Checking blood sugar levels in Kenya for control of diabetes.

The inflated costs of insulin and control of its price and supply – are barriers preventing people with diabetes from accessing this life-saving medicine, according to a report released by the World Health Organization (WHO). 

Insulin is the basis of diabetes treatment, essential for nine million people with type 1 diabetes who cannot make the hormone that controls the blood glucose level, and 63 million people living with type 2 diabetes, with limited or diminishing insulin.

It reduces the risk of kidney failure, blindness and limb amputation – but half the people living with type-2 diabetes cannot afford it.

Around 90% of the market tightly controlled by three multinational companies: Novo Nordisk, Eli Lilly, and Sanofi, according to the WHO report.

With a higher number of people today being diagnosed with diabetes, the WHO has said that unaffordable insulin, stakes of multi-billion dollar companies in manufacturing and supply, and storage of the life-saving medicine are the main barriers of access to insulin.

According to the report, released to coincide with World Diabetes Day on 14 November, the use of insulin analogues, or synthetic insulin, has increased in high-and middle-income countries although it is significantly more expensive than human insulin. 

Eighty percent of the 420 million people living with diabetes live in low- and middle-income countries.Type-2 diabetes is the most common type of diabetes and access to affordable insulin and treatment is critical to their survival. 

There is a globally agreed target to halt the rise in diabetes and obesity by 2025. Currently, over a million deaths each year are directly attributed to diabetes.

Lower-income countries bear the brunt

Insulin was discovered a century ago and the scientists then had sold its patent for a dollar to encourage its use for saving lives and not to make profits.

“Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps. WHO is working with countries and manufacturers to close these gaps and expand access to this life-saving medicine for everyone who needs it,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. 

According to an article in the  latest edition of The Lancet, 25% of the seven million insulin patients in the United States, a high-income country, struggle with its high cost. Controversial insulin pricing practices, including price-fixing, has led to repeated market failures and continued unnecessary deaths in the U.S, the Lancet article showed.

The pricing landscape is also uneven and reveals a lack of transparency in the way prices are set, according to the report. The benefits of cheaper biosimilar insulins are not enjoyed by many countries, including lower-income ones. 

Although three-quarters of type-2 diabetics live outside North America and Europe, yet these two regions accounted for 60% of revenue worth US$16.6 billion in 2020.

The report highlights that there are a “significant number of underserved markets” in lower-income countries and in the WHO African Region, WHO South-East Asia Region and WHO Eastern Mediterranean Region. 

The market for insulin and diabetic care has shifted from human insulin, which can be produced at relatively low cost, to more expensive analogues or synthetic insulins, which are up to three times the cost. This has financially burdened lower-income countries. 

One of the studies cited in the report showed that the lowest-paid unskilled government workers in the 13 low-and middle-income countries studied would need to spend six to eight days of wages to purchase 1000 IU insulin analogue doses in the public sector and 7–16 days’ wages to purchase the same in the private sector.  To buy human insulin would need four days’ of wages n the public sector and two-four days in the private sector. 

Expensive insulin is not the only problem

The report also highlighted the issue of access to devices and equipment for monitoring glucose levels. These are necessary for the detection of the disease and its complications and are responsible for shaping insulin use and diabetes care. 

In low-, middle-and upper middle-income countries, less than 50 percent of primary health care facilities have the needed supplies for measuring glucose and the apparatus for screening diabetes complications.

Half to one-third of these tested devices were able to meet the standards of International Organization for Standardisation (ISO). 

All forms of human insulin are no longer under patent protection. There is a lack of biosimilar human insulin approved by stringent regulatory authorities. Currently, intellectual property barriers created by patents on devices and secondary patents have implications on pricing and affordability, the report said. 

So what is the solution? 

WHO recommends the increased local production of insulin and associated devices to cater to the demands of the population without having to pay a premium to large conglomerates.

Locally produced quality-assured insulins and associated devices may also improve to scale up production and operational costs.

Currently, case studies in six low-and middle-income countries showed that there was a  cumulative mark-up of 8.7% to 565.8% for insulin, depending on country and health system context. 

The WHO report also highlights the need to improve the collection and publication of data on diagnostic, pricing and usage of insulins and associated devices. 

Pharma response –  high prices and access barriers are due to a wider range of supply chain factors

In a response to the WHO report, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) took issue with the WHO claim that market dominance by the three largest insulin producers is the root cause of high prices in many low-and middle-income countries.

The IFPMA cited a recent report by the IQVIA Institute, a pharma research firm, which surveyed 32 low- and middle-income countries finding “no correlation between the three largest companies’ market shares” and the average cost of insulin per day, adding that “other factors are evidently driving average costs per day for patients.”

The report also notes that six large global biosimilar manufacturers and 12 other manufacturers are operating in the countries surveyed.

“By way of example, one innovative biopharma company, Novo Nordisk, has committed to supplying human insulin in 76 LMICs at a cost of $2-3/vial – which equates to 8 or 12 cents per day for LMIC country purchasers that are governments or UN/humanitarian organizations, respectively, said the IFPMA statement.

“And yet LMIC patients are still not getting access to insulin (or quality diabetes care) at the point of care.  The reasons for this are complex and multi-faceted and do not fit a single narrative…. We recommend that all stakeholders acknowledge this reality, ‘roll up our sleeves’ and tackle it in a constructive, collaborative way while toning down the rhetoric.

“From an LMIC patient perspective, organizations like PATH have highlighted the serious problems caused by massive pricing markups along the supply chain, which impact patients at the point of care.  We also recommend a greater focus on the essential devices required to measure a patient’s blood glucose and to administer insulin safely and effectively.  These elements go hand in hand with supporting patients with quality diabetes care, and (according to PATH and other organizations) often represent by far the greatest out-of-pocket cost for PLWDs.

Concluded the IFPMA: “The pricing landscape is also uneven and reveals a lack of transparency in the way prices are set, according to the report. For example, biosimilar insulins (essentially generic versions) could be more than 25% cheaper than the originator product, but many countries, including lower-income ones, are not benefitting from this potential saving,” it stated, referring again to Novo Nordisk’s public commitment to sell insulin at $3/vial and $2/vial to UN/humanitarian organizations.

It called for more “innovative approaches and multi-stakeholder partnerships to address the various barriers to access…. which are often overlooked and poorly understood.

“These barriers include availability and pricing issues, to ensure there are appropriate, affordable products (insulin, other medicines, devices, diagnostics) at the point of care but go far beyond this. They include, for example, regulatory approval and policy issues; supply chain issues including cold chain; inventory management and aggregation of products; and other holistic issues such as lack of capacity in health systems, poor health literacy and empowerment of PLWDs, and inadequate financing.”

Action zone at the COP26 venue in Glasgow, Scotland where this rotating globe hanging from the ceiling reminds delegates of what they are trying to save.

