Deaths by diabetes more than doubled in the Eastern Mediterranean, with a global increase of 70%, between 2000 and 2019.

The NCD Alliance has called the millions of avoidable deaths due to noncommunicable disease (NCDs) a “collective failure”, as new WHO data shows NCDs now constitute 7 of the top 10 causes of death globally, up from 4 of 10 top causes of death in 2000.

According to WHO’s new Global Health Estimates released Wednesday, the top 10 causes of death amounted to half of the total 55 million deaths worldwide last year. But deaths from NCDs are increasing the most rapidly and dramatically, according to the report, which also looks at trends over the past twenty years, from 2000 to 2019.

More and more low- and middle-income countries (LMICs) are suffering from rising NCD rates, associated with poor diets, environmental conditions and unhealthy lifestyles.

In the past 20 years, for instance, deaths from diabetes more than doubled in WHO’s Eastern Mediterranean region, which has been beset by an epidemic of obesity, while diabetes deaths rose globally by 70%.

Heart disease retained its position as the leading cause of death, causing some 9 million deaths last year – up by 2 million since the turn of the millennium. Alzheimer’s and other forms of dementia ranked as the 3rd highest cause of death in the Americas and Europe.

The data highlights the need to focus much more intensely on the prevention and treatment of cardiovascular diseases, cancer and chronic respiratory diseases, among others, WHO said.

“These new estimates are another reminder that we need to rapidly step up prevention, diagnosis and treatment of noncommunicable diseases,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO.

“The WHO report depicts a devastating toll on human life that could have and should have been prevented,” said Katie Dain, CEO of the NCD Alliance.

“If governments are serious about preventing both avoidable death on a massive scale and better preparing the world for future pandemics, then they have to invest in the health of their citizens and promote healthy environments by tackling the common risk factors.”

The “collective failure to” address alcohol, tobacco and substance abuse, unhealthy diets and lifestyles, and air pollution, she said, “has got us to an unsustainable position”.

LMICs Still Struggling with Communicable Disease Despite Global Decline

Even as the number of NCDs in the top 10 causes of death globally increased by 3, and WHO noted a global decline in deaths caused by communicable diseases like HIV/AIDS and tuberculosis (TB), LMICs are still strapped by both.

For example, TB left the global top 10, falling from 7th place 13th and seeing a 30% reduction in deaths worldwide. But in low-income countries, TB remains at a much higher 8th place. Similarly, HIV/AIDS dropped from 8th to 19th globally, but sits at 9th place in low-income countries.  Groups in countries where undernutrition is still prevalent also now are seeing pockets of obesity and malnutrition, as a result of increasingly unhealthy diets, including too many fat-rich fast foods and processed foods.

Dr Samira Asma, WHO Assistant Director-General, Division of Data, Analytics and Delivery for Impact.

Speaking at a press conference on Wednesday as the report was published, Dr Samira Asma, WHO Assistant Director-General, Division of Data, Analytics and Delivery for Impact, said: “It is important to acknowledge the progress we have made in addressing communicable diseases, such as HIV/AIDS and TB.

“This reflects sustained investments made to bring down the burden of these diseases. It is, however, very important to underscore the need to stay vigilant and to avoid backsliding.”

In recent years, WHO has cited a plateauing of progress against infectious diseases like HIV and TB. Available resources for HIV dropped by US$1 billion in 2018, marking the first time global HIV funding declined since 2000.

While the global AIDS response was off track before the COVID-19 pandemic, the onset of lockdowns and travel restrictions created additional setbacks, WHO and UNAIDS said on World AIDS Day in December.

26 million people living with HIV/AIDS today are now regularly using antiretroviral therapies, falling short of the 30 million target for 2020, that was set before the COVID pandemic began.

UNAIDS warned that the world may still see up to 293,000 more HIV infections and up to 148,000 AIDS-related deaths by 2022, despite treatment services having successfully “rebounded” from the pandemic, as WHO stated.

“There are many chronic conditions which commonly occur together, such as HIV and cervical cancer, TB and diabetes, or hypertension, diabetes and chronic kidney disease – and now COVID-19,” NCD Alliance’s Director of Policy and Advocacy Nina Renshaw told Health Policy Watch.

“But because of the imbalance in global health funding and programmes, someone living with HIV is likely to have access to affordable antiretrovirals – which is great – but they might die very young because of lack of access to insulin or to screening for cervical cancer or early treatment for heart disease.  We are hearing more and more stories like this.”

100 Million More Healthy Life-Years Lost in 2019 Than 2000

The WHO report also found that although people were living on average 6 years longer than in 2000, only 5 of those years were lived in good health.

Dr Bente Mikkelsen, WHO Director for NCDs.

Heart disease, diabetes, stroke, lung cancer and chronic obstructive pulmonary disease contributed to a total of nearly 100 million additional healthy-life years lost globally in 2019, compared to 2 decades earlier: the same diseases that are also causing the most deaths.

“We have seen that it is the people living with NCDs that have been most impacted from the pandemic,” Dr Bente Mikkelsen, director of WHO’s Department of Noncommunicable Diseases, said at a press conference. “Many have become severely ill and, of course, they have been untreated, undiagnosed and, to some extent, unprotected.”

The Americas region experienced a threefold increase in deaths from drug use: the only region to note this in its top 10 contributors to healthy life-years lost. In all other regions, drug use lies outside the top 25.

NCDs Are Now Diseases of Poverty

Mikkelsen said that the data counters the common “misconception” that NCDs are “the diseases of the wealthy and the high-income countries, given bigger risk appetites” related to tobacco, alcohol and diet.

“I think we see from this data that … health systems are not prepared to respond to [increasing cases of] heart disease, diabetes, cancer and lung disease,” she said. “The leading causes of death are draining resources.”

In a factsheet published alongside the new report, WHO notes that in most low-income countries “policy-makers still do not know with confidence how many people die and of what causes” – a data gap worsened by excess COVID deaths, also going unrecorded in some cases.

In a statement, Dr Tedros said that the report highlights “the urgency of drastically improving primary health care equitably and holistically. Strong primary health care is clearly the foundation on which everything rests, from combating noncommunicable diseases to managing a global pandemic”.

As one response, this week saw the launch of a new NCD Poverty Network, Alliance to improve NCD interventions and treatments in low – and middle income countries.

The new network includes some 20 low- and lower-middle-income countries (LLMICs) with large populations of people living in extreme poverty. The network will collaborate with the Lancet NCDI Poverty Commission to identify and advocate for effective evidence-based policies and services to combat NCDs in poor countries.

A map indicating which countries will belong to which phase. The majority fall into Phase 1: prioritising conditions and interventions.

Collaborating countries will pass through a 4-phase system designed to introduce and expand the delivery of care that can be offered to people doubly affected by extreme poverty and NCDs.

  • Phase 1: prioritize conditions and interventions.
  • Phase 2: develop models for integrated delivery of priority interventions.
  • Phase 3: establish training sites and national operational plans.
  • Phase 4: build financial and technical partnerships to support scale-up.

