The meeting of the 148th session of the WHO Exeuctive Board.

Reform and diversification of the World Health Organization’s (WHO) funding model is vital if the global health body is to avoid repeating the consequences of the US’s withdrawal in April 2020, member states have said during WHO’s Executive Board meetings.

The global COVID-19 pandemic has magnified the “open secret” within the field of global health that WHO has long suffered from disproportionate expectations and resources, Singapore said Wednesday, during the 148th EB session.

“Stable funding will be required for adequacy, predictability and stability they have been lacking in WHO’s budget for some time now,” the EB representative said.

It is no coincidence that such a reference to predictability and stability was made on the same that the new US President Joe Biden’s inauguration: a day that also marked the first step in the country’s return to the global health organization.

In April, former President Donald Trump announced that the US was to immediately suspend its WHO funding, followed in July by his announcement that the country would withdraw from the Organization entirely.

Trump’s decision 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. At the time Trump gave notice, the US was the biggest single donor to WHO, providing US$400 million in 2019, and accounting for around 15% of its annual budget.

And it was as Biden made his way to the Capitol for his inauguration, on 20 January, that the WHO Executive Board members were examining the future of the body’s financing.

Top contributors to WHO’s Budget (2018) – The United States has historically been the largest contributor overall.

“It is timely to initiate a discussion on sustainable financing for the WHO, to take a comprehensive look at its functions, work, and associated costs,” the representative from Canada noted.

Furthering the point that there is a growing gap between what Member States expect from WHO and what resources are currently available to meet those expectations, he added:

“The challenges arising from the current funding model are evident in the persistent pockets of poverty across various technical areas as well as in the chronic underfunding of particular WHO functions including core science and normative work, emergency preparedness and enabling functions such as internal oversight.”

The US’ decision to rejoin the body, and pay up on its contributions, as Biden’s newly appointed Chief Medical Advisor Anthony Fauci promised to do on Thursday (see related HPW story)  is clearly a positive step towards restabilizing WHO’s finances, EB members said. But that doesn’t solve the long-term problems of the Organization, which include an overreliance on a few key member states, as well as on voluntary contributions, which may vary year to year, instead of fixed member state assessments.

Other budget challenges include the need to improve staffing and resources at country level – which are at the core of WHO’s work with governments and Ministries of Health.

The committee also noted that improving geographical representation among WHO staff should be considered through the lens of member states geographical representation— and not that of WHO regions.

Also, although WHO Director General Dr Tedros Adhanom Ghebreyesus has trumpeted the fact that his senior staff has reached gender parity – in lower levels of the Organization and particularly in countries and regional offices, men still well outnumber women professionals, the EB committee members noted, saying that more steps be taken towards the goal of gender parity at all levels, especially among heads of country offices.

Image Credits: WHO, WHO .

Major fire at Serum Institute Vaccine Complex in Pune, India

Five people have died in a major fire at the Serum Institute’s manufacturing facility, charged with producing India’s supply of the Oxford/AstraZeneca vaccine –  just days after the country’s national vaccine campaign got underway.

Serum Institute Chief Executive Adar Poonawalla was quick to say that the fire at its main complex in Pune, would not affect its delivery of some one bilion doses of vaccines in 2021.

“I would like to reassure all governments & the public that there would be no loss of COVISHIELD production due to multiple production buildings that I had kept in reserve to deal with such contingencies,” Poonawalla said. ‘COVISHIELD’ is the branded name for the AstraZeneca vaccine being produced by the Serum Institute in India. The fire would mean delays in launching new products, he added however.

Even so, the huge billows of smoke pouring out of the buildng plainly visible on social media led observers to wonder if that optimistic forecast would hold up.  Along with supplying India’s domestic market, the Serum Institute has major contracts with other low- and middle-income countries in Africa and South-East Asia, as well as with the WHO co-sponsored COVAX global procurement facility – which has promised to start rolling out vaccines to countries worldwide in the first quarter of 2021.

The fire could have been caused by an electrical fault, according to government officials. India media reported that the fire had broken out in a part of the complex that was under construction.

 

The Serum Institute is producing approximately 50 million doses of COVISHIELD a month across multiple facilities in India: a number it plans to up to 100 million.

Additionally, the manufacturer is set to produce up to 50 million doses of the US’ Novavax candidate from April, if the vaccine, now in Phase 3 trials, is approved.

India began its COVID immunization campaign over the weekend, but the rollout saw lower turnout than expected with only around 50% of people registered to be vaccinated receiving their dose. Additionally, there is a lot of hesitancy among its health workforce.

Serum Institute vaccines figure heavily in the distribution timeline for the WHO co-sponsored COVAX facility’s commitment to distriute some 2 billion vaccine doses in 2021 (Gavi, 7 January 2021).

Image Credits: Twitter via https://en.gaonconnection.com/, WHO.

A small study of 50 blood samples from people previously infected with SARS-CoV-2 found that 90% had reduced immune response to the 501Y.V2 variant and almost half did not recognise it at all.