As the Glasgow Climate Conference winds to a close, the final COP26 declaration appears destined to contain watered-down language on fossil fuel phase-out, and no clear way forward for the $100 billion in finance needed by low-income countries. Against that landscape, Médecins Sans Frontières Dr Maria Guevara talks about why health is the elephant in the room – and needs to be more central to future climate debates.  

GLASGOW –  As the final negotiations in Glasgow in Scotland wound to a close with a weakened text on fossil fuel phase-out likely, and no clear commitment from rich countries for a promised $100 billion annually to finance the green transition – the health aspects of the climate crisis are another one of the issues on the cutting floor.  Although the “devastating impacts of the coronavirus disease 2019 pandemic” and the “right to health” are mentioned in passing in the preamble of the draft COP26 decision, health has not been a driver of COP26 debates or decisions. The health impacts of climate change are not quantified nor are the potential health benefits of mitigation. 

This is despite the fact that tens of millions of people in rich and poor countries alike are already suffering from the health impacts of extreme weather and other climate-related events, as reflected in recent reports by WHO and a Lancet Countdown series. Nowhere is this more evident than in fragile states and conflict zones of the developing world, where the climate crisis has placed an additional burden on fragile health systems. As a result, leading humanitarian groups from Médecins Sans Frontières  to the International Committee of the Red Cross (ICRC) increasingly see climate as critical to their future crisis response. 

Dr Maria Guevara is the International Medical Secretary for Médecins Sans Frontières (MSF).

Dr Maria Guevara, International Medical Secretary for (MSF),  or Doctors Without Borders, was representing the organization this year at COP – and officially participating in the conference for the first time ever.  She sat down with Health Policy Watch to explain why she felt MSF’s presence at climate talks is increasingly important: 

“Health and humanitarian emergencies have always been at the heart of what we do,” Guevara said, speaking at the action hub area of the COP venue, where a giant rotating globe is suspended from the ceiling, reminding the delegates what they are here to save. 

Latest reports from the UN suggest that if countries meet their current climate pledges, the global temperature will rise by 2.2°C to 2.4°C by the end of this century. That is a virtual death sentence for large parts of the world already hit by the rising sea levels, heatwaves and toxic air. 

“But what’s going to be different is [the climate crisis] is more intense, more uncertain, more unpredictable. And the vulnerable will be even more vulnerable, which we’re seeing already today.”  says Guevara. 

Climate emergencies have compounded impacts of conflict and natural disasters

Dead and dying animals in Arbajahan, Kenya, in 2019. Global warming is increasing droughts, flooding, and other ecosystem changes across large parts of Africa.

MSF’s mandate is emergency response – often in conflict situations.  But in recent years, climate emergencies have compounded the overwhelming global health and humanitarian situation, she notes. 

With temperatures rising, droughts or flooding are becoming ever more frequent in the Middle East, the Horn of Africa, and other places where chronic conflicts already are raging.  Against this landscape, climate change adds to food insecurity and hunger and increases the transmission of infectious diseases  – which are central to the mission of groups like MSF. 

Guevara cited, as an example, a maternal and child facility that MSF is running in the Balochistan region of Pakistan, where rising temperatures are raising a whole new set of challenges.

“When it’s 50°C outside, and women are giving birth and having to be in a facility, we still have to maintain a core temperature to maintain the [stability of] newborns, including premature babies,” explained Guevara. 

Premature babies that lack adequate physiological mechanisms to adequately control their body temperatures are typically kept in incubators in their first days or weeks of life. But when ambient air temperatures rise too high, incubators fail to operate properly – in the absence of reliable air conditioning. 

And yet air conditioning is extremely difficult to maintain in low-resourced settings with unreliable electricity – as well as contributing to even more climate change.  

Need to rethink health systems globally  

Incubators at a modern newborn care facility in Afghanistan. Healthcare is energy-intensive. Yet many rural maternal and children care facilities lack adquate electricity, or any electricity at all, leaving mothers and newborns as victims. 

That is just one of the multiple dilemmas faced by relief groups, attempting to respond to immediate crises while also reducing their carbon footprint.

“We’ve been really looking at how we run our facilities in a changing climate,” concludes Guevara, explaining that there are no easy answers. 

On the one hand, high-end health facilities  in high income countries are huge carbon emitter – guzzling enormous amounts of electricity for heating and cooling, as well as water and disposable plastic products.  A 2019 estimate by Healthcare Without Harm found that if the global healthcare system was a country, it would be the fifth largest global carbon emitter. 

Recognizing that, around 50 countries pledged to decarbonize their health systems at this year’s COP. But at the same time, health facilities in low-income settings often lack access to reliable electricity for even basic services.  

Despite those dilemmas, MSF is making attempts to reduce its own carbon footprint where it can do so, for instance, by replacing plastics with more sustainable materials.  

It is also looking at greener health facility designs that would incorporate the use of solar-powered electricity alongside air conditioning “sustainable setups that would allow us to continue to run our maternal child health hospitals where it needs to.”

Convergence of health theme with core climate conversations still not happening 

Along with the absence of health, as such, on the COP-26 official agenda, the lack of adequate representation at the COP26 from vulnerable communities has been a focus of protest.

However, health needs to play a much larger role in climate debates, says Guevara, insofar as health is so heavily impacted by climate change in multiple domains.

At this year’s COP,  the topic received marginally more attention than in the past – with a full-fledged Health Pavilion in the official COP “Blue Zone” conference spaces. 

There also was a day-long conference Health and Climate Conference on the margins of COP26, organized by WHO, civil society and a consortium of UK universities, as well as health-focused events in the Blue Zone Health Pavilion, which touched upon climate in relation to children’s health, air pollution, sustainable cities, and more. 

But what remains missing is the convergence of  the core topics of climate negotiations with key global health priorities – and this needs to change, says Guevara. 

“I think it should be the compass of the decisions of any policy,” she said. “We should be going for our collective well-being and health. And it is because of that, it [health conversations] should be front and center.”  

As a starting point for that, the health impacts of climate change, as well as the health benefits of effective climate mitigation and adaptation, should be clearly referenced in the negotiated text of climate decisions.  

“I think it is a work in progress for us to start to put all our actions through the climate lens. But it’s getting there and we hope that we can add our voice to the table and our experiences because what we’ve been able to do in low-resource settings will be part of the solutions as well to whatever our future climate is.”

Disha Shetty is reporting for Health Policy Watch from COP26 as a part of the 2021 Climate Change Media Partnership, a journalism fellowship organized by Internews’ Earth Journalism Network and the Stanley Center for Peace and Security. Follow her on Twitter @dishashetty20

Disha Shetty on left, moderating a COP26 event on climate air pollution and health on 7 November with Maria Neira, WHO: Ani Dasgupta, President and CEO, World Resources Institute; Rosamund Kissi-Debrah, Co-Founder, Ella Roberta Family Foundation; and
Olumide Idowu, Nigerian climate change activist

Image Credits: Brendan Cox / Oxfam, World Bank, Disha Shetty .

