the pandemic and developed an ABC emergency plan. The ABC plan, among other things, promotes gender equality, and helps with food distribution and housing.

The city had extensive public communications campaigns, including dedicated telephone lines to assist its residents with any COVID-19 related queries or counselling. Many people, especially the elderly who did not have access to the Internet, used the telephone lines to ask about preventative measures, vaccines and testing centres.

Cosse said while they were not responsible for vaccine distribution, they assisted 23  polyclinics in Montevideo with staff and mobile gear.

Lightfoot said there was no “playbook” on how to manage cities during a pandemic.

Partnerships and collaborations with various stakeholders was vital to fighting the pandemic on various levels, she said.

“I think the mayors have to be the center of gravity for what’s happening, but bringing other people to the table that are necessary to address vaccine hesitancy, For example, we’ve done everything from celebrities talking about vaccines, you know, athletes, entertainers.”

Proper Systems

Lightfoot said her city was able to provide a robust response because as the  Department of Public Health had proper systems in place.

“You remember the early days of this pandemic, where people were flying around with suitcases of money to find personal protective equipment and mass ventilators? We didn’t have that struggle in Chicago, because we have a robust public health structure, ” said Lightfoot.

But more importantly, she said, following the data and transparency about decision making was “critical”.

“People have been carrying a lot of burdens over this last year. We treated people like adults, and we’ve done it with data, and science. Without rebelling in the way that we’ve seen in other parts of the world, is because we told them the truth.”

For Cosse, it was about cities having holistic responses to healthcare provision and finding a working solution between science, education and the economy.

“The solution is complex, but the solution is not in the main office. Go out and talk to people.”

infectious disease
A villager’s eyes are being examined for African eye worm by Dr Philippe Urwotho, a medical doctor and Provincial Coordinator of the DRC’s Neglected Tropical Disease National Programme.

Global funding to develop new drugs for some of the world’s leading infectious disease killers, such as HIV/AIDS, TB, and malaria, was US $3.876 billion, with the drop of US $185 million from 2018 reflecting COVID-related difficulties in data collection, according to the G-Finder Report, which tracks annual global investments.

However, once participation is accounted for, the report estimates that 2019 funding was virtually unchanged from its record high in 2018, with only a marginal decline of US $8 million. 

On the other hand, funding for neglected tropical diseases (NTDs) remains stagnant as it had for the past decade, with most NTDs seeing little change to their individual funding levels (although the majority did receive small increases), according to findings in the report, launched on Thursday by the Australia-based Policy Cures Research group. 

Mixed Signals in Global Trends; Policy Makers Need to Step Up to Address NTDs 
Nick Chapman, CEO, Policy Cures Research

The G-Finder Report is a comprehensive analysis of global investment into research and development of new products to prevent, diagnose, control or cure neglected diseases. It is widely used by national governments, industry, civil society, and the World Health Organization to identify gaps in progress and areas where investments would be needed. 

Reactions to the news remain mixed, in line with the good and bad news the report contains. 

“It’s not necessarily a good one or a great one. I don’t think that the level or the distribution of global funding for neglected disease is as we wanted or as it should be,” said Nick Chapman, CEO of Policy Cures Research, during the launch of the report. 

Ricardo Baptista Leite, member of the Parliament of Portugal, called on policy makers, who have both the legal and moral obligations to represent underserved populations, to tackle neglected diseases. 

“Policymakers are the ones who are at the interface of academia, social science, civil society, philanthropy, private sector, and media, be it social or conventional, and therefore they can truly represent the multi-sectoral approach needed to fight poverty and therefore tackle directly the root causes of these diseases.” 

Leading Infectious Diseases Account for Three-Quarters of Funding

Changes in neglected disease funding – increases in TB, HIV/AIDS, salmonella infections, and snakebite, decreases for helminth infections, malaria, hep C, and diarrhoeal diseases

The G-FINDER report tracks investments across 36 diseases including HIV/AIDS, tuberculosis, and malaria – which together represent the world’s leading infectious disease killers. The three accounted for US $2.7 billion, or three-quarters of global funding in 2019 

While global funding for HIV/AIDs and tuberculosis research and development increased from 2018 (up US $29 million for both), funding for malaria dropped slightly, falling US $32 million – the first drop since 2015. 

The latter quarter of R&D investment was split between the remaining 33 diseases, with funding remaining relatively stagnant, although the majority of diseases did receive small increases in funding.

Increased funding was the result of two United Kingdom public funders – Department for International Development (DFID) and Department for Health and Social Care (DHSC) – which supported a Global Health Research Group on African Snakebite Research, and ongoing funding from the UK NHS. 