CAPE TOWN – Scientists are concerned that antibodies that could detect SARS-CoV-2 in South Africa’s first wave will be less effective against a virus variant that first emerged here and is known as 501Y.V2.  What’s worse, they still don’t know if brand new COVID-19 vaccines will work against the variant – which is deemed to be 50% more transmissible than ones prevailing until now.

The uncertainty contrasts sharply with the more optimistic profile of vaccine efficacy against British variants that have spread widely across the world.

A small study of 50 blood samples from people previously infected with SARS-CoV-2 found that 90% had reduced immune response to the 501Y.V2 variant and almost half did not recognise it at all, South African scientists told reporters at a scientific briefing this week.

They stressed that there was no evidence yet that a vaccine would not be effective against the variant, but acknowledged that the lack of antibody sensitivity, known as ‘immune escape’, among people who had already recovered from COVID-19 in the first wave could suggest they might be vulnerable to re-infection with the new variant.

Professor Penny Moore, research chair of Virus-Dynamics at the University of the Witwatersrand and the National Institute of Communicable Diseases, conducted the research on blood samples of 50 people who had been previously infected.

While there was a concern that the new variant could drive reinfections, “the data at this point does not point in that direction” says Professor Salim Abdool Karim.

Given that vaccines are also based on triggering similar antibody responses, they might also be less effective. But while the immune escape was “concerning”, Moore stressed that the dynamics of antibodies triggered by vaccines also could be different than natural antibody response.

“What we are doing now is taking blood from those people who mounted a response to the vaccine during vaccine trials and we are testing those antibodies against the viruses,” said Moore.

“That will give us a sense of whether the new variant is less sensitive to the antibodies that various vaccines elicit. But again, there are lots of caveats, because there are many vaccines, they all behave in a different way, and they all tickle the immune system to produce antibodies in a different way.”

‘Tweaking’ Vaccines a Possibility – But World May be Constantly Dealing with More & More Variants

Moore said that while it might be possible to “tweak” existing vaccines, slightly adjusting them to deal with the new variant, a new strategy might be necessary: “There is potential to do this [tweak the design] for some of the vaccines but in the future I think we will be consistently dealing with more and more of these variants.

“So we might need to be a little bit cleverer in how we design vaccines and look for other parts of the virus that cannot change so effectively and try to design vaccines to target these.”

‘Don’t Call It South African Variant’
Salim Abdool Karim
Prof Salim Abdool Karim, co-chair of the South African Health Minister’s advisory committee

Professor Salim Abdool Karim, co-chair of the South African health minister’s advisory committee on COVID-19, who led the briefing, appealed for the variant to be called by its scientific name, 501Y.V2, and “not the South African variant” just as COVID-19 “is not called the China virus”.

Variants have been identified in many parts of the world including the UK and Brazil, all with mutations to the spike protein that binds to the human cells.

Abdool Karim reported that the 501Y.V2 variant has 23 mutations including a 20% rotation in the spike protein which enables it to bind more strongly to human cells. Mathematical modelling predicts that it is 50% more infectious than its predecessor but not more severe.

In the Western Cape province, it took 107 days for 100,000 cases to develop, whereas in the second wave, it took only 54 days. However, hospitalisations for both waves were similar, indicating that the variant was not more severe.

Reinfection and The Variant

While there was a concern that the new variant could drive reinfections, Abdool Karim said “the data at this point does not point in that direction”.

Dr Koleka Mlisana, Executive Manager of Research at the National Health Laboratory Service (NHLS), said that an analysis of over 1.1 million positive tests found that by 6 January, there had been about 4000 reinfections.

“We have not seen a marked increase in reinfections since the variant, but bear in mind, we’re only talking about a month’s data so far, so this is an area that we need to look very closely,” said Mlisana.

Although national statistics are not yet available, the latest data for KwaZulu-Natal province found that the variant was present in 59 of the 61 genome sequences analysed.

501Y.V2 Variant Raises More Concern than UK-Identified Variant

While the variant identified in the United Kingdom has received a great deal of attention for driving a big surge of infections there, across Europe and elsewhere, scientists have been even more concerned about the 501Y.V2 – which makes more significant changes in the protein structure of the characteristic coronavirus spike, which new vaccines are targeting.

Pfizer/BioNTech has already published a number of studies on the variant identified in the UK late last year, (known as B.1.1.7).  One such pre-print study claimed the antibodies in the blood of vaccinated people still recognize the variant.  However, that study has already been hammered by online reviewers saying that the study sizes are far too small (16), and Pfizer’s interpretation of the data was overly optimistic.

Some Pharma Companies Already Preparing For Next Stage Variant Vaccines

While scientists try to assess the impacts of variants on existing vaccines, some pharma companies are already gearing up for a second generation of vaccine development to address them.

One example is the startup biotech firm, Gritstone Oncology, which will begin human testing for a “backstop” vaccine in the event that mutant strains do evade the current range of vaccines, STAT has reported.