A French official checks a woman’s COVID-19 certificate, providing evidence of vaccination or a recent PCR test.

It may be too late for many European countries to avoid harsh measures to try to curb the intense transmission of COVID-19, according to World Health Organization (WHO) officials on Friday.

“Almost two million cases of COVID-19 were reported in Europe last week, the most in a single week in that region since the pandemic started,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the global body’s media briefing.

“Almost 27,000 deaths were reported from Europe, more than half of all COVID-19 deaths globally last week.”

High rates of infections are being experienced both in more vaccine-hesitant countries in Eastern Europe, as well as in countries with some of the world’s highest vaccination rates in Western Europe – reflecting the fact vaccinations alone are not enough to halt the virus, according to the WHO.

A number of European countries have already started to clamp down on public activities. The Netherlands is poised to introduce a three-week partial lockdown including a 7pm closing time for restaurants this weeked, while Austria expects to introduce more restrictions on unvaccinated people.

Last month, Russia – part of the WHO Europe region – ordered all unvaccinated people over 60 and with underlying conditions to stay at home until February as it battles its worst case load amid vaccine hesitancy.

At least 12 European countries including Italy, France, Germany, Portugal, Greece and Belgium now require people entering public places such as restaurants, museums and concernts to show proof of vaccination or a recent test with a COVID digital certificate, with Denmark being the most recent to introduce such a measure this week. Some countries are also applying the passes in workplaces, particularly schools and health facilities.  

Restrictive measures

“Quite frankly, some countries are in such a difficult situation now that they’re going to find it hard not to put in place restrictive measures at least for a short period of time to reduce the intensity of transmission,” said Dr Mike Ryan, WHO’s head of health emergencies.

“Other countries can re-engage with communities around masks, around avoiding crowded spaces, around limiting their contact with others, work from home and many other initiatives and very importantly increasing vaccine coverage in high-risk populations,” stressed Ryan.

However, each country would have to assess their own unique situations – weighing vaccination levels and “what level of compliance can be expected from the implementation of personal measures versus government-mandated measures”, he added. 

Predictable surge after curbs lifted

WHO’s COVID-19 lead, Dr Maria Van Kerkhove described the surge in Europe as “predictable” given that most restrictions on social mixing and masks had been lifted.

However, the European surge was also showing “quite strongly how effective vaccines actually are in terms of reducing hospitalizations and reducing deaths”, she added.

New research from the UK has shown that an unvaccinated person has a 32 times higher risk of death than a vaccinated person, said Ryan, but these vaccines had to reach the most vulnerable people.

Places with high vaccination rates of vulnerable people were seeing cases increase but this had not translated into pressure on health systems. But in countries where there were significant pockets of vulnerable people unvaccinated, the same incidence or even lesser incidence of disease will lead to pressure on the health system, added Ryan.

WHO remains opposed to boosters in Europe

Despite the stiff WHO warnings about the possible need for stricter lockdown measures, WHO officials have continued to recommend against the wider uptake of booster shots in Europe or other high-income countries.

WHO has maintained that there is insufficient evidence for boosters, which also divert vital vaccine supplies from countries that haven’t even yet had one jab.  And on Friday Tedros once again appealed for a moratorium on boosters until the end of 2021, so that available doses can be channelled to countries that have not yet reached the WHO goal of 40% vaccination coverage.  He pointed out that, every day, there are six times more boosters being administered globally than first or second doses in low-income countries.

Even so, it appears that boosters are being administered with ever increasing frequency in high-income countries seeing surges – with 92 high- to -middle income countries initiating booster programmes for at least some population groups.

US Chief Medical Officer Anthony Fauci recently hailed the successful Israeli booster campaign as a model that others will have to follow. Israel was one of the first countries to initiate mass administration of boosters in August after it became clear that vaccine immunity from the first two shots had waned significantly after five month. The campaign  drove down new infections from one of the word’s highest levels to levels below that of almost any country in Europe or North America today.

There are now signs that boosters are helping to reduce new infection rates and hospitalizations in the United States, although they are only available to people over age 65, and at least stabilise persistently high rates in the United Kingdom, where people over age 50 can now get a third jab.

According to WHO, 25% of the doses administered every day worldwide are now booster doses, as compared to only 5% two weeks ago.

WHO remains mum on COVID-passes requiring proof of vaccination or testing

Resistance to both lockdowns, as well as much milder measures “COVID pass” rules, is strong in a number of European countries. Large protest rallies have taken place recently in a number of Swiss, German and French cities.

In Switzerland a national referendum is planned for 28 of November to vote on whether to maintain the new system of COVID passes required in almost any indoor venue outside of a private home.

Scope of Switzerland’s COVID Pass

In anticipation of the vote, a series of large demonstrations have been underway – protesting the COVID certificates that are the main focus of controversy. French and Italian opponents of COVID certificates also are eyeing the Swiss debate and the precedent that may take shape on referendum day.

WHO has largely recommended against the use of COVID vaccine or PCR test passes for international travel – pointing to the inequalities between rich and poor countries in accessing vaccines.

But it has refrained from entering into the fray over domestic use of COVID certificate in countries where vaccines are universally available.

Asked about the issue by Health Policy Watch, a WHO spokesperson responded Friday evening saying that the organization was “still checking” for a response.

–Elaine Fletcher contributed to this story

  • Updated 14.11.2021

Image Credits: Mat Napo/ Unsplash, https://www.ge.ch/en/covid-19-certificate/scope-covid-certificate.

moderna

Moderna has fired back against claims made by US National Institutes of Health (NIH)  that its scientists at the National Institute of Allergy and Infectious Diseases (NIAD) helped to invent the crucial component of the pharma company’s COVID-19 vaccine, stating that the mRNA sequence was “selected exclusively” by Moderna scientists. 

“We do not agree that NIAD scientists co-invented claims to the mRNA sequence of our COVID-19 vaccine,” a tweet from a thread on intellectual property by the company said on Thursday.

The thread continued: “The mRNA sequence was selected exclusively by Moderna scientists using Moderna’s technology without input of NIAID scientists, who were not even aware of the mRNA sequence until after the patent application had already been filed.” 

However, Moderna does recognize the “substantial role that the NIAID has played in helping to develop Moderna’s COVID-19 vaccine,” and has said that it has, in fact, included NIAID scientists as co-inventeres on published patent applications where they have made inventive contributions.  

Genetic sequencing dispute; Moderna turned ‘people’s vaccine into rich people’s vaccine’ 

In a story first reported by the New York Times on Tuesday, Moderna had excluded three NIH scientists as co-inventors of a central patent for the company’s COVID-19 vaccine in its application filed in July. 