Factors associated with both NCDs and poverty often include unhealthy housing and living environments, including excessive exposures to air pollution; unhealthy workplaces including exposures to chemicals or toxics in workplaces; unhealthy foods including an over-reliance on cheap starches, fast foods and processed foods; and a lack of physical activity associated with increased urbanization and a lack of safe outdoor spaces for leisure and exercise.

Treatment Can Cost One-Third of Household Income

NCDs are also extremely expensive to treat, and in countries like Jamaica, they can eat up one third of household income, said Jamaica’s Minister of Health and Wellness Christopher Tufton on Tuesday, at a press conference hosted by the NCD Alliance.

NCDs also lead to disability, which can mean joblessness and a loss of income, particularly said Tufton. These hit hardest at households in LMICs which may not have large disability and unemployment benefits in the first place.

In Caribbean countries like Jamaica where the brunt of chronic diseases is among the highest in the world, the NCD crisis accounts for 56% of total deaths every year, Tufton added. In 2015, 7 out of 10 Jamaicans died from four major NCDs, including cancers, cardiovascular disease, diabetes and chronic lower respiratory disease, he added.

He emphasized that access to healthcare must go beyond the “bare minimum”, and ensure that healthcare systems offer high-quality medicines that do not perish several months after they are purchased. He quoted surprising results from a Rwandan study that found that up to a fifth of antihypertensive formulations were of substandard quality at their time of purchase, and that 70% became substandard after six months in tropical conditions.

“Improving integration of NCD care and prevention into universal health coverage is an important step towards upscaling cost-effective solutions and implementing policies that ensure that those who cannot afford to pay the associated costs have access to care without suffering financial hardships,” warned Tufton on Tuesday.

Image Credits: WHO/INADI, The Lancet NCDI Poverty Commission.


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Prime Minister Boris Johnson on the day of the COVID vaccine roll-out
UK Prime Minister Boris Johnson at the COVID-19 Vaccine Centre, Guy’s Hospital in central London today.

London. The cameras were focused on the face of 90 year-old Margaret Keenan, the first UK citizen to receive the newly approved Pfizer/BioNTech COVID-19 vaccine on Tuesday at University Hospital in the city of Coventry.  After her jab, she passed through a corridor of applauding nurses. Behind her mask was the glint of a smile as she described the experience as an “early birthday present”. She turns 91 next week.

But underneath the hopeful photo-ops, staged in England’s north, one of the areas hardest hit by the coronavirus, a technically complex “V-Day” operation was getting underway across the hospitals, and primary health care centers of the UK’s National Health Service (NHS).

Famed for its octopus-like bureaucracy, the vaccine rollout could still be a model for other countries if it goes off smoothly as 800,000 vaccines are rolled out this month, to be followed by up to 4 million more vaccines in January 2021.

Some 50 hospital hubs around the country, with cold chain capacity to manage the -70C ultra-cold conditions required for the Pfizer vaccine, were the first to begin administering vaccines on Tuesday, according to a detailed NHS plan, that is to be executed with military-style precision.

In line with the recommendations of an independent expert group published just last week, the campaign will focus first on vaccinating people over the age of 80, as well as some of the most vulnerable health and care staff – particularly people working in care homes.

UK Health Secretary Matt Hancock.

Health Secretary Matt Hancock dubbed Tuesday “V-day”. The term, hearkening back to the legacy of Britain’s World War II’s D-Day landing at Normandy, illustrated both the drama of the moment as well as the complex logistics required to successfully execute the vaccination operation.

“Today marks the start of the fight back against our common enemy, the coronavirus,” said Prime Minister Boris Johnson, on a visit to a London hospital where others were lining up to receive their first vaccine doses. He summoned national pride as well, declaring that getting vaccinated was “good for you and good for the whole country”.

Initiative Begins at Hospitals – Moving Next Week To Primary Care Networks

While the initiative was beginning at 50 hospital hubs across the country, there were also plans to distribute about one-fifth of the vaccines through about 280 pre-selected NHS ‘primary care networks’ (PCNs).

These PCNs are local health care centres that house clusters of NHS general practitioners who are the first point of care for patients’ routine healthcare needs in the state-sponsored NHS system. The PCNs will be expected to deliver around 945 vaccines in the 3 days after receiving a vaccine batch; they would also executive “roving vaccine” services to nearby care homes.

An exhaustive NHS circular on Monday outlined the steps that would be required for the vaccine campaign, in nitty-gritty detail, to those local practitioner centres

These steps ranged from details of the protocols for selecting and booking the first patients, to instructions about the drop-off of portable refrigerators to ensure adequate cold-chain storage for the sensitive Pfizer vaccines.

The PCNs must also perform a battery of assessments, reviewing the readiness of their site, supplies, workforce, IT systems and medical records, and how they plan to dispose of vaccine waste. Training webinars, a hotline and a process to request more vaccine supplies have also been set up.

The NHS document outlined how doctors’ offices should prepare to store the Pfizer vaccine at sub-zero temperatures.

The circular illustrated the special measures being put into place to handle the ultra-cold conditions required for the vaccines – and ensure their use rapidly after delivery. It read:

“A separate delivery of an under-counter sized refrigerator will be made to every site between Tuesday 8 th – Saturday 12th December. You will be given 24 hours’ notice before your delivery is made. Deliveries will be made between 08:00 and 18:30 on weekdays and between 09:00 and 16:00 on Saturdays,” the circular told primary care networks.

“We expect the remaining vaccine shelf life once delivered and stored at 2-8°C to be in the range of 86 hours (3 days 14 hours) to 99 hours (4 days 3 hours).”

On storing the vaccine, it said: “Shelf life will be clearly marked on the vaccine box label. Further guidance on the appropriate cold chain procedure can be found in the SOP. Note that it is essential that sites have sufficient vaccine storage space at 2-8 °C for up to 5 days.

“Sites that receive the initial vaccine delivery on 14 December will receive their corresponding vaccine delivery for dose 2 on Monday 4 January 2021. Sites that receive their initial vaccine delivery on 15 December will receive their corresponding vaccine delivery for dose 2 on Tuesday 5 January 2021.”

Ethnicity Also A Recommended Factor in First Vaccine Selections

The recommendations to GPs also include advice to consider placing older people who are members of an ethnic minority to go first in line.

“GP practices know their local populations and are responsible for generating patient lists based on the priority cohort definition, which for sites going live next week is ‘All those 80 years of age and over’ (excluding the housebound),” the circular clarified.

“If your site potentially has more than 975 patients over 80 years who may wish to be vaccinated, and you need to prioritise which patients should have access to the first supply of vaccine to your designated site, then you could consider the following: i. Age 80 or over; ii. Co-morbidities; iii. Ethnicity.”

That last recommendation is based on the Department of Health and Social Care expert group  findings that “certain black, Asian and minority ethnic groups” should also receive preferential vaccine treatment because they are at higher risk for serious disease. This risk is due largely to socio-economic inequalities, inequalities in access to health services, and related health conditions.