Preclinical work on the vaccine was supported by the Bill and Melinda Gates Foundation. Though no data is publicly available yet, its Phase 1 clinical trial is due to begin shortly.

The firm’s CEO Andrew Allen told the outlet that “we all hope that this will not be necessary” and that he thinks “it’s prudent to have it developed as a backstop”.

It should also be noted, however, that if a virus variant were to escape the immune response generated by existing vaccines, updating the tool would take only a matter of months.

Image Credits: National Institute of Allergy and Infectious Diseases, NIH, Twitter: @WHO.

Researchers have reported pausing many or all of their late-stage trials due to the COVID-19 pandemic. This is likely to have a knock-on effect.

The demands of fighting the COVID-19 pandemic are draining resources from global health research and development (R&D) programs and disrupting clinical trials and other work, presenting a potential post-pandemic scenario of a world more vulnerable to a host of infectious threats.

That’s what our organization, the Global Health Technologies Coalition (GHTC), learned after conducting extensive, candid conversations at the end of 2020 with global health researchers around the world from both the public and private sectors. We reached out to them to understand how the fight against COVID-19, an effort that has often relied on their expertise and innovations, may be imperiling science to reduce the burden of many other infectious pathogens. That includes malaria, tuberculosis, HIV/AIDS and a broad spectrum of neglected tropical diseases.

Their reports revealed an urgent need to bring together the global health research community and our allies—in government, industry and international institutions—to avoid lasting damage to hard-fought progress and prevent further delays in delivering new advances.

Everyone understands that right now, COVID-19 must be the focus. We spoke with many researchers who were proud to see their capabilities contributing to developing better diagnostics, vaccines and new treatments. But they also were keenly aware of the toll it was taking on any work not related to the pandemic.

Scientists, speaking confidentially in order to provide a frank assessment, talked about staffing and funding being shifted to focus on pandemic-related work—and with no clear indication on when non-COVID-19 work would resume, or if diverted funding would be restored.

Meanwhile, clinical trials—the most costly and complex aspect of developing new health interventions—have been hit especially hard by pandemic-related shutdowns. Nearly every interviewee involved in clinical trials, many of which are located in low- and middle-income countries, reported significant issues, including trials being delayed indefinitely. The biggest disruptions have involved phase 3 trials. That’s understandable, as these trials are logistically complex and typically require managing thousands of participants. But reaching Phase 3 means a project is tantalizingly close to delivering a new breakthrough, which makes interruptions at this stage particularly devastating.

Researchers reported pausing many or all of their late-stage trials. One clinical trial administrator reported that where a trial was already underway, numerous trial participants were not showing up for essential follow-up visits at the clinic due to fears of contracting COVID-19. Virtual follow-ups were proving challenging in many cases, in part due to infrastructure barriers in low-resource settings—such as the need for many people to regularly purchase new SIM cards for their phones, which changes their phone number. Virtual visits are also not an option for trials that require in-person follow-up to collect samples.

Outside of clinical trial disruptions, scientists noted a number of discrete challenges. For example, there were reports of work stymied because laboratory reagents or personal protective equipment (PPE) were needed for pandemic response. Operational expenses have increased significantly for many projects, due to issues like higher shipping costs and additional resources needed for safety.

The cumulative effect of so many obstacles is presenting staggering challenges for global health researchers. But there is a way to recover from these setbacks—and avoid a situation where we emerge from the battle against one deadly disease less prepared to fight off many others.

First, we must work with our partners in the public and private sector to ensure scientists are given the resources and flexibility to recover from their pandemic-related problems and restart their work. Second, we must emphasize that decades of investments in global health R&D generated new insights and alliances that have played a big role in speeding the development of COVID-19 interventions. The fast pace of that work, especially around vaccines, demonstrates that, with greater funding, the field is poised to produce rapid progress in fighting many other infectious diseases.

In fact, we did hear a measure of optimism among some of the researchers we interviewed that the harsh experience of the pandemic—and the fact that scientists are leading the effort to end it— could create a new era in which investments in global health R&D become an enduring political priority.

But another scenario is one in which disruptions caused by the pandemic are compounded by long-term funding problems. Global health R&D funding always has been a hard sell and the economic impact of the pandemic is likely to constrain spending in both the public and private sector for years to come. It will require a concerted effort by our community to ensure global health R&D quickly regains lost ground and, equally important, that we can capitalize on opportunities revealed by pandemic-related advances to accelerate work on a number of diseases.

Jamie Bay Nishi is director of the Global Health Technologies Coalition (GHTC), a coalition of 30 nonprofit organizations, academic institutions, and aligned businesses advancing policies to accelerate the creation of new drugs, vaccines, diagnostics, and other tools that bring healthy lives within reach for all people. For more on this topic, read the GHTC’s full synthesis of the interviews: Pain Points and Potential: How COVID-19 is Reshaping Global Health R&D.

Image Credits: Dato Koridze /STUDIO for TB Alliance.