But the NIH has asserted that three of its scientists at the NIAD, Dr John Mascola, Dr Barney Graham, and Dr Kizzmekia Corbett, helped design the genetic sequence used in Moderna’s vaccine, and should be included on the patent application. 

Had federal researchers been named as co-inventors in the patent, the government would have almost exclusive right to license the vaccine to other manufacturers, opening access to low- and middle-income countries who are still lagging behind in vaccination rates. 

“Recognition as the vaccine’s joint inventor can help the U.S. government finally responsibly steward the vaccine’s use, including by helping secure access for the billions of people still awaiting a safe path out of the pandemic,” said Peter Maybarduk, director of US-based advocacy group Public Citizen’s Access to Medicine, in a statement.

“But Moderna has turned this people’s vaccine into a rich people’s vaccine; refusing to share technology with WHO or developing country manufacturers and sharing very few doses with COVAX while overcharging poor nations.”

Both Moderna and Pfizer have been lambasted by WHO’s Director General Dr Tedros Adhanom Ghebreyesus in the past for offering and planning COVID boosters while billions in LMICs await their first jab.

NIH not backing down from claims

Speaking to Reuters, NIH Director Dr Francis Collins made clear that the NIH, the government’s biomedical research agency, was not backing down. 

 “I think Moderna has made a serious mistake here in not providing the kind of co-inventorship credit to people who played a major role in the development of the vaccine that they’re now making a fair amount of money off of.”

Advocacy group Public Citizen has pointed out Moderna’s failure to name NIH scientists as joint inventors, imploring NIH to “ensure the contributions of federal scientists are fully recognized,” in a letter to Director Collins last week.  

“NIH is showing a modicum of verve at last, suggesting it will not allow federal scientists’ role in the invention of the NIH-Moderna vaccine to be erased,” said Maybarduk. 

Moderna has received around $10-billion in US government money to develop its vaccine but has not responded to US government pressure to share the vaccine technology with low and middle-income countries.

Image Credits: Gavi .

covaxin
Covaxin

Following World Health Organization approval last week, interim data from a phase 3 trial of BBV152, a COVID-19 vaccine developed in India, reports 77.8% efficacy against symptomatic COVID-19. 

The study, published in The Lancet, indicated that BBV152 induced a robust antibody response, with the majority of adverse events, including headache, fatigue, fever, and pain at the injection site, were mild and occurred within seven days of vaccination. 

BBV152, also known as Covaxin, is an inactivated whole virion vaccine developed by India-based Bharat Biotech. The vaccine has recently received emergency use approval (EUL) from WHO for people aged 18 and older, and is administered in a two-dose regimen, 28 days apart. 

The trial conducted an efficacy analysis of 24,419 randomly-assigned participants across 25 hospitals in India who received either two doses of the vaccine or a placebo between 16 Nov 2020 – 17 May 2021.

Vaccine cold-chain requirements make it suitable for low- and middle-income countries

covaxin
Covishield and Covaxin Drive in India

Covaxin’s ability to be stored and transported between 2-8 degrees Celsius has made it suitable for  low- and middle-income countries.

Jing-Xin Li and Feng-Cai Zhu of the Jiangsu Provincial Center for Disease Control and Prevention in China, who were not involved with the study, say “the roll-out of BBV152 might ease the ultra-cold chain requirements of other SARS-CoV-2 vaccine platforms, increase the finite global manufacturing capacity, and improve insufficient supply of vaccines which disproportionately affects low-income and middle-income countries.” 

Bharat Biotech said the WHO EUL approval will help countries “expedite their regulatory approval processes to import and administer Covaxin.” 

“It allows procurement by UNICEF, the Pan-American Health Organization (PAHO), and the GAVI COVAX for distribution to countries in need,” a company press release said. 

The Gavi managed COVAX global vaccine facility has not  yet  signed an agreement with Bharat Biotech, with India delaying committing supplies to the COVAX global sharing effort, sources told Reuters.  

The world’s biggest vaccine maker resumed exports of COVID-19 doses in October, for the first time since April. It has sent about 4 million doses to countries such as neighboring Bangladesh and Iran, but none to COVAX.  

The vaccine has, however, been distributed widely already in India, with 121 million doses administered since the beginning of the country’s big COVID surge in the spring of 2021. 

Covaxin gears up for major distribution abroad 

Airfinity’s COVID Vaccines Revenue Forecasting predicts 545 million Covaxin doses to be sold to low-middle-income countries in 2022.

Following the WHO approval and publication of its Phase 3 results, Covaxin is gearing up for major distribution abroad.

Airfinity’s COVID-19 Vaccine Market Forecast 2021 – 2022, which covers global demand scenarios, supply and production, and revenue of COVID vaccine, has predicted 545 million Covaxin doses will be sold to low-middle-income countries in 2022.

As many as 96 countries have already recognized Covaxin, with Hong Kong the latest to approve the vaccine for international travelers. 

Canada, the US, Australia, Spain, the United Kingdom, France, Germany, Belgium, Russia, and Switzerland, are among the 96 nations to recognize both Covaxin and Covishield, another India-manufactured vaccine. 

Further research needed against COVID-19 variants 

The next step for studies of BBV152, noted Li and Zhu, should be long-term monitoring of vaccine efficacy against COVID-19 and its efficacy against variants. 

This is to “identify whether the vaccine provides ongoing protection when any variation of concern replacement (other than the variants of concern investigated in the study) has occurred,” they said. 

Preliminary analysis of efficacy found Covaxin to be 65% effective against symptomatic COVID-19 from the delta variant. 

Additionally, there was no decrease in efficacy against the alpha variant (B.1.1.7) and marginal reductions in efficacy against other variants of concern, including delta and gamma variants.

Image Credits: Mohammed Naseeruddin/Twitter, Airfinity.

COVID-19 Ministerial meeting, convened by US Secretary of State Antony Blinken

Pakistan and eight other countries, mostly in or around conflict zones, face the largest gaps in vaccine commitments needed to reach a WHO goal of 70% coverage by September 2022. 

The data is part of a new “COVID Global Tracker” – launched Wednesday during a first-ever meeting of the world’s foreign ministers, convened by US Secretary of State Anthony Blinken.  At the meeting, the US also announced that it had brokered a deal to deliver more J&J one-shot vaccines to countries in humanitarian crisis.  

Pakistan, which has a population of some 221 million people, is short nearly 60 million doses, according to the new data tracker. Data from the other countries, locked in prolonged crises or conflict, reflects the fact that, so far, most of the doses that will be needed have not yet been secured at all.