“There is clear evidence that certain black, Asian and minority ethnic (BAME) groups have higher rates of infection, and higher rates of serious disease, morbidity and mortality,” the expert group report, published last week, stated.

“There is no strong evidence that ethnicity by itself (or genetics) is the sole explanation for observed differences in rates of severe illness and deaths.”

“What is clear is that certain health conditions are associated with increased risk of serious disease, and these health conditions are often overrepresented in certain BAME groups. It is also clear that societal factors, such as occupation, household size, deprivation, and access to healthcare can increase susceptibility to COVID-19 and worsen outcomes following infection. These factors are playing a large role in the inequalities being seen with COVID-19.”

Roll-Out Logistics Aside – The Public ‘Hearts-and-Mind Challenge’ Remains

Precise, considered actions – like those outlined above – coupled with close monitoring of vaccinated populations, are vital in ensuring the NHS gives a strong performance on the global stage this December, but the true challenge lies in public uptake, a professor of general practice in south west England told Health Policy Watch.

“The supply, the manufacturing, the distribution – these are all going to be very stretched,” said Professor John Campbell, Professor of General Practice and Primary Care at the University of Exeter Medical School. He said that despite the government’s assurance “that Brexit is not going to affect any of that, you can imagine getting this into the UK is going to be quite a challenge”.

The first batch of the Pfizer coronavirus vaccine left the manufacturing facility in Belgium on Thursday 4 December and was ready for use by Tuesday morning with no delays.

But the UK’s Brexit deadline of 31 January has also raised concern as to how quick and easy deliveries can remain after that date.

Even more pressing concerns, Campbell said, are not strictly logistical. While complications in the distribution and administering of a vaccine can be ironed out, “the bigger issues are related to the public perception and understanding of a new type of vaccine”, referring to the relatively novel mRNA technology used by Pfizer.

“There is a hearts-and-mind challenge for the wider public that we have to be sure to overcome,” he warned. “While people are desperate to get back to some sort of normality, people are still questioning [getting vaccinated].”

Increasingly positive vaccine news has caused concern among health leaders that the public will throw precautionary measures to the wind.

Both the UK and WHO have acknowledged the threat posed by a limited vaccine uptake by the public. WHO has published guidance for improving acceptance – and the UK’s Department of Health is also making patient engagement a key part of its package for primary care networks.

But there could be an equal threat growing in the opposite camp, Campbell underlined: among those who are willing to be vaccinated as soon as possible.

The other concern is that increasingly positive news of an imminent vaccine roll-out could urge the public to throw precautionary measures to the wind, despite the fact that most people will remain unprotected until a critical level of herd immunity is reached in vaccine coverage.

“People are now thinking that the new vaccine is around the corner,” Campbell noted. “Realistically, for the majority of the population, it’s going to be many months off.”

This was a fear that was shared by WHO last week, with WHO Director General Dr Tedros Adhanom Ghebreyesus warning last Friday: “There is a growing perception that the pandemic is over. The truth is, at present, many places are witnessing a very high transmission of the virus, which is putting enormous pressure on hospitals, intensive care units and health workers.”

Campbell said: “People have this sense that the vaccines are here so we don’t need anything else, and that’s very much not the case … It’s in this 6 to 9 month gap that there are important opportunities for other interventions.”

A Vaccine Can’t Come Too Soon

For most countries, weary of economic lockdowns, social strains, pressured hospitals, not to mention the human tragedies of serious illness, death and “long COVID” after effects, the introduction of vaccines cannot be too soon.

Over 1.5 million people have died since the pandemic began nearly a year ago, including more than 61,000 in the UK, the fifth hardest hit in terms of mortality, after only the United States, Brazil, India and Mexico – and just ahead of Italy, France, Iran, Spain and Russia. Many of those same countries are now in the thralls of a second or third wave of virus infections and deaths.

At a press conference on Friday, WHO officials held out hope that low- and middle-income countries, and more affluent ones, could begin vaccinating the highest-risk groups, like health workers and older people in the first quarter of 2021, with the support of the WHO co-sponsored Act Accelerator’s COVAX vaccine facility initiative.

Most of the world’s countries, rich and poor, have joined the initiative – which also aims to raise donor funds to supply 2 billion vaccines to countries that cannot afford to purchase them on their own.

However, despite repeated pleas to donors for support, the facility remains some US$28 billion short on the funding needed for next year to fully fund the vaccine drive, as well as drugs, tests and health system support services in the world’s poorest 92 countries.

Meanwhile, a parallel initiative by India and South Africa in the World Trade Organization to extend a “waiver” on COVID-related patents, copyrights, and trade secrets for vaccines, medicines and health equipment has picked up considerable support among African, Asian and Latin American member states. But it is stiffly opposed by a wall of G-20 countries with huge pharma interests at stake.

WTO members are due to meet again on Thursday to debate the waiver proposal – ahead of a full hearing by the WTO’s General Council on 17 December. While a number of high- and middle-income countries, including Canada and Australia, have tried to mediate a highly polarized debate, leaders of the initiative have also threatened to put it to a vote, if it’s not taken seriously.

Medicines access groups are now stepping up their campaign for approval of the WTO waiver – saying it’s the only way to ensure fair distribution of the brand-new technologies.

“While the world waits with bated breath for the possible approval of these COVID-19 vaccines, it’s not time to celebrate yet,” said Dr Sidney Wong, Executive Co-Director of Médecins Sans Frontières Access Campaign in a press release on Tuesday.

“Right now, we’re in a situation where a lion’s share of the limited number of first doses have already been snatched up by a handful of countries like the US and UK, as well as the EU, leaving very little for other countries in the short term. What we really want to see is a rapid expansion of the overall global supply, so there are more vaccines to go around and doses can be allocated according to WHO’s public health criteria, not a country’s ability to pay.”

Image Credits: Pfizer, BioNTech.

The first peer-reviewed clinical trial results for a coronavirus vaccine were published Wednesday

Just hours after the UK jabbed its first citizen against the coronavirus, researchers have confirmed that Oxford’s vaccine is safe and effective in the first peer-reviewed publication of a Phase III coronavirus vaccine trial yet. 

“The results for me are very compelling,” said AstraZeneca’s executive vice president Mene Pangalos on Wednesday at a press conference. “They clearly show that we have an effective vaccine that meets the regulatory standard for approval around the world.”

He added that there were no cases of death, severe COVID-19 or hospitalization in the vaccine arm of the trial; in contrast, the control arm recorded 10 hospitalised COVID-19 cases, two of which were severe, including one death.

The pooled analysis, which was published in The Lancet, was pre-specified and was designed in collaboration with regulatory bodies in the UK, Brazil and Europe. It includes data from four ongoing randomised trials across the UK, Brazil, and South Africa involving almost 24,000 adults, said the head of the Oxford Vaccine Group Andrew Pollard on Wednesday.

“The vaccine is safe, it’s highly effective, and we also know it can be manufactured in large quantities, and at a low price and can feed into existing supply and distribution networks,” Pollard said, speaking at a press conference on Wednesday.