Dr Anthony Fauci, Chief Medical Advisor to new US President Joe Biden addresses the WHO Executive Board Thursday, 21 January, the morning after Biden’s inauguration..

In a brief, but historic speech Thursday morning before WHO’s Executive Board, President Joe Biden’s Chief Medical Advisor, Dr Anthony Fauci, reversed course on four years erratic and often hostile approaches to the World Health Organization and global health – which had alienated and bewildered friends and allies worldwide. . 

As one of the first acts of the new president, inaugurated only yesterday, the United States was rejoining the WHO and joining the global COVAX facility and Act Accelerator, WHO’s platforms for ensuring global access to medicines and vaccines, Fauuci announced. The United States will also cease its “drawdown” of seconded US personnel and honor outstanding financial commitments, which the previous administration had failed to pay. 

“The Biden administration also intends to be fully engaged in advancing global health, supporting global health security, and the global health security agenda and building a healthier future for all people,” Fauci told the EB’s Thursday morning seession. 

“The United States will work with the WHO and member states to counter the erosion of major gains in global health, that we have achieved through decades of research collaboration and investments in health and health security including in HIV AIDS. Food Security malaria and epidemic preparedness,” said Fauci, citing the longstanding involvement of the US in the WHO from its foundational days in 1948.  

Fauci’s announcement also carried a personal flair, describing his own longtime involvement with WHO and addressing WHO Director General Dr Tedros Adhanom Ghebreyesus as “my dear friend”:

 “I also know firsthand the work of WHO, with whom I am engaged in a collaborative manner. Touching all aspects of global health. Over the past four decades. And as such, I am honored to announce that the United States will remain a member of the World Health Organization,” Fauci said. 

“Yesterday, President Biden signed letters retracting, the previous administration’s announcement to withdraw from the organization. And those letters have been transmitted to the Secretary General of the United Nations, and to you. Dr. Tedros, my dear friend. also reflected the close working relationships he has maintained over the years with WHO.”

New Policy for Reproductive Health Rights 

Notably, Fauci also said the new Biden Administration, politically bolstered by a Democratic-controlled Congress, would revoke the 1980-s era “Mexico City Policy”, despised by gender and reproductive health rights advocates around the world.  The 1984 policy of the Reagan-era, which Donald Trump had reinstated and expanded, banned US aid to any foreign NGOS that might be seen as providing any form of abortion assistance.  

During the Trump period, the United States abstained from, or opposed, countless WHO and UN resolutions that even indirectly referred to women’s “reproductive health rights” – including a clause in a milestone COVID-19 pandemic response resolution, adopted by the World Health Assesmbly in May.  

“It will be our policy to support women’s and girls, sexual and reproductive health and reproductive rights in the United States, as well as globally,” Fauci declared.  

From Trump Administrations’ Bitter Attacks to Thanks 

Fauci’s remarks were also noteworthy for their dramatic U-Turn  in tone from the harsh Trump Administration attacks on WHO seen over the spring and summer, 

Rather, Fauci praised the Organization, saying, “I joined my fellow representatives in thanking the World Health Organization for its role in leading the global public health response to this pandemic under trying circumstances. 

“This organization has rallied the scientific and research and development community to accelerate vaccines therapies and diagnostics, conducted regular, streamed press briefings that authoritatively track, global developments, providing millions of vital supplies from lab reagents to protective gear to healthcare workers in dozens of countries, and relentlessly worked with nations in their fight against COVID-19.”

But Fauci also said that the US was committed to WHO reform as well as getting to the truth behind the pandemic’s viral sources, saying, “we are committed to transparency, including those events surrounding the early days of the pandemic. It is imperative that we learn and build upon important lessons about how future events can be averted. 

“The international investigation must be robust and clear. And we look forward to evaluating it.” 

A stronger system of global health pandemic alert and preparedness will be another US priority, Fauci said, saying that the US would work “to strengthen and reform the WHO and improve mechanisms responding to health emergencies, build health security and expand pandemic preparedness: 

“”We will seek an improved shared system for early warning and rapid response to emerging biological threats. We will support it scientifically robust and ethically sound collaborative science research and research capacity building, as well  as the rapid pace of research results pathogen samples and data are essential to research progress.”” 

WHO Executive Board Members Welcome US Statements
Martin Essono Ndoutoumou, Ministry of Health delegate to the EB, Gabon, welcomes the US statement on behalf of the Africa group of states

Fauci’s comments were welcomed by traditional US allies in the WHO wall-to-wall, including the United Kingdom, The European Union, Norway, Finland and Israel; and in the Western Pacific, Australia, Japan, and New Zealand.

Germany called it “a great day for multilateralism and for WHO.” 

Added Austria’s EB delegate, Clements Auer. “This is good news for all of us who regard multilaterlisim as an indispensible strength and not a weakness in our work.”

The African bloc, Pacific small island states, and Latin American countries such as Argentina, Chile and Brazil, also issued positive statements. 