For instance, Afghanistan, with a population of 39 million people, remains short 22 million vaccine doses.  Yemen, with a population of 30 million, is short some 18 million doses.  And the Democratic Republic of Korea (PRK), with a population of some 26 million people, is some 16 million doses.  The gaps between demand and supplies available to the countries with the biggest long-term needs would be narrowed if one-shot J&J shots are deployed. 

Syria with a population of 17.5 million people is short 11 million doses, and Haiti (HTI), with 11.4 million people, is short some 7 million doses. Other countries on the list include Papua New Guinea (pop: 9 m), Nicaragua (pop: 6.6 m) and Laos (pop: 7.3 m).  

Top 9 Countries with Largest Gaps to Reach 70% Coverage (millions of doses)

Data published on the “COVID Global Tracker, highlights in vivid detail the shortfall in vaccine access that low- and middle-income countries face, including a large swathe of Africa – and which is likely to persist throughout 2022.  

First-ever meeting of foreign ministers on COVID pandemic 

The meeting marked the first time that the US had convened foreign ministers to discuss responses to the COVID-19 pandemic since it began in February of 2020. 

Ït brought together some 40 ministers, including China’s, said Gayle Smith, State Department coordinator for global COVID-19 response in a press readout following the meeting. 

Noting that the pandemic is not just a health crisis but a security, economic and humanitarian crisis, Blinken said, “we need foreign ministers to step up and lead as well.” 

In press statements after the meeting, Blinken also called for expanded government and private sector collaborations to expand vaccine manufacturing, unlock supply logjams, and support expanded vaccination efforts in low- and middle-income countries.

Only 13% of COVAX contracted doses delivered so far – ministerial meeting fails to yield more concrete commitments on delivery 

But the meeting did not translate into any immediate commitment to close the gap in dose deliveries to low- and middle WHO Director General Dr Tedros  Adhanom Ghebreyesus, asked ministers to immediately set up a working group to deliver the estimated 514-680 million vaccine doses that would be needed needed to ensure 40 percent of each country’s population is vaccinated by year’s end.

Some some 74 countries, mostly in sub-Saharan Africa, remain off track for meeting that 40% coverage goal, according to the data on the newly-released COVID19 Global Tracker.  Sixty of those countries are among the 91 low- and middle-income countries that are primarily depending on COVAX, or the African Vaccine Acquisition Task Team (AVATT), for deliveries. The remainder are in fact  upper-middle income countries that have fallen through the cracks. 

Expected Effective Vaccine Supply at End-2021 (% of Total Population): Most of sub-saharan Africa, and parts of Asia, could, at best, only reach 10-20% coverage – as compared to the 40% WHO goal.

Only 13% of doses contracted by COVAX, and 6% of doses contracted by AVATT have actually been made available for delivery so far by manufacturers, the COVID Global Tracker also shows. That translates into a whopping 3.45 billion COVAX doses still missing from supplies, according to the Global COVID Tracker. 

Civil Society groups issue new call to prioritze LMICs in new dose deliveries as well as donations

Along with WHO’s call on rich countries to release more dose donations, civil society groups called upon the ministers to let low- and middle-income countries jump the line – and receive first priority for forthcoming vaccine deliveries. 

The ministers should  “agree to share all doses between those needed for domestic demand, as soon as they come off the production line,” in coordination with COVAX and AVATT, stated the open letter signed by nearly 40 civil society groups, including the Rockefeller and Open Societies Foundations:  

“HICs must publicly commit to send their expected deliveries straight to COVAX and regional mechanisms in Q4 2021 and organize this without delay with pharmaceutical and delivery companies. Ministers must use all routes available, including donations and ‘queue swaps’, to deliver doses to LMICs quickly.”

But far those appeals have failed to get a response – including at the recent meeting.  G-20 countries also remain far off course in delivering doses against promised donations. 

Insufficient progress on delivering pledged doses to COVAX – across most high-income countries

Waiving Indemnity – eases vaccine delivery to crises regions

On a brighter note, the US deal with J&J should ease the flow of those one-shot vaccines, including US vaccine donations, to a range of states in crises. The arrangement involves the company’s waiving of liability requirements that vaccine manufacturers typically demand of countries before vaccine acquisition deals are signed. 

“I’m pleased to share that the United States has helped broker a deal between J&J and COVAX to facilitate the first delivery of J&J vaccines to people living in conflict zones and other humanitarian settings,” Blinken said at the meeting.   

“We’re eager for people in these difficult circumstances to get protection against COVID-19 as soon as possible. We know the urgency of this fight,” he added.  “We’ve got to be relentless because this pandemic is relentless. And we have to be coordinated, united, because that’s what a global health emergency like this requires.”

Only a handful of other  Chinese firms have also waived such indemnity requirements, including: Sinopharm and Sinovac, which have WHO-approved jabs on the market, as well as the biotech firm Clover, whose vaccine R&D was has been supported by the Oslo-based Coalition for Epidemic Preparedness (CEPI), followed by a recent IPO that raised $240 million on the Hong Kong stock exchange just last week.

While still undergoing WHO review, Clover has already signed a deal with Gavi, the Vaccine Alliance, to supply its vaccine to COVAX following successful results of a Phase 2/3, multi-country trial of 30,000 people.

In that trial, Clover announced that it’s vaccine had been 84% efficacious against moderate-to-severe COVID, and 100% efficacious against severe COVID. 

Image Credits: US Department of State, https://covid19globaltracker.org/, https://covid19globaltracker.org/.

COP26 president Alok Sharma

A draft agreement released by UN Climate on Wednesday “calls upon parties to accelerate the phasing out of coal and subsidies for fossil fuels” – as countries work toward reaching consensus by the time the Glasgow Climate Conference (COP26) ends on Friday.

The word ‘health’ also was noticeably absent from the draft text, reflecting the continued failure of the global community to recognise and address the intrinsic linkages between planetary and human well-being.

Despite a recent spate of promises, including new pledges by the US and China, limiting global warming to 1.5° Celsius remains well out of reach.  Even if all commitments are met, the world would still see 2.4°C warming by the end of the century, experts now predict.

That was the conclusion of the non-profit Climate Action Tracker, which added up the most recent country pledges – or Nationally Determined Contributions (NDCs) – for CO2 reductions – translating those into forecasts for expected temperature rise. 

Target shortfalls reported by Climate Action Tracker.

Earlier calculations had estimated a 2.7°C temperature rise – showing slight gains in the slow race to carbon neutrality.  

Dr Stephen Cornelius, the World Wildlife Fund’s chief advisor on climate change, described the country pledges as “woefully inadequate”.

“COP26 has gotten further than Paris, but we are nowhere near the 1.5°C needed to avoid the worst impact of climate change,” Cornelius told a media briefing on Wednesday.

However, he welcomed the draft’s recognition of the importance of science, including reference to the “code red” warning contained in a recent report issued by the Intergovernmental Panel on Climate Change (IPCC) on the urgency of climate action.