This is probably the best day we’ve had in 2020,” added the Oxford vaccine’s architect Sarah Gilbert on Wednesday, who co-authored the peer-reviewed Lancet report. “It’s a study that’s taken place in three different countries and that’s important.”

Sarah Gilbert, Professor of Vaccinology at Oxford University

Oxford Vaccine Is Safe, But Dosage Regimen Still Unclear 

The interim analysis found that the Oxford vaccine was safe, based on a three and a half month long assessment of 23,745 adults. While 175 severe adverse events were recorded in total, 172 were deemed unlikely to be related to the COVID-19 vaccine – or the placebo  given to the control group. 

There were, however, three events that experts concede may be related to the trials including: one case of haemolytic anaemia in the control group; one case of transverse myelitis in the vaccine group; and one case of severe fever in South Africa in a participant who is still masked to group allocation. On the upside, all three participants are recovering or have already recovered, and are still part of the Oxford vaccine trial.

Nonetheless, the efficacy of the Oxford vaccine is less clear-cut than its safety results, and depends on the vaccine dose that was received. While the “general” pooled efficacy was at 70%, the “minimum” efficacy was at 62% in those that received two standard doses of the vaccine. 

Intriguingly, efficacy rose to 90% in a group that accidentally received half a dose followed by a standard dose – due to an error in the preparation of one large vaccine batch that was used for one group of trial participants. 

In response to a question on the ideal dosage regimen, the vaccine-makers refrained from drafting any recommendations, and have left it in the hands of regulatory agencies to decide for themselves based on the Lancet report. AstraZeneca’s CEO has previously said, however, that a new trial of the lower dose regimen would be undertaken to unequivocally confirm the results and the best dosing protocol. 

Andrew Pollard, head of Oxford’s Vaccine Group

“It is entirely up to the regulators to look at the data and decide exactly what they think their label should say [efficacy and dosage regimen] at the end and so that’s sort of in their hands,” said Pollard. 

Even if the minimum efficacy were to be only 62% – almost thirty percentage points lower than Pfizer’s and Moderna’s mRNA vaccines – the Oxford vaccine will still meet the threshold set by major regulators in the UK, Europe and the United States for efficacy, and have a “very important” impact on healthcare systems around the world, emphasized Pangalos. 

At only about US$ 3 per dose, as compared to US$20-US$25, the Oxford vaccine is much cheaper than its mRNA counterparts, and also can be stored at normal refrigeration temperatures, making it particularly suitable for distribution in low- and middle-income countries. 

“It is hard not to be excited about these findings and now the existence of three safe and efficacious COVID-19 vaccines, with 57 more in clinical trials,“ emphasized Maria Deloria Knoll and Chizoba Wonodi from Johns Hopkins Bloomberg School of Public Health in a  joint comment, referring to the results of the Pfizer, Moderna and AstraZeneca trials. 

However, further studies of the AstraZeneca vaccine are needed in more diverse groups – out of the 11,636 people enrolled in ongoing Phase III trials in Brazil and the UK, only 12% were older than 55, and over 80% were white. In addition, all of those volunteers who accidentally received the half-dose regime that appears more effective were under the age of 55.

Image Credits: John Cairns, UK Science Media Centre:.

Dr Tedros admitted there “could be a conflict of interest” as money would come from areas where WHO cannot mobilise directly.

The WHO Foundation has appointed a senior pharma executive as CEO of the flagship WHO Foundation, suggesting it will make a big push to secure donations from the broader private sector as the curtain closes on a precarious budget year.

But speaking at a press briefing on Monday, the WHO DG commented on the recruitment of an industry figure, Anil Soni of the US-based Viatris, to the WHO Foundation would create a whole new set of headaches in the form of potential conflict of interests with industry donors whose money WHO Foundation is soliciting – at the same time that the Organization must also act as a neutral broker for the worldwide endorsement of new pharma products.

“The money will come from areas where WHO cannot mobilise directly … and where there could be a conflict of interest,” Tedros admitted. But since the relationships fostered with industry would be “indirect”, they wouldn’t pose a conflict of interest for WHO, as such.

“So, the relationship between WHO and WHO Foundation is not direct,” he said. “So one thing I would like to assure you is that we have done all the assessments.”

The WHO Foundation, which was launched in May 2020, operates as a separate legal entity, allowing it to recruit funds from the private sector and private individuals and use that money to invest in research and science-based initiatives for which WHO lacks adequate budget.

Soni will be joining the WHO Foundation in January 2021 from the Pennsylvania-based company Viatris, formed in November 2020 as a combination Mylan N.V. and Pfizer’s Upjohn business, where he has worked as Head of Global Infectious Diseases for nearly 10 years.

US President Donald Trump’s announcement in April to suspend the US funding to WHO, followed by his July announcement of a US withdrawal from the global health body, highlighted the delicate nature of the Organization’s resource base, which relies heavily on voluntary donations from member states as well as from other charities.

Until April, the US was the biggest single donor to WHO, providing US$400 million in 2019, accounting for around 15% of its annual budget. Although the subsequent election of a new US president, Joe Biden, will see another US about-face, since Biden has declared his intention to rejoin WHO, the events of the summer, in the midst of a pandemic, underlined the precarious state of WHO’s budget: its programme budget for 2020-21 amounts to about US$5 billion a year.

“If any of [our] donors withdrew their funding, WHO would experience a shock which it cannot absorb,” Dr Tedros said at Monday’s briefing, adding that since his election to head WHO in 2017, his “strategy solution … was for WHO to broaden its base of donors”.

Soni has a two-decade career in the public, private and nonprofit sectors. He also served as CEO of the Clinton Health Access Initiative. Prior that he also worked for the Global Fund to Fight AIDS, Tuberculosis and Malaria between 2002-04 as the Advisor to the Executive Director, and he has been an advisor to the Bill & Melinda Gates Foundation: the second largest contributor to WHO’s annual budget this year, after Germany.

The COVID-19 outbreak has sparked new trends in counterfeit medical products, including masks, medicines, hand sanitizers, and vaccines.

The approval of the world’s first COVID-19 vaccine candidate last week in the United Kingdom is stoking fears that the global rollout of vaccines to fight the pandemic could also stimulate a counter-pandemic of fake online cures as well as criminal attempts to sabotage or interrupt vaccine supply chains. 

To counter the growing threat, a new industry-backed alliance to fight fake COVID-19 medicines and vaccines was launched on Monday. Building on the informal Fight the Fakes advocacy campaign and week (7-13 December), the new Fight the Fake Alliance aims to muster more government, civil society and private sector awareness and support about the risks posed by the attempts of organized crime, individual profiteers and hackers to interfere with the COVID-19 vaccine and medicines supply chain, as well as profit from fake products. 

The Alliance was formed just a few days after Interpol, the international criminal police organization, issued a sharp warning to law enforcement agencies in its 194 member states that criminal networks were laying plans to target COVID-19 vaccine supply chains, physically and online, disrupting distribution of legitimate products and sowing confusion. 