“We’ve heard on a number of occasions that the only way of overcoming this and other international health emergencies. In the future, is by pooling our efforts,” said Chile. “We’ve underscored the fundamental leadership role of the WHO. And so the renewed commitment of the United States of this organization is important. They’ve also renewed their commitment to multilateralism.

Russia was loudly silent. But China sounded a cautiously positive note.  

“China has noted the statement made by the US. China reiterates that we firmly advocate multilateralism and we wisupport the WHO to truly play aa scientificy, fair and professional guidance frole in global public heatlh. China welcomes any work that contributes to global solidarity to fight the virus,” said China’s EB delegate.  

This is despite the increased level of anti-US rhetoric coming from Beijing.  That rhetoric has pushed conspiracy theories that regard the new mRNA vaccines developed by European and North American pharma companies such as Pfizer and Moderna as dangerous to older people and part of a US military plot.

China has also launched a propaganda campaign that aims to  muddy the waters around the origins of the SARS-CoV-2 virus, just as a WHO-led independent research team visits Wuhan to search for the elusive trail of how the virus, from a family of coronaviruses that circulates among bats in southwestern China, first infected humans in the city of 10 million.  But official Chinese media and spokespeople are now saying that researchers should look in Southeast Asia or Europe – and one China Foreign Ministry spokeswoman speaking a recent media briefing pointed the finger at a US army base.

“My Friend -“My Brother” – Tedros and Fauci Exchange Warm Words
Dr Tedros Adhanom Ghebreyesus, WHO Director General, welcoming Fauci and the United States back into the WHO “family”.

Against that background, US moves to not only rejoin WHO but also play an active leadership role the global health scene – without provoking uneecessary hostility and tension as the Trump Administration was prone to doing, will certainly be welcomed by WHO. And the enthusiastic WHO response was plainly evident in the reception Fauci received on Thursday. 

Calling Fauci “my brother,” the Director General said, “This is a good day for WHO and a good day for Global Health.”

He hearkened back to the historically strong role the United States has played in the global organization. 

“The United States, its global role is very very crucial. …. we must work together as one family, to ensure vaccination of health workers and either high risk group is underway in all countries within the first 100 days of 2021 with your commitment. We’re one step closer. 

“Since WHO’s founding in 1948. The United States has played a vital role in global health, and the American people have made enormous contributions to the health of the world’s people. We look forward to continuing this partnership. As I know all member states, do we have a lot of work to do.”

US Move to Rejoin WHO Will Help Expedite Global Vaccine Rollout  – WHO’s Regional Director For Africa

The fact that the United States has now committed to join the global vaccine facility, COVAX, which aims to roll out vaccine doses to countries worldwide, is “extremely significant”, Dr Matshidiso Moeti, WHO Regional Director for Africa told Health Policy Watch this afternoon.

“For WHO and for global health, I would say this is indeed a very important and very significant development,” Dr Moeti said, adding, “The US has been one of the biggest partners supporting some major health development actions in Africa – and if we are working with them as the member state of WHO, I believe it facilitates even this bilateral support.”

The honeymoon between WHO staff – and their US counterparts in the incoming Biden administration – was also plainly evident in the back and forth banter on the Twitter channels, in the hours following the Fauci speech.

“Effective leadership is the ultimate ‘vaccine’ against coronavirus,” tweeted WHO special advisor Peter Singer, a Canadian, in a post that featured emojis of the US and UN side by side with hands grasped in thanks.

Replied Colin McIff, Biden’s new Deputy Director of Global Affairs at the Department of Health and Human Services: “Amen brother, we are so much stronger together!”

– Paul Adepoju in Ibadan, Nigeria, contributed to this story

Image Credits: WHO.

Drop-in testing COVID-19 clinic in the ultra-orthodox Jewish city of Bnei Brak; Defiant ultra-Orthodox communities resisting lockdown restrictions are  driving a virus surge that is confounding a successful vaccine campaign.

JERUSALEM – As the countries around the globe watch Israel’s massive COVID-19 vaccine rollout to see if it can really beat back the virus, once soaring hopes that vaccines, on their own, could offer an easy way out of the pandemic are now coming back down to ground.

On the positive side, the vaccine itself appears to be about as effective as reported in clinical trials.  And yet at the same time, new COVID-19 cases reached yet another record of 10,000 new infections daily this week in Israel – which now has the dubious honor of boasting one of the highest infection rates per capita in the world. The infection surge led to a government decision on Tuesday to extend a lockdown in effect until 1 February. 

The virus is running rampant, despite the fact that nearly one quarter of the Israeli population have now received at least one dose of the vaccine – and health officials are trying to figure out why. Some have blamed it on the fact that most peole have only been administered one dose so far, others have attributed it to the rampant violations of social distancing rules among the ultra-Orthodox Jewish community.  Another factor is likely the many Israelis who returned from abroad over the past month, passing unchecked, through the airport – with the virus. 