Dengue, a WHO-categorized NTD listed as one of the top ten threats to global health, had its funding increased slightly by US $3.2 million. The only other NTD to see increased funding in 2019 was Buruli ulcer, which rose (up US $0.2 million) to US $2.8 million.

US Primary Contributor, But Report Calls for Diversity in Funding

The US NIH contributes to most of global infectious disease funding

Investment by public sector and philanthropic groups reached another year of growth and record highs, while private sector funding declined in 2019, according to the report.

The United States contributed close to three-quarters of total public funding, once again making it the largest public funder at US $1.878 billion. The UK was the second-largest contributor (US $210 million), followed by the European commission.

According to Paul Barnsley, senior analyst at Policy Cures Research, this “warrants celebration”, but also a “small amount of concern” as Policy Cures Research Group warned in the past about dependence on only a few major funders, and pushes for diversity in funding. 

“It’s fair to wonder whether decision makers are paying as much attention to G-FINDER report briefings as they ought to be.” 

Alongside the US, the next largest increases in funding came from low- and middle-income countries – Brazil and Colombia – with France and Switzerland following.

Most of the increase in public funding was directed to HIV/AIDS, TB, and malaria. 

Philanthropic funding for neglected disease R&D totaled US $782 million in 2019. Increases came mainly from the Gates Foundation (up US $35 million) and the Wellcome Trust. The Open Philanthropy Project became the third largest Philanthropic Funder, increasing their funding US $9.3 million from their modest investment of US $14 million. 

COVID-19 Funding Unprecedented 

COVID-19’s unprecedented funding may result in fiscal tightening that impacts NTD investment

In spite of  concerns surrounding lack of diversified funding, the Policy Cures Research Group still found the funding pledged in the last year for COVID-19 to be positive.

“Even if a chunk of these [pledges] turned out to be empty promises more than 9 billion pledged in the first 9 months of 2020 still represents an unprecedented response, much bigger than anything we saw for Ebola, much bigger than our annual spending across all neglected diseases combined,” said Paul Barnsley. 

Barnsley said high income economy interest rates remained “mostly low” and nations that had to “spend their way through COVID still have the means to spend the way out of recession.” 

While this initial picture is relatively welcoming, future fiscal tightening may impact neglected disease funding.

“We have anecdotal evidence that funding designed to help people in other countries fares badly during general belt tightening,” said Barnsley.  

But COVID-19 does speak to the need for collaboration across sectors in order to combat both pandemics and neglected diseases. 

“It is not just the science of product development, but it’s really the science of partnerships. The COVID experience will give us valuable lessons about how to be really good scientists in creating the best possible partnerships to address global health needs,” said Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative (IAVI). 

Image Credits: DNDi, Policy Cures Research Group .

The hospitals and health workforce in Papua New Guinea are under pressure amid surging COVID-19 cases.

As the world quickly approaches the highest weekly rate of infection recorded since the start of the pandemic over a year ago, several countries that have largely held COVID-19 at bay so far are seeing surges in infections. 

Papua New Guinea (PNG), a small Pacific island state that successfully shielded itself from the SARS-CoV2 virus until recently, has reported a total of 9,343 cases and 82 deaths, half of which were reported in the last month. This sharp rise in cases holds the potential for a large epidemic, according to WHO officials. 

PNG and the broader Western Pacific region was the focus of the WHO biweekly press conference on Friday.

The global number of new cases per week has nearly doubled over the past two months and continues to increase, along with the number of deaths, at “worrying” rates, said Dr Tedros Adhanom Ghebreyesus, WHO Director General.

The Western Pacific region has been “relatively fortunate” in the pandemic, Dr Takeshi Kasai, WHO Regional Director for the Western Pacific Region, told the press conference. Home to one quarter of the world’s population, the region has only recorded 1.6% of the global cases and 1.2% of the deaths. 

However, several countries in the region, including PNG, are now witnessing surges in cases.

“In remote Pacific countries, even a few cases could have a devastating impact,” said Kasai. “The pandemic means that every corner of every country in every part of the world must be prepared and protected against COVID-19.

“We must continue to pay special attention to small countries who have so far been able to stop the virus [from] coming in,” he added.

The WHO has deployed 13 experts to assist with case management, epidemiology, infection prevention and control, lab support, and information management. Emergency medical teams from Australia, Germany, and the US have also arrived to aid in PNG’s response. 