“As governments are preparing to roll out vaccines, criminal organizations are planning to infiltrate or disrupt supply chains,” said Jürgen Stock, Interpol Secretary General, in a statement released last Wednesday (2 December). “Criminal networks will also be targeting unsuspecting members of the public via fake websites and false cures, which could pose a significant risk to their health, even their lives.” 

Interpol Infographic on the dangers of fake medicines and medical supplies
Interpol infographic warning about the dangers of counterfeit medical supplies.

The Alliance is composed of 15 groups involved in various aspects of the medical supply chain and representing health care professionals, manufacturers, wholesalers, researchers and patients. Its members include the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), International Alliance of Patients’ Organizations (IAPO), and International Council of Nurses (ICN).

“In the current environment of misinformation – the so-called ‘infodemic’ by the World Health Organization (WHO) – it is particularly important to prevent the manufacture and trade of falsified COVID-19 vaccines as they have the potential to undermine trust in modern medicine, health care professional and health care systems as a whole,” the Alliance’s new Vice Chair and Director of Partnerships & Programmes at the World Heart Federation, Andrea Vassalotti told Health Policy Watch.  

“With the on-going COVID-19 pandemic and the rise in falsified medicines now and in the future, our combined efforts to mitigate, control and ultimately eradicate the damage they cause to patient health and lives are more crucial than ever,” said Adam Aspinall, Chair of the new Fight the Fakes Alliance and Senior Director of Access and Product Management at Medicines for Malaria Venture, in a press release. 

“The threat of fake medicines knows no borders,” said Miriam Holm, co-head of the Secretariat for Fight the Fakes, in a podcast Monday hosted by King’s College London lecturer, Bahijja Raimi-Abraham. “I think it’s only a matter of a few weeks until we have fake COVID vaccines circulating.” 

“We have joined forces with the Fight the Fakes Campaign to raise awareness of the dangers of fake medicines,” said the International Council of Nurses (ICN), one member of the new alliance, in a statement. “ICN supports international initiatives to combat counterfeiting and urges nurses and national nurses associations to collaborate with pharmacists, physicians and others to disseminate accurate information on detection and elimination of counterfeit medicines.”

High Income Countries not Immune to Attacks 

While low- and middle-income countries with weaker regulatory systems have been the most typical targets for the trade in fake medicines, high-income countries are not immune either.

That was evident as news emerged last week about cyberattacks targeting the vaccine distribution networks in the United States that are being prepared to roll out new COVID-19 vaccines, following expected approval of a Pfizer vaccine later this week. 

According to the Cybersecurity and Infrastructure Security Agency, which operates under the Department of Homeland Security, cyber actors were impersonating a biomedical company in phishing emails, which aimed to steal log-in credentials of executives and officials at companies and government organizations involved in distributing vaccines. One aim of the hackers was the disruption of sensitive vaccine cold chain processes. 

The cold chain process is the refrigeration system critical for the storage, transportation, and distribution of vaccines, especially mRNA vaccines, such as the ones developed by Pfizer and Moderna, which require sub-zero storage temperatures. Interference with this system could affect the quality or effectiveness of the vaccine and compromise the infrastructure to deliver vaccines to billions of people globally. 

Organizations in Taiwan, South Korea, Germany, and Italy, involved in development of solar-powered vaccine cooling systems, as well as UNICEF, which has been part of the WHO co-sponsored vaccine planning in low-income countries, were targeted in similar cyberattacks, the New York Times reported. 

Rise In Falsified COVID-19 Diagnostic Kits Heralded New Threat 

The launch of the new Fight the Fakes Alliance coincides with the third annual Fight the Fakes week, designed to raise awareness about the dangers of falsified and substandard medicines among governments, industry and civil society. 

“Fight the Fakes Week 2020 is appropriately timed to inform the general public of the importance of consulting health care professionals for legitimate advice on COVID-19 vaccines,” Vassalotti told Health Policy Watch. 

“While we saw a rise in falsified diagnostic testing kits and substandard personal protective equipment during the initial stages of the pandemic, falsified COVID-19 vaccines will likely emerge sooner rather than later,” she added.

Early on in the pandemic, when numerous countries were experiencing shortages of personal protective equipment for healthcare workers, there was a surge in the circulation of poor quality and fake masks, gloves, and diagnostic testing kits. Additionally, with the speculation of hydroxychloroquine as a treatment for COVID-19 came reports of falsified versions, particularly in the African region.

An Interpol operation in March in Mozambique seized dangerous falsified pharmaceuticals related to COVID-19 worth USD 14 million.

WHO’s Global Surveillance and Monitoring System for Substandard and Falsified Medical Products issued a medical product alert in late March to warn consumers, healthcare professionals, and health authorities against a range of falsified products claiming to prevent, treat, or cure COVID-19

The convergence of falsified medical products with the infodemic, characterized by the overabundance of misinformation and falsified information, is highly damaging. Together, these crises have the potential to undermine the already shaky trust of the public in the reliability of vaccines and health institutions. The existing hesitancy of accepting a COVID-19 vaccine could be further fueled by the circulation of falsified products and misinformation.

Substandard and Falsified Medicines

Substandard medical products are authorized products that nonetheless fail to meet quality standards, perhaps due to incorrect storage or damage during transportation. Falsified products, on the other hand, deliberately misrepresent their identity, composition and source and do not meet regulatory requirements. 

One in 10 medical products in low- and middle-income countries is either substandard or falsified, according to a study by the WHO. These medicines not only fail to treat or prevent diseases, but can also cause serious illness or death. 

The higher burden in developing countries is due in part to less rigorous regulatory requirements and more porous borders, which allows for illegal trade between countries. While fake medicines have posed a danger in all disease areas for decades, COVID-19 has amplified the threat of fake medicines to public health.

The lack of access to necessary medicines and vaccines creates a vacuum often filled by falsified and substandard medical products.
Fake Medicines Also Can Fuel Antimicrobial Resistance

Along with the immediate issues of the COVID-19 pandemic, falsified and substandard antibiotics, anti-viral and anti-parasitic medications can also contribute to another major global health threat, antimicrobial resistance (AMR). 

The administration of weakened drugs may foster the development of drug-resistant microbes that will then be resistant to full drug course as well. While a great deal of research has documented how the overuse of antibiotics is stimulating the rise of antimicrobial resistance, there is, however, relatively little work examining the role of poor drug quality in fostering resistance of bacteria, fungi, viruses and parasites to drugs. 

Antibiotics are, however, among the most frequently reported falsified medical products. One study found that antimicrobials with low doses of active ingredients lead to low levels of the drug in the patient. Exposing drug-resistant microbes to subtherapeutic doses of medicines, through falsified or substandard drugs, enables the survival and spread of resistance.

Falsified medical products also cause very immediate and direct damage because they compromise the treatment of potentially deadly chronic and infectious diseases, causing disease progression and even death. 

For instance, falsified pneumonia medicines cause an estimated 170,000 children to die each year, according to the Alliance. 

Image Credits: Interpol, Interpol, Interpol, Interpol, WHO.

WHO Director General has said he is “concerned” by the growing perception that the pandemic is over, as WHO officials reasserted the need to adhere to prevention methods like wearing a mask or social distancing.