‘Wreckers’ like Saudia Arabia and Australia will try to weaken text

Greenpeace International Executive Director Jennifer Morgan described the draft declaration as “a polite request that countries maybe, possibly, do more next year”. 

“We’ve just had a landmark study showing we’re heading for 2.4°C of warming,” said Morgan. “The job of this conference was always to get that number down to 1.5°C, but with this text, world leaders are punting it to next year.”

Greenpeace wants an agreement that is much stronger on finance for countries to mitigate and adapt to climate change.  

It also wants a commitment from countries to report annually – instead of every five years – on “new and better” plans until the world is able to reduce the global warming trajectory to the 1.5°C goal. 

While the language calling for an accelerated phase out fossil fuel subsidies, estimated to exceed $5 trillion annually, is seen as a signal of progress, there is no timeline for that to take place. 

And Morgan predicted that “wreckers like the Saudi and Australian governments” would try to delete the call for an accelerated phaseout of coal and fossil fuel subsidies from the draft. 

UK Green MP Caroline Lucas also condemned the draft, saying that it “utterly fails to rise to the moment” by failing to phase out all fossil fuels not just coal.

COP26 delegates ignore warnings that fossil fuel subsidies are dangerous to health 

Fossil fuel subsidies have been repeatedly decried by the World Health Organization and other health experts at a series of health-focused COP26 events as particularly pernicious. 

Such subsidies, WHO points out, fuel dirty energy and transport sources – leading to air pollution emissions that kill an estimated 7 million people a year – while also discouraging investments in cleaner solutions that would be more cost-effective for societies overall.

But the draft final COP statement had nary a word about health – or the climate-air pollution nexus plaguing many developing cities, particularly in South-East Asia.  

“Nearly half a billion will suffer severe health harm from north India’s air pollution even as COP26 offers up unambitious targets to a world at the brink of extinction,” stated the Indian NGO Care for Air. 

Paradoxically, COP will be concluding just as northern India’s seasonal air pollution emergency begins – a situation seen every autumn when smoke from crop stubble-burning in rural areas drifts toward Delhi, where it combines with a potent mix of fumes from construction, traffic, waste burning, and firecrackers celebrating the Hindu Diwali festival.  

Grand promises by politicians last year to devise more sustainable alternatives for farmers – such as composting or machine threshing of crop stubble – to have so far failed to materialize.   

‘Massive credibility gap’, absence of clear targets for fossil fuel phase-out

In Glasgow, politicians seemed anxious to avoid making the potent linkages between climate change and millions of deaths a year from air pollution.

Language in the draft agreement remained general and non-specific around critical points, such as setting a target or timeline for actually phasing out fossil fuels. 

The draft agreement merely “invites parties to consider further opportunities to reduce non-carbon dioxide greenhouse gas emissions”.

The statement does, however, go further than previous COP declarations in suggesting that a more holistic approach to the climate crisis is needed, emphasising the “critical importance of nature-based solutions and ecosystem-based approaches, including protecting and restoring forests, in reducing emissions, enhancing removals and protecting biodiversity”.

Even so,  “at the midpoint of Glasgow, it is clear there is a massive credibility, action and commitment gap that casts a long and dark shadow of doubt over the net zero goals put forward by more than 140 countries, covering 90% of global emissions”, Climate Action Tracker’s briefing document observed.

The country targets for 2030 remain “totally inadequate”, added the report, estimating that they “put us on track for a 2.4°C temperature increase by the end of the century”. 

Another significant unresolved issue: LMIC financing  

COP26 President Alok Sharma confirmed at a plenary on Wednesday that while “some significant issues remain unresolved”, he expected “near-final” texts from the various negotiating groups by Thursday morning and a consensus document for adoption by the close of the summit on Friday.

Aside from the inadequate emission targets, other sticking points concern financing, including agreement on finance for countries’ claims of climate change-related loss and damage – most of which are likely to be filed by low- and middle income countries. 

UK lead climate negotiator Archie Young told the plenary that more work also needs to be done on the “significant finance agenda and the $100-billion goal” – the annual finance target set by the Paris Agreement to be available by the end of 2021 to assist LMIC countries to mitigate and adapt to climate change.

The draft appeals to “the private sector, multilateral development banks and other financial institutions to enhance finance mobilization in order to deliver the scale of resources needed to achieve climate plans, particularly for adaptation”.

Glasgow flooded with fossil fuel lobbyists

While the global business and finance community is said to have an unprecedented presence at COP26 – the largest contingent at the entire conference – is in fact the fossil fuel industry, an analysis of participants found.  

Some 503 fossil fuel lobbyists are registered at Glasgow, according to the analysis by the civil society groups, Corporate Europe Observatory (CEO) and GlobalWitness.org. 

The report “Glasgow Calls Out Polluters” found that if the fossil fuel lobby were a country delegation at COP it would be the largest with 503 delegates – two dozen more than the largest country delegation. In addition, the report found that: 

  • Over 100 fossil fuel companies are represented at COP with 30 trade associations and membership organisations also present;
  • Fossil fuel lobbyiests are members of 27 official country delegations, including Canada, Russia and Brazil.
  • Fossil fuel lobbyists dwarf the UNFCCC’s official indigenous constituency by around two to one.
  • The fossil fuel lobby at COP is larger than the combined total of the eight delegations from the countries worst affected by climate change in the last two decades – Puerto Rico, Myanmar, Haiti, Philippines, Mozambique, Bahamas, Bangladesh, Pakistan.

Image Credits: Climate Action Tracker., Climate Action Tracker.

Solar panels provide electricity to Mulalika Health Clinic in Zambia.

Fifty countries have committed to building sustainable, low-carbon and climate-resilient healthcare systems, and 14 of these have set net-zero carbon emission target dates from as early as 2030. 

This emerged from a health and climate change session at COP26, the United Nations climate conference in Glasgow, that was co-hosted by the World Health Organization (WHO).

“As part of a green and resilient recovery from COVID-19, we need to recognise the role of health systems as emitters accounting for 4% to 5% of global emissions,” said Dr Rachel Levine, US Assistant Secretary in the Department of Health and Human Services.

If the global health care sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet, according to Health care’s climate footprint, a report produced by Health Care Without Harm.

“These emissions are predicted to increase as health systems develop, and demographic changes lead to increasing healthcare demand,” said Levine, adding that the countries that had committed to building low carbon health systems were responsible for about one-third of all health sector emissions globally.

The US has committed to decarbonizing the nation’s health systems by reducing  greenhouse gas emissions in the federal health system, as well as the private sector via  “incentives, guidance, technical assistance and regulatory approaches and partnerships”, Levine added. 