The lesson to other countries, however, which is emerging, appears clear.  Vaccines are important tools – but they will not curb the pandemic on their own, at this stage. In fact, they have to remain part of a broader strategy that includes the so-called “non-pharmaceutical measures” like masking and social distancing.

Efficacy of First Dose Now Under Debate

Initial analyses of some 460,000 Israelis vaccinated have suggested that the first dose was providing roughly 50-60% protection – but only after two weeks.  Still, health officials yesterday were suggesting the protective quality of the first dose may be less than previously believed- although they didn’t offer concrete data to back that up. 

“Many people have been infected between the first and second injections of the vaccine,” Nachman Asch told Israel’s Army Radio station, adding that the first dose seemed to be  “less effective than we thought” and “lower than [the data] presented by Pfizer.”

Israel has the higest vaccination rate in the world, by far – but it also has one of the highest rates of daily infections .
More than 80% of Israelis Over Age 70 Received One Dose 

As of Wednesday, a total of 2.3 million out of 9 million Israelis had received the first dose of the vaccine to date. And nearly half a million people had received both doses, according to Israel’s Health Ministry. More than 80 percent of Israelis over 70 have received at least one dose of the vaccine, along with 68 percent of those aged 60 to 69, and 50 percent of those aged 50 to 59. 

Among those fully-immunized, efficacy appears to be reassuringly high – in the 95% range as per Pfizer’s clinical trial results. In one study of 1,000 health workers by Tel Aviv’s Sheba hospital, a group heavily exposed to the SARS-COV-2 virus,  protection was as high as 98% after the second dose. 

Confidence in the vaccine’s safety record has also been such that Israel’s Ministry of Health on Wednesday began recommending that pregnant women at risk of COVID-19 exposure be immunized – even though Pfizer’s clinical trials didn’t include pregnant women at all. 

The decision was defended in light of the fact that numbers of COVID- positive pregnant women being hospitalized in critical condition has doubled from December to January. 

The trend of more serious cases in pregnancy, however, is only a small part of a larger picture that has seen Israel’s rate of new SARS-COV-2 infections rise to become one of the highest per capita in the world. 

Per capita, Israel rates of new cases are now second in the world, only to Spain, and higher than the United States and United Kingdom, which was the first to report the appearance of a new, and more infectious coronavirus variant.
Vaccine Supply Chain Oiled By Novel Data-Sharing Agreement With Pfizer 

The  infection rate has been rising – despite the stunning achievement of Israel’s national health system, in which its four public health maintenance organizations, managed to get first vaccine doses into the arms of nearly one quarter of the population in just one month. 

The impressive vaccine campaign has been facilitated by large and frequent supplies of vaccines from Pfizer – in exchange for an Israeli commitment to share data about safety and efficacy – as some 60% of the population, or 5.2 million people, are vaccinated by the end of March. 

Israeli officials were quick to underline that the agreement with Pfizer, published this week in a redacted form, commits only to providing Pfizer with data disaggregated by age, gender and ethnic identity – but safeguarding individuals’ private medical information.   

Among most Israelis, keen to get vaccinated and see life return to normal, the milestone understanding was met with only mild interest.  In any case, digitized records of every Israeli’s medical history are maintained by the four national health funds that provide universal health coverage.  And that data is constantly being scrutinized by teams of local researchers, looking at trends and risks. 

But the accord, handled by the Prime Minister’s office without any invovlvement of Ministry of Health professionals, was not without criticism in some quarters. Professor Eyan Friedman, chairman of Israel’s Helsinki Committee,the statutory body that reviews proposals on human medical trials, initially protested that the agreement should have been submitted first to the Helsinki Committee.  In a follow-up statement, he hastened to add that he supported the vaccine campaign. 

“It is vital to make clear that we support the Covid-19 vaccination effort, only that we ask that the rights of Israeli citizens are protected under the deal struck between Israel and U.S drugmaker Pfizer,” said Friedman, in an interview with an Israeli biotech magazine. 

Variants & Defiance Of Lockdown Restrictions Now Driving Virus Surge 
Waiting after vaccination at Tel Aviv’s mobile vaccine station operating in a large city partk.

Such debates have also been perceived as largely academic in light of the way that the virus, and its new variants, have been rampaging through unvaccinated groups with ever greater speed and ferocity.  

While the common wisdom held that once older, more vulnerable people were largely vaccinated, serious cases would decline because younger people don’t become as sick, Israeli hospitals have remain packed. Intensive care units are treating nearly 1,200 critical cases, well above a “red line” of 800 set by the government months ago.  But as cases rises so steeply in absolute terms, the virus is still managing to surcharge the hospitals,hitting more and more younger people, as well as pockets of older people who haven’t been reached by vaccines. 

International Travel as a Virus Vector 

It has been estimated that some 25-30% of cases in Israel may also now be due to new COVID-19 variants, imported by wanderlust Israelis returning from abroad. Israelis traveled to and returned from the United Kingdom, Europe, the United States and Latin America – around the fall and winter holiday seasons.