While the UK and US are likely to start vaccinating its citizens against COVID-19 before the end of the year, the 189 countries that are part of the COVAX initiative should expect to start getting vaccines towards the end of the first quarter of 2021, the World Health Organization (WHO) has said.

Soumya Swaminathan, WHO Chief Scientist.

Currently through COVAX,  the vaccine arm of the WHO-led Access to COVID-19 Tools (ACT) Accelerator, WHO has agreed deals that could provide 700 million doses of a COVID vaccine.

“But that’s not sufficient,” said Dr Soumya Swaminathan, WHO’s Chief Scientist, at a media briefing on Friday. “The goal is to get at least two billion doses by the end of 2021, which would be enough to vaccinate approximately 20%, of the populations of the countries that are part of COVAX.”

She stressed that equitable access was key, as there is “no point in having products that do not reach the majority of the world’s population”.

COVAX, a global collaboration to accelerate the development, production, and equitable access to COVID-19 products, covers 90% of the global population.

The programme would be able to negotiate good prices with manufacturers because of the volume of its orders, but it “urgently needs another US$5 billion in order to meet that goal of two billion does”, stressed Swaminathan, adding that political leaders around the world also had to demonstrate their commitment to equity by “sharing available doses of vaccines fairly around the world”.

WHO ‘Concerned’ by Growing Belief the Pandemic is Over

Describing the UK’s emergency authorization of Pfizer’s COVID-19 vaccine as a sign that there is “light at the end of the tunnel”, the pandemic is far from over, warned the WHO  Director-General Dr Tedros Adhanom Ghebreyesus.

Dr Michael Ryan, WHO Executive Director for Emergencies.

Many countries are currently experiencing second spikes in cases, with heightening transmission rates, as others enter national “circuit-breaker” lockdowns. Dr Michael Ryan, WHO’s Executive Director of Emergencies flagged that “there is no prospect that vaccines will end that transmission in time”.

“WHO is concerned that there is a growing perception that the pandemic is over,” Dr Tedros warned. “The truth is, at present, many places are witnessing a very high transmission of the virus, which is putting enormous pressure on hospitals, intensive care units and health workers.”

Supporting Dr Tedros, Ryan, said that “vaccines do not equal zero COVID” and while “vaccination will add a major, powerful tool to the toolkit, by themselves, they will not do the job [of eliminating the virus]”. 

Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead, appealed for patience and adherence to wearing masks and social distancing to contain the virus: “The next six months require … strict adherence and vigilance to keep ourselves safe.”

Ryan added: “We need to recognise that the vaccine will not be with everyone, early next year.”

Maria Van Kerkhove
Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead.

He cited that many authorities around the world were following WHO advice: to  prioritise the safety of frontline workers, older persons and people with underlying conditions.

“Focusing on those groups will significantly reduce severe disease and that will take the pressure off the health system that will take a lot of the sorrow of this pandemic. But it will not stop the transmission by itself,” he closed.

“We’re all tired and we need hope, but we also need to be realistic. We’re in a pivotal moment and there are some countries whose health systems are at a point of collapse, and right now we have got to take the heat out of this transmission in order that those health systems can cope and bring that vaccine on quickly and safely.”

WHO: Countries Should Prepare Systems for Vaccine Distribution

Dr Tedros called on all countries to conduct “readiness assessments that take into account cold chain capacity, health worker capacity, micro-planning, initial target populations and training”.

Establishing the framework for a national deployment strategy and vaccination plan ahead far in advance would help identify where potential bottlenecks might occur, or prevent them entirely.

“This means passing any legislation and policies needed to expedite the process ensuring the regulatory process is fit for purpose, and confirming that the financing is in place,” he said.

Professor Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, stressed that “no country is going to have enough supply from the very beginning to immunise everybody who should be immunised’.

“With vaccines, we are really at the very, very beginning. And we do expect to have more vaccines that will reach authorization based on the efficacy trials that are being conducted.

“We’re also seeing in the media some concerns around who will go first. Prioritisation in every country is going to need to take place, and it’s really critical that the communities, and the population of each country has a clear understanding of what the basis was for those choices and, and why there are certain groups that are going first and which groups there are and the evidence is for that.”

Image Credits: Wikimedia Commons: Alteo31300, WHO.

The UK has seen large anti-vaccine protests in its capital as it approved the Pfizer vaccine for use: a similar resistance in Africa could be more challenging to combat.

Information about COVID-19 has been viewed online more than 270 billion times globally since February, with a large proportion deliberately misleading, misinforming, or lying to readers. But a new ‘infodemic’ response alliance, launched by the World Health Organisation (WHO) Regional Office for Africa, is hoped to improve scientific literacy among the general public, as countries around the world prepare to begin their vaccination campaigns.

The Africa Infodemic Response Alliance (AIRA) will aim to support journalists by encouraging disclosure by data holders, WHO has said, and to aid individual African countries by developing tailored responses based on behavioural trends.

The network consists of 13 international and regional organizations and fact-checking groups specialising in behavioural science and epidemiology, including WHO, United Nations (UN), and Africa Centres for Disease Control and Prevention (CDC).

“During health emergencies, people need proven scientific facts to make informed decisions about their health and well being,” WHO Regional Director for Africa, Dr Matshidiso Moeti, said in a press briefing on Thursday. “News of coronavirus has many people on edge. From social media to street corners, people are hearing conspiracy theories.

“Rumors on the origin of the virus, its mode of transmission and its severity harms people’s physical and mental health.”

AIRA will rely on four pillars – identifying, simplifying, amplifying and quantifying – designed to flag knowledge gaps in the population, present information in a simple manner, promote correct information more actively, and evaluate how effective the interventions have been. Key actions to be taken in 2021 include:

  • Monitoring the media and social media discourse surrounding COVID-19 vaccines to identify information gaps.
  • Working with community leaders, religious leaders and social influencers to disseminate timely and accurate information.
  • Launching a social media brand dedicated to debunking health misinformation.
  • Briefing media and fact checkers on key technical updates related to vaccines.

The steps are similar to those outlined in the WHO technical advisory group guidance for improving vaccine uptake, published on Friday.

Dr Matshidiso Moeti, WHO Regional Director for Africa.

The launch comes at a key turning point in the global response to the COVID-19 pandemic, as countries worldwide are experiencing second or third spikes, while other, high-income countries prepare vaccination campaigns en masse.

“This is all the more important,” Moeti said. “Compared to last month, cases are increasing in around half of the countries in the African region, and countries [elsewhere] are preparing for the introduction of COVID-19 vaccines.”

But there is growing concern for uptake of the vaccine, given the amount of misinformation, and the staggered rollouts globally caused by lack of availability and inequity.

“We have two concerns,” said Melissa Fleming, UN’s Under-Secretary-General for Global Communications. “One is that we won’t have enough people to actually take the vaccine so that we won’t be able to create herd immunity because people are listening to this misinformation and are becoming fearful, and our second concern is that there will not be enough availability of the vaccine.”