“The United States action on health system decarbonization is influential and critical. The US accounts for approximately 25% of the world’s health sector greenhouse gas emissions. This commitment to reducing greenhouse gases will also result in decreasing the negative health impacts of air pollution, such as premature death, heart disease, stroke, and more,” said Levine.

Josh Karliner, International Director of Program and Strategy at Health Care Without Harm, said that “there is a growing global movement of hospitals and health systems” that were already reducing their carbon emissions.

“There are more than 54 institutions in 21 countries representing more than 14,000 hospitals and health centres committed to race to zero,” said Karliner. “This is from Newcastle to New York. It’s from Sao Paulo to South Africa. It’s from Kerala to California.” 

Karliner explained: “We’re seeing hospitals and health systems taking action by investing in renewable energy by investing in zero-emission buildings and transport; by substituting anaesthetic gases with more sustainable alternatives; by implementing sustainable procurement programmes to purchase sustainably produced food, energy-efficient medical devices and lower carbon pharmaceuticals.” 

However, ‘greening’ health systems is a massive, expensive undertaking that requires many fundamental changes covering architecture, waste disposal, energy, and water.

 

A flash flood in Fiji in 2018

Small island states struggle to make health services climate-resilient

Dr Satyendra Prasad, Fiji’s permanent representative to the UN, told the meeting that his country struggled to keep health services running when faced with superstorms and other adverse weather events.

“It is quite tragic when your doctors and nurses are being evacuated when they should be providing frontline services to people who have been injured and who need care,” said Prasad. 

“This conundrum is very tough, and it is a conundrum that exists for so many countries,” said Prasad, adding that Fiji is in the process of relocating health services to higher ground and equipping facilities with renewable energy to enable them to remain operational after major cyclones of flooding.

“We losing fewer lives to extreme weather catastrophes. We are losing more lives to waterborne diseases and all the diseases that come following a major catastrophe such as flooding, and cyclone,” he added.

Similarly, the Maldives has seen the emergence of vector-borne tropical diseases such as Dengue, which it didn’t use to have, said Aminath Shauna, Minister of Environment, Climate Change and Technology in the Maldives.

“The Maldives is one of the most vulnerable island nations to climate change. We are experiencing things that we thought would happen towards the end of the century,” said Shauna.

“Our coral reefs are dying. We are running out of fresh water. Our islands are eroding, and our islands are getting more frequently flooded, which poses a significant challenge to our public health system,” she added.

To mitigate these risks, the Maldives has integrated climate risks into health policy, developed climate-sensitive disease programmes and is promoting climate-resilient healthcare facilities that are able to withstand climate events. It is also working to ensure that its essential services such as water, sanitation, waste management and electricity can still function during extreme weather events. 

“The Maldives health sector is also committed to initiating the greening of the health sector by adopting environment-friendly technologies and using energy-efficient services,” said Shauna.

Finances for adaptation

However, finances to make these changes are a challenge for countries like Fiji and the Maldives. Lack of finance has been a recurrent theme at COP26, with smaller countries with small carbon footprints appealing for reparations from large polluting countries to assist them to mitigate climate change.

Former UK prime minister Gordon Brown and WHO Ambassador for Global Health Financing told the meeting that “you cannot cut investment in health at the expense of climate change – and you cannot cut investment in climate finance at the expense of health”.

“We really have to recognise that we’re dealing with global public goods – the control of infectious diseases, a clean environment, clean air and a clean environment,” said Brown.

“And we need to have a system of global burden-sharing where the richest countries that are responsible for the historic emissions and have the wealth and the capacity to pay, make good the funding that is necessary for mitigation and adaptation, and that includes the adaptation of healthcare systems, particularly in the poorest parts of the world,” said Brown.

Despite the global commitment made at Paris COP to ensure $100 billion a year in financing to mitigate climate change by the end of this year, it looks like this target will only be reached in 2023.

However, Brown stressed that if this target was not reached, it would deprive developing countries “of the opportunity not only to build coastal defences and renewable industries, but to build the healthcare systems that are necessary for resistance to droughts and famine, and also to pollution in the air”.

Addressing the meeting via a recorded message, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the changes the world needed to make to energy, transport and food systems to meet the Paris climate goals “would bring massive health gains”.

He added that the WHO is committed to working with the countries that had committed to building greener health systems “for a healthier and more sustainable future”.

Image Credits: UNDP/Karin Schermbrucker for Slingshot , World Meterological Organisation.

WHO Director-General Dr Tedros receiving an open letter about climate change, signed by health professionals from around the world and organized by Doctors for XR.

GLASGOW – Conversations on the health impacts of the climate crisis have grown this year at COP26 – the United Nation’s annual climate conference, now in its 26th year. Experts hope that this increase in conversation will lead to greater awareness about the health crisis exacerbated by the climate crisis and lead to concrete action in the months and years ahead. 

Around 85% of countries now have a designated focal point for health and climate change in their ministries of health, according to the 2021 World Health Organization (WHO) health and climate change global survey report released on Monday. 

But countries report that a lack of funding, impact of COVID-19, and insufficient resource capacity are major barriers to progress.

Many countries are unsupported and unprepared to deal with the health impacts of climate change, according to the survey. 

“We are here at COP26 to urge the world to better support countries in need, and to ensure that together we do a better job of protecting people from the biggest threat to human health we face today,” said Dr Maria Neira, WHO Director of Environment, Climate Change and Health.

At the sidelines of the climate negotiations, the WHO held a day-long conference over the weekend focussed on the climate and health that was attended by high-level delegates. 

“We are used to talking about climate as an environmental challenge, an economic challenge, an equity challenge. But it is also one of the most urgent health challenges facing us all today,” said Julia Gillard, former Prime Minister of Australia and Chair of Wellcome Trust.

The conference sought to highlight that while climate change affects health, the mitigation strategies will also automatically translate into health gains. 

“Health must become the beating heart of climate action”, said Jeni Miller, executive director of the Global Climate and Health Alliance. “Political leaders must prioritise health and social equity, emission reduction and impact mitigation over politics, profit and unproven technological fixes. The decisions made during COP26 will define the health and wellbeing of people all over the world for decades to come”.

Dr. Maria Neira, Director of WHO Environment, Climate Change and Health

Highlighting the health gains of clean air

In the first week of the COP26 negotiations, WHO also co-hosted a panel discussion on both the health and climate gains of clean air that this reporter helped moderate. Given that air pollution alone kills around seven million people worldwide every year, any progress on this would save millions of lives annually.  

The event also came at a time when air pollution in India’s capital, Delhi, had reached lethal levels following last week’s celebration of the festival Diwali, during which people set off fire crackers. 

The densely populated Indo-Gangetic plain where Delhi is, is one of the world’s most polluted regions, and emerging research suggests the source of air pollution is local. 

Dr Neira said that the time for conversations was over, the evidence on air pollution is clear and it is time now to act. 