And in a brief interlude, after the establishment of diplomatic relations, when travel was permitted between Tel Aviv and Dubai, Israelis on weekend trips where they shed social distancing inhbitions altogether, returning with still more COVID-19 infections, including the 501Y.V2 varian, first identified in South Africa. The only requirement for returnees was a declaration of quarantine – which many people violated. Only yesterday, did the government finally decide to require anyone entering the country to present the results of a negative COVID-19 test before boarding a flight – following on from new US Centers for Disease Control guidance.

Ultra Orthodox Jewish Groups Defiant In Mass Gatherings & Crowded Schools

But it is not travel or variants alone, that are responsible for the coroavirus surge.  Health officials also are pointing the finger at the small, but significant sectors of the ultra-Orthodox Jewish public that have resisted social distancing and lockdown orders. Although the ultra-Orthodox only comprise about 10% of the population, they now represent some 30% of new COVID cases – three times their weight in numbers. Positive COVID test rates in some ultra-Orthodox communities are running at 20-30% – well above that in the rest of the population. 

The more extreme sects have confronted police in violent demonstrations and battles over COVID-related restrictions on in-person schooling and mass gatherings for prayers, weddings and other ritual events. Social media posts by indignant secular Israelis have documented the crowding that accompanied likely superspreader events, such as a recent wedding in the ultra-Orthodox city of Bnai Brak, attended by hundreds of people. 

Police enforcement in the ultra-Orthodox communities has, meanwhile, been restrained by political considerations – which are in turn driven by a government coalition where ultra-Orthodox parties hold inordinate sway over Prime Minister Benjamin Netanyahu. And Netanyahu is more dependent than ever on the good will of his ultra-Orthodox political allies  – as he stands once more for parliamentary elections to be held in March, following the collapse of a unity government coalition.  

Serious COVID cases are also higher among Israel’s Arab citizens – who make up about 20% of Israel’s population – but for different reasons. Higher overall levels of chronic diseases among older people leave them more vulnerable to serious COVID disease, officials explain. And vaccination rates have been lower than average – due to partly to greater vaccine hesitancy and partly to initial shortcomings in initial outreach – which health funds and Arab political leaders are scrambling to address. 

No Vaccines So Far – But Palestinians Infection Rates Remain Lower  
Infection trends in West Bank and Gaza show lower rates of new infections than in Israel and decline in new cases since mid-December

Paradoxically, rates of new infections in the Occupied Palestinian Territories of the West Bank and Gaza are far lower than those in Israel, and at least according to the official data, on the decline – despite the fact that the Palestinian Authority has yet to get access to any COVID vaccines. 

On Tuesday, 19 January, there were only 538 newly reported new cases among the roughly 5 million West Bank and Gazan Palestinians, according to the latest WHO data. 

That’s roughly one-tenth of the levels of new infections being reported daily in Israel, which has about 9.3 million residents.  The Palestinian Authority, which has limited health and intensive care facilities to care for COVID patients, in comparison to Israel, has placed the West Bank under periodic, strict COVID restrictions of its own, as has the Hamas government in the Gaza Strip.  

The close proximity of Palestinians – whose borders are tightly controlled by Israel, health services are less well equipped, and vaccines unavailable – to higher-income Israelis, where vaccination is in full swing but so are infections from both imported variants and local transmission,  illustrates yet again the complex dynamics driving transmission in other more and less affluent parts of the world. 

After peaking in early December, rates of new COVID-19 infections in the Occupied Palestinian Territories have gradually declined
Initial Palestinian Shipments of Russia’s Sputnik Vaccine Due to Arrive This Week

The Palestinian Authority is naturally keen to begin immunizing health workers and people at risk – both to ward off a surge like those being seen in Israel and to relax COVID social restrictions; the PA was thus due to receive this week its first dispatch of Russian-manufactured Sputnik vaccine doses, UN sources in Jerusalem confirmed to Health Policy Watch. 

That first symbolic shipment of 5,000 doses had initially been due arrive on Tuesday, after senior Palestinian Authority official Hussein al-Sheikh visited Russia last weekend, meeting with Russian Foreign Minister Sergei Lavrov and signing contracts for the purchase of the 4 million doses procured by the Palestinian Authority. But a technical glitch delayed transport at the last minute.  

 PA Ambassador to Russia, Abdel Hafiz Nofal told the Palestinian Ma’an News Agency that he expects the problem to be resolved by Friday.  A larger shipment of some 100,000 doses is also expected to be delivered in the next two weeks. 

Israel Says It Will Facilitate Delivery – But Not Responsible For Palestinian Health Services  

Israel has said it will facilitate the delivery of the Russian vaccine orders to the PA – but that health services for Palestinians are the PA’s responsiblity, in line with interim peace agreements signed in the 1990s.  

“According to the Oslo Accords and the Paris Agreement, the Palestinian Authority is solely responsible for health regarding the residents of the PA.  In fact, the Interim Agreements of 1995 explicitly mention the PA’s responsibility regarding vaccinations,” stated an Israeli spokesperson in Geneva.