Africa Health Officials to Monitor UK Vaccine Campaign

From as early as next week, the UK will begin its rollout of Pfizer and BioNTech’s COVID-19 vaccine to immunise 20 million people, after it became the first country to approve a vaccine for public use.

“If I had it my way and I could take a flight to the UK, I would take that vaccine right now,” John Nkengasong, Director of the Africa CDC, one of the 13 institutions forming the AIRA, told Health Policy Watch. “I want everyone to be very clear, and on the same page.

“There are no issues of safety, there are no issues of efficacy. We heard prior to the UK announcement that the vaccine is around 95% effective, and that is on a large number of people that took part in large clinical trials.”

John Nkengasong, Director of the Africa CDC.

But the UK has seen large anti-vaccine protests in its capital, leading to 150 arrests made last weekend: a similar resistance in Africa could be more challenging to combat. High levels of scientific illiteracy could realistically undermine a successful, government-led vaccination campaign.

Nkengasong noted, however, that it was important to remember this is far from the African continent’s first mass-vaccination campaign, and that there is reason to be confident in the success of the COVID vaccine rollout, currently expected to take place in spring.

“This is not the first time that the continent will be dealing with vaccines against an infectious disease,” he told Health Policy Watch. “Personally, I’ve received over seven different vaccines over my lifetime from childhood to now.

“The history of infectious diseases shows that vaccines are the most potent public health tools that we have. The Africa CDC is working very hard to ensure that only the best vaccine is introduced on the continent.”

“Interestingly, it’s most pervasive in countries in the West – in the US and in countries in Europe,” Fleming said at the WHO briefing. “It seems that in Africa, people are more accustomed to and are very embracing, and understanding of the wonders of vaccines and vaccination.”

Melissa Fleming, UN’s Under-Secretary-General for Global Communications.
Facebook: Cracking Down On Conspiracies

In a separate statement made on the same day as the WHO and CDC announcement, Facebook said that it will begin actively removing false claims about COVID vaccines from its platform and from Instagram, if they have been debunked by health experts.

It cited a recent conspiracy theory circulating on the site that these new vaccines contain microchips, or that specific populations are being targeted for vaccine trials without their consent.

It noted that it will regularly update its guidance as public health authorities “learn more” and as “facts about COVID-19 vaccines … continue to evolve”.

Image Credits: National Institutes of Health (NIH) , Africa CDC.

Improving vaccine uptake
The WHO report says the key areas for improving vaccine uptake are creating an enabling environment, harnessing social influences and increasing motivation.

As the first vaccination campaign for COVID-19 could begin as early as next week, following the UK’s approval Pfizer and BioNTech’s mRNA vaccine, the World Health Organisation (WHO) technical advisory group (TAG) has published a series of guidelines and behavioural insights to improve vaccine acceptance and uptake across all populations.

The report, published on Friday, details the recommendations made during a 15 October meeting between TAG members and WHO Department of Immunization, Vaccines and Biologicals.

TAG identified three categories of drivers of vaccine uptake, based on existing behavioural research: enabling environments, social influences and motivation.

Political decision-makers, health workers, media outlets and community leaders may all influence vaccine uptake, the report says.

Enabling Environment

Reducing barriers and making the process of getting vaccinated simple and straightforward – especially for large populations who are not deliberately avoiding vaccination – can improve uptake, the report says.

It cited that what appears to be reluctance, resistance or even opposition among a group might be a response to the inconvenience of getting a vaccine. Environmental factors include:

  • Location of the vaccination.
  • Costs: including for the vaccine, for travel, or by missing work.
  • Time: booking should be accessible, and vaccines should be delivered at convenient times of day.
  • Quality of care: health workers should be informed and able to answer questions.
  • Information: relevant details should be provided ahead of time, with benefits outlined.
  • Regulations: vaccination may be mandatory for employment, education or social activities.

The report says that making vaccines available from familiar and convenient locations, like drop-in services, can encourage uptake. It also noted, however, that fears of contracting COVID-19 in a health facility might impede immunization efforts, and so safety measures should be implemented visibily.

Social Influences

Social influences that affect vaccination decision-making include family members, friends, members of a broader community, and digital or media outlets. The TAG report notes that “[harnessing] social influences” can be used to “promote favourable behaviours”. This can be achieved by:

  • Improving communication efforts to promote the perception that “most people are getting vaccinated”. Making uptake visible, either via social media or by enabling ways for people to signal they have been vaccinated, can normalise vaccination.
  • Amplifying endorsements from community members.
  • Supporting health professionals to encourage engagement. Motivational interviewing, designed to explore the reasons behind an individual’s hesistancy, has ben found to facilitate vaccination.
Increasing Motivation

Motivation towards getting vaccinated is the results of risk perception and severity of illness or infection, the report says. Some groups may believe they are at low risk, and so are reluctant to be vaccinated, for example, while others may be wary of the safety of the vaccine. Key strategies to remove motivational barriers include:

  • Building trust in vaccines before vaccination. Evidence indicates that strategies designed to change attitudes towards vaccination are not always successful. Building up trust ahead of the decision to receive a vaccine is vital.
  • Emphasizing the social benefits. Communicating the benefits of vaccination, such as restored engagement with the community and family members, has been found to increase vaccination intention.
  • Leveraging regret. Anticipated regret – the fear of regetting a future action – is a strong barrier. Highlighting the consequences of inaction – for instance, by asking people how they would feel if they do not get vaccinated and end up contracting COVID-19 or transmitting it to loved ones – may encourage vaccination.

Image Credits: Keystone/ Hans Pennick.

The WHO calls on countries to commit to the ACT Accelerator, calling it a “global solution” with economic benefits.

The economic benefits to the economies of ten high income countries being asked to support the equitable, worldwide distribution of COVID-19 vaccines, treatments and tests would be 12 times the costs, a new report has found.

The study, undertaken by the global political risk research firm Eurasia Group, on behalf of the Bill and Melinda Gates Foundation, found that the world’s ten largest donors would reap some US$466 billion in an economic boon over the next five years, if they were to support the US$ 38 billion required by WHO’s Access to COVID-19 (ACT) Accelerator to fund more equitable distribution of emerging treatments, vaccines and tests.  The same ten countries would reap at least US$153 billion over the coming year – due to improvements in global trade, tourism and economic activity that would result.

The report examined the economic benefits that would accrue to ten leading donor countries – including Canada, France, Germany, Japan, Qatar, South Korea, Sweden, the United Arab Emirates, the United Kingdom and the United States.

So far, the 10 countries featured in the report have contributed $2.4 billion to the work of the ACT Accelerator. The UK committed just more than US$1 billion, and Germany, Canada, France, committed US$618 million, US$290 million, US$229 million, and US$147 million respectively.

The ACT Accelerator is a unique global collaboration that supports the development and equitable distribution of tests, treatments, and vaccines the world needs to fight COVID-19. However, the ACT Accelerator, which published its Urgent Priorities and Financing Requirements last month, still has a significant funding gap of US$28.2 billion, and needs US$4.3 billion immediately for critical areas of work.