As many of the pollutants that cause air pollution also lead to a greenhouse effect, the WHO has made efforts to highlight the dual climate and health gains of improving air quality that disproportionately affects vulnerable groups like children and the elderly. 

Developing countries are pushing for climate finance and technology transfer at COP so that they have the support they need to clean their air but much of this also needs to happen at sub-national levels, especially at city-level, that will also require local action, highlighted Ani Dasgupta, President and CEO of World Resources Institute (WRI).

Health not a part of text of negotiations

It was clear although that while health is a part of the growing conversation, it is far from figuring in the main climate negotiations. A former negotiator elaborated that, given how bitter and exhausting climate negotiations are, adding health to the text might not be practical and that any reduction in global carbon emissions will automatically translate into health gains.

At this year’s COP there is also a push to hold the rich countries accountable for the loss and damage being caused by the climate crisis in vulnerable nations. Public health crisis, even though directly caused or exacerbated by extreme climate events, aren’t part of these negotiations either.

“I don’t see it coming up very directly into the loss and damage negotiations here because the negotiations are more about the overarching structures, not necessarily on a very particular theme,” said Sven Harmeling, the International Climate Policy Lead, from CARE and CAN Europe. He did add that it does factor in how many of the developing countries think about the damages being caused. 

WHO’s latest survey backs his view. It found that virtually all (94%) countries have incorporated health considerations in their nationally determined contributions (NDCs) to the Paris Agreement, voluntary pledges by the government to reduce their carbon emissions.

Emissions from coal-burning power stations are causing air pollution that is affecting millions of people worldwide.

Highlighting emissions from healthcare and silos

Among the conversations at COP26 that centred on healthcare was also how to get the healthcare sector to reduce its own emissions. A 2019 report from Healthcare Without Harm based on 2014 data on carbon emissions suggests that globally 4.4% of carbon emissions are from the healthcare sector itself. The US health sector had the largest greenhouse gas emissions.
Andrea Epstein, climate programme manager for Latin America at Healthcare Without Harm said that number is probably higher now that despite the region being a part of the developing world, there is a growing interest in decarbonizing the health systems. “The problem is of course the means of implementation. Not just the financing and the technology but also having the capacity for that. So while it is a challenge, the interest is there.” 

Members of the civil society organisations present at COP highlighted the silos that continued to exist in conversations around health, climate and food – all of which affect each other but are handled by different organisations. 

Disha Shetty is reporting from COP26 as a part of the 2021 Climate Change Media Partnership, a journalism fellowship organized by Internews’ Earth Journalism Network and the Stanley Center for Peace and Security. Follow her on Twitter @dishashetty20

 

Image Credits: WHO/Chris Black, Planetary Health Eastern Africa Hub.

A nurse takes the temperature of a child suspected of COVID-19 symptoms in a Lebanese public health centre.

An international pandemic treaty based on equity could be the antidote to current weaknesses and imbalances in the global response to COVID-19, according to a group of influential authors in a Lancet paper published on Tuesday.

A number of the authors are associated with The Independent Panel for Pandemic Preparedness and Response chaired by Helen Clark and Ellen Sirleaf Johnson, which was set up to assess the World Health Organization’s (WHO) response to COVID-19.

Based on a timeline developed by the panel that lays out the global COVID-19 response, the authors conclude that the International Health Regulations (IHR) are too weak, and the required country actions are too slow, to protect the world against pandemics.

Revised after the 2005 Severe Acute Respiratory Syndrome (SARS) outbreak, the IHR focus on balancing disease notification and health risks with international trade and travel considerations. They specify when and how Member States should notify WHO of a local disease outbreak, and what actions WHO and States should take after that notification. 

The IHR are currently the only legally binding international instrument governing countries’ obligations to report and respond to pathogens that could result in cross-border disease outbreaks and potential public health emergencies.  

In their review, the authors identified a number of significant IHR weaknesses, including: constraints on WHO reporting publicly about national events with pandemic potential; the need for greater specificity on the information that countries need to share with WHO; and a streamlined process to facilitate WHO verification of events within 24 hours of the first signals of an outbreak being received.

Special World Health Assembly

The article comes a few weeks before global leaders meet at a World Health Assembly special session (29 November – 1 December) to consider adopting an “instrument or treaty” to address pandemic preparedness and response. 

“It’s clear: if a new, fast-spreading pathogen were to emerge next month, the current IHR regime would not protect people and trade as intended,” said Dr Sudhvir Singh, lead author on the paper and an advisor to the Independent Panel.

“We suggest change to the IHR and a new treaty or another instrument that would result in more information shared faster, WHO able to investigate rapidly, all countries moving immediately to assess risk;  and tools, like tests and vaccines, available to all who need them.”

Georgetown University’s Dr Alexandra Phelan added that “COVID-19 has shown that the existing obligations under the IHR are insufficient for our interdependent and digital world.” 

 “Our analysis demonstrates that collectively, countries urgently need to update our international system to respond to the potential rapid spread of a high impact respiratory pathogen,” said Phelan.

“We have concrete suggestions for ways in which the IHR may be revised or amended, as well as the approach and issues that must be covered in any new legal framework, like a pandemic treaty.”  

Four reasons for a pandemic treaty

The authors advance four reasons why a pandemic treaty “presents the opportunity to enact comprehensive reform in pandemic preparedness and response”. 

“First, a pandemic treaty centred on the principle of equity would be an important signal of international commitment to guard against the entrenchment of global division and injustice.”

A pandemic treaty offers an opportunity to “develop and instil norms of equity, justice, and global public goods of pandemic preparedness and response”, they argue.

“Second, a pandemic treaty could provide high-level complementarity to the IHR and any potential post-pandemic reforms and proactive multidisciplinary approaches to zoonotic risk,” they argue.

Their third argument is that a treaty establishes greater accountability, outbreak support, and global access to vital public health information. 

Finally, a pandemic treaty could provide the opportunity to develop “a solid evidence base for non-pharmaceutical interventions” that might prevent the next outbreak from becoming a pandemic.

“The upcoming Special Session of the World Health Assembly is a critical opportunity for Member States to move ahead with strengthening the IHR and to agree on a process for negotiating a pandemic treaty. We must not lose this opportunity to protect global public health and future generations,”  said Phelan.

At a recent event hosted by G2H2, civil society organisations expressed fear that a pandemic treaty was a distraction from the TRIPS waiver.

But Björn Kümmel, deputy head of the global health unit in the German Federal Ministry of Health, disputed that there is any direct political link between the treaty and the TRIPS waiver.

Kümmel added that amending the IHR also would take time to negotiate.  And a key question here is: “would they be a game-changer for the next pandemic to come? Certainly not,” he added, noting that there is “no compliance mechanism that currently is foreseen in the IHR.”

Image Credits: UNICEF .