The Australian medical team leaving for Papua New Guinea last week, taking with them critical medical equipment to assist local authorities.

In addition, several countries have donated much needed PPE, oxygen concentrators, and biomedical equipment, which are critical to strengthen the local capacity across the country.

PNG Began Vaccine Rollout, But Best Defense is Public Health Measures

Australia provided PNG with an emergency supply of 8,000 doses of the AstraZeneca vaccine in late March, enabling the country to vaccinate healthcare and frontline workers. However, out of a population of 8.7 million, only 1,600 people have received at least one dose of the vaccine. 

But the first batch of 132,000 AstraZeneca vaccines was received earlier this week from the COVAX facility. The government expects to administer these jabs nationwide by May, said Jelta Wong, PNG’s Minister of Health. 

“With rising infections, understandable fatigue with social restrictions, low levels of immunity among the population and the fragile health system, it is vital that [PNG] receives more vaccines as soon as possible,” said Tedros. 

In the broader Western Pacific region, several countries are yet to receive any vaccines or have only received very few doses. In this context, “it is important to emphasize that vaccines alone will not end the Papua New Guinea outbreak or the pandemic,” said Kasai.

Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at the press conference on Friday.

The supplies that the PNG expects to receive in the coming months will only be enough to protect the most high-risk and vulnerable groups in the country. 

Instead, the country’s best defense is the strong enforcement of, and compliance with, proven public health measures, Kasai stressed. 

Improving Information Sharing Will be Central Topic at World Health Assembly 

Meanwhile, at the upcoming 74th World Health Assembly in May, it is expected that the ongoing evaluations of the WHO’s response to the COVID-19 pandemic will be the subject of numerous discussions, specifically on information sharing. 

Several reports on the COVID-19 response, WHO’s work in health emergencies, and strengthening WHO’s global emergency preparedness and response will be reviewed, according to the provisional agenda. 

In addition, several reports on WHO reform will be discussed. 

“I think we do have to look at how information moves in the system,” said Dr Mike Ryan, Executive Director of the WHO Health Emergencies Programme. “We have so much data, our problem is [establishing the platforms]…so that each user in the system, from the frontline primary health care worker, all the way through to global epidemiologists and modelers, have access to data in real time, at the right time, before, during, and after epidemics.”

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

“We have not invested enough in accessing, managing, and using data to prevent, to respond to, and to recover from pandemics. This is a major focus for WHO going forward,” Ryan added. 

According to WHO officials, member states are “pushing very hard” for increased investments in the gathering and sharing of local, national, and global surveillance data and the sharing of biological tools and technology to strengthen global preparedness in the face of threats. 

“We will continue to make the system really robust because information is the basis and that’s how we can beat the current [pandemic] and also prepare for the future,” said Tedros. “It’s a learning organization and we will continue to learn and improve our system.”

Vaccine Passports Raise Several Issues if Made Mandatory

Meanwhile, WHO officials advise all individuals and governments to keep a record of vaccinations, but say that there are scientific, ethical, and equity implications of requiring a COVID-19 vaccine for activities and travel. 

“Having a record…of your vaccination status is good for you, that’s good for your health. And it’s good for the authorities to know who’s been vaccinated in any given country,” said Ryan. “That’s very different to what that document is then used for.”

Research is still underway on the efficacy of the vaccines against asymptomatic infection or infection with mild symptoms, as well as protection after national infection. This means that the scientific rationale behind vaccine passports – that those with a vaccine certificate are unlikely to infect other people – is currently unsupported. 

“We cannot take it for granted that, just because somebody is vaccinated, they are absolutely not going to be infected and therefore not be a risk to others,” said Dr Soumya Swaminathan, WHO Chief Scientist.

Dr Soumya Swaminathan, WHO Chief Scientist, at the press conference on Friday.

While a vaccine certificate would likely represent the immunity of the individual, it may not reflect that the person won’t transmit the virus. 

In addition, ethical and equity issues are raised once vaccine certificates are required to access a person’s school, workplace, or international travel, “especially in a world where vaccines are distributed in such a grossly inequitable way,” said Ryan. 

“While some countries have vaccinated over 30 or 40% of their adult populations, others have barely reached 1% or even less,” Swaminathan said. “So this is not something that can be applied globally right now because not enough people have had the vaccine.”

The International Health Regulations Emergency Committee, the committee advising WHO on travel regulations, held its seventh meeting on Thursday. Updated guidance on using vaccination certificates as a prerequisite for travel is expected to be received by Dr Tedros by Monday. 

Image Credits: ABC News Australia, ABC News Australia, WHO.