If that shortfall isn’t met, low- and middle-income countries (LMICs) risk delayed access to vital tools including vaccines in 2021. This would result in a prolonged pandemic with severe economic consequences – not just for LMICs, but for the wider global economy. The benefit to supporting LMICs with access to treatments and vaccines far outweigh the cost, the report, which was commissioned by the Bill & Melinda Gates Foundation, emphasizes.

 

Ratio of economic benefits (2020-25) to current US$5B billion funding gap for COVAX-AMC.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, called on countries to commit to the work of the ACT Accelerator, stating that, “The ACT Accelerator is the global solution to ending the acute phase of the pandemic as quickly as possible by ensuring equitable access to COVID-19 tools. Contributing to the ACT Accelerator is not just the right thing to do – it’s the smart thing for all countries – socially, economically and politically.” 

ACT Accelerator: Economic Gains to Low and Middle-Income Countries and High-Income Countries

Over just seven months, the ACT Accelerator’s progress has evaluated over 50 diagnostic tests and ensured the development of new rapid antigen diagnostics for LMICs. In addition, it has rolled out life-saving Dexamethasone treatments, research into monoclonal antibody treatments and has mapped out the health system requirements for delivery of COVID-19 tools have been mapped in 4 out of the 6 world regions. 

COVAX, the vaccines pillar of the ACT Accelerator, aims to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for participating countries.

According to the International Monetary Fund, if medical solutions can be made available faster and more widely, there could be a reduction of income divergence in all countries. Rapid, widespread, and equitable vaccinations, tests, and treatments have the potential to save countless lives in LMICs, allowing policymakers’ focus to return to the core development goals of raising living standards, empowering women, and marginalized communities, and strengthening institutions. 

 

Level of access to COVID-19 tools as of November 2020 in high-income compared to low-income countries.

WHO has stated that it is in every economy’s interests to finance a global solution, as all economies are interdependent through mobility and global trade. 

“There is a clear humanitarian and ethical case for supporting the ACT Accelerator and the COVAX facility, along with the obvious economic gains it would bring to developing countries. Doing nothing risks reversing years if not decades of economic progress. But our analysis shows that the program is likely to yield economic and other returns for major donor countries as well,” said Alexander Kazan, Managing Director for Global Strategy at Eurasia Group and one of the authors of the report. 

Kazan added: “The ACT Accelerator is a unique opportunity to save lives, repair the global economy, and build diplomatic capital that will last a generation.”

Image Credits: Marco Verch/Flickr, Eurasia Group, WHO.

Commission for Narcotic Drugs meets in Vienna this week, in a hybrid virtual and in-person meeting

The UN Commission on Narcotic Drugs voted on Wednesday to remove cannabis and cannabis-derived substances from its “Schedule IV” list of the world’s most dangerous narcotics.

The move comes nearly two years after the WHO recommended to the UN Secretary General that cannabis and cannabis resin be removed from Schedule IV of the 1961 Single Convention on Narcotic Drugs – a classification of drugs with “particularly dangerous properties”, including narcotics such as fentanyl, heroin and other opioids.

While the long-delayed decision is non-binding for countries – it is expected to clear the way for more national legislation that would enable more scientific research into medical cannabis and cannabis derivatives, including non psychoactive cannabidiol (CBD).

There has been a surge of interest over the past decade in the therapeutic use of cannabis as “medical marijuana”, particularly for chronic pain management.

“Medical marijuana”, e.g., cannabis grown and prescribed for some form of therapeutic treatment, had been legalized in 30 countries around the world, ranging from Argentina, Chile, Canada, Germany, Greece, Israel, Switzerland, Turkey, and Zimbabwe, and some states in United States.

Recent years have also seen a major uptake of non-psychoactive cannabis derivatives, particularly CBD – with one brand-name formulation “Epidiolex” gaining US Food and Drug Administration approval for treating a rare form of childhood epilepsy. Other studies have suggested that CBD may also have potential therapeutic uses against anxiety, depression and as adjunctive therapy to common anti-psychotics.  Despite the increasing evidence about potential therapeutic benefits,  mainstream medical researchers have often been hamstrung by continued tight legal restrictions on production, sale and trade in cannabis, as a result of the Schedule IV international classification, which can stymie legitimate research.

At a meeting in November 2018, the WHO Expert Committee on Drug Dependence (ECDD), recommended that cannabis and cannabis-derived products be removed from the list of the most dangerous opoid and narcotic drugs.  Those recommendations were transmitted in a letter from WHO Director General Tedros Adhanom Gheyebresus to UN Secretary General Antonio Guterres in late January of 2019. However, the UN Commission meeting in March of that year postponed consideration of the WHO proposal – due in part to objections from members states at the time, including the United States, to the reclassification.

In Tuesday’s session, the 55 member states attending the Commission voted 27 in favour of the WHO recommendation and 25 voted against, while one abstained, clearing the way to greater recognition of the medicinal and therapeutic potential of the commonly-used but still largely illegal recreational drug.

The United States cast its vote in favor of removing cannabis from Schedule IV of the Single Convention while retaining them in Schedule I, saying it is “consistent with the science demonstrating that while a safe and effective cannabis-derived therapeutic has been developed, cannabis itself continues to pose significant risks to public health and should continue to be controlled under the international drug control conventions”.

 

WHO Expert Committee Recommendations 

The 2018 recommendation of the WHO Expert Committee on Drug Dependence concluded that: “The evidence presented to the Committee did not indicate that cannabis plant and cannabis resin were particularly liable to produce ill-effects similar to the effects of the other substances in Schedule IV of the 1961 Single Convention on Narcotic Drugs. In addition, preparations of cannabis have shown therapeutic potential for treatment of pain and other medical conditions such as epilepsy and spasticity associated with multiple sclerosis. In line with the above, cannabis and cannabis resin should be scheduled at a level of control that will prevent harm caused by cannabis use and at the same time will not act as a barrier to access and to research and development of cannabis-related preparation for medical use.”

However, the committe recommended that cannabis should still remain on the list of Schedule 1 controlled substances, which is the least restrictive classification under the 1961 Convention,  due to: “the adverse effects associated with long-term cannabis use, including increased risk of mental health disorders, such as anxiety, depression and psychotic illness. Regular cannabis use is particularly problematic for young people, because of its effects on the developing brain.”

The committee recommendation came shortly after the US Food and Drug Administration in August issued the first-ever approval of a CBD oral solution, Epidiolex, to treat certain forms of very severe childhood epileptic conditions, including Dravet and Lennoz-Gastaut syndrome.

Regarding CBD, the WHO committee noted that it had recommended that “preparations considered to be pure cannabidiol should not be scheduled within the International Drug Control Conventions at all.”

Cannabidiol “does not have psychoactive properties and has no potential for abuse and no potential to produce dependence. It does not have significant ill-effects,” the committee added, reiterating its findings once more in this year’s report. “Cannabidiol has been shown to be effective in the management of certain treatment-resistant, childhood-onset epilepsy disorders. It was approved for this use in the United States in 2018 and is currently under consideration for approval by the EU.”

Image Credits: @CND.