Human rights advocates have said it’s not quite that simple. Those accords were meant to be interim arrangements, but Israel still controls all of the Palestinian borders – as well as occupying large chunks of the West Bank bank outright.  As an occupying power, it still holds ultimate responsibility for Palestinian health – particularly in a pandemic.  And the Oslo Accords, also call upon both sides to cooperate. 

“It is of course in Israel’s interest that the Palestinian population be vaccinated, and we will do all that we can to facilitate the transfer of vaccines the PA will obtain, either from COVAX or from bilateral agreements reached with pharmaceutical companies (a first shipment from Sputnik V vaccines should arrive today),” said Israel’s Geneva Mission spokesperson, responding to a query from Health Policy Watch. “Note as well that Israel is vaccinating thousands of Palestinians workers who enter Israel every day, especially those working in the health and education systems,” the spokesperson added. 

The Palestnian Authority is also hoping to receive more vaccine doses via the WHO co-sponsored COVAX facility, in the first quarter of 2021. 

Israel is also a member – but after ordering more than enough doses on the private market – its shares in COVAX, may be redirected, the Israeli Mission source said. 

“Israel has been one of the first States to join COVAX, because we indeed believe in the importance of equitable access to vaccines. Note that COVAX, which has not been joined by all WHO Members, does not prevent bilateral agreements to be reached with pharmaceutical companies. Moreover, all doses Israel won’t need from COVAX will be available to other populations.

“Israel supports international solidarity efforts against COVID, and especially the Facility. We hope it will promptly deliver doses, including to the Palestinian people.”

In the pandemic petri dish that this small slice of the world represents, the policies and politics around COVAX distribution will certainly be watched closely by everyone as well.

Image Credits: Israel Ministry of Health, Our World in Data, Our World In Data , World Health Organization, Eastern Mediterranean Regional Office .

WHO’s Executive Board meeting in 2017, which was face-to-face

Almost twenty years after a landmark WHO treaty was adopted to curb tobacco consumption, a new “pandemic treaty” could become a key tool to garner stronger political commitment from member states to better prevent, prepare and respond to infectious disease outbreaks, WHO’s Director General said on Wednesday.. 

The recommendation, initially proposed by the European Council’s president Charles Michel, was among a handful of reforms floated at this week’s meeting of WHO’s Executive Board, ranging from more sustainable financing mechanisms to a new Swiss “Biohub” repository to share new samples of infectious pathogens as they evolve. 

“I think a Pandemic Treaty is the best thing that we can do that can bring the political commitment of member states.”  Dr. Tedros Adhanom Ghebreyesus, the Organization’s director-general, told member states on Wednesday at the Executive Board’s meeting. 

“Of course, it will be up to the member states to deliberate on this and decide, but from the WHO  side, we believe that this is a very, very good idea. It will give the IHR [International Health Regulations] the political dimension.”

Ever since the pandemic began, Member States have continued to flout the WHO’s recommendations – mainly because they lack the incentives to do so under the current International Health Regulations (IHRs), noted the WHO’s former legal counsel Gian Luca Burci last April at the outset of the pandemic. 

But if member states quickly set up a working group to push the treaty forward, they could present a draft resolution at the next World Health Assembly this May and thus prop up the  Organization at an urgent time, said Dr Tedros.

He warned, however, that without the “full cooperation” of member states, “good ideas can’t happen”.

“At the end of the day, it’s your treaty, and you have to deliver it in a working group to decide on how to handle it.”

Swiss-Based Biohub To Share Samples of Infectious Pathogens 

Meanwhile, Dr. Tedros called on countries to share samples of new and threatening pathogens through the new Swiss-based “biohub” in a voluntary initiative that seems more timely than ever, given the emergence of new variants with potential to undermine the performance of diagnostic tests or even vaccines.

“Sharing of genetic material has been very contentious and very difficult,” said Dr. Tedros, referring to previous attempts to share pathogen samples through the Nagoya Protocol. “I call on all member states to really join this voluntary system, because it can help us in the emergency preparedness and response.”

Three countries have already signed up to share SARS-CoV-2 samples through the Swiss-based Biohub, including Italy, South Africa, and Thailand, Dr. Tedros said earlier this week. 

If an initial Biohub pilot bears fruits in upcoming weeks, WHO will scale it up, added WHO’s director of the Global Infectious Hazard Preparedness department Sylvie Briand, noting that the Organization is still exploring where the samples will be stored. 

It is still unclear, however, what benefits member states will reap through the Biohub, and to what extent they will be able to access the available data, though a “parallel discussion” with member states will help clarify these concerns, with more details at the next WHA in May, she added.  

Concise WHO Guidance on Non-Pharma Measures  

As policymakers come to realize that herd immunity from vaccines will take a long time to develop, countries need to have a better understanding of how and when to implement  “non-pharmaceutical interventions” like physical distancing, mask wearing or lockdowns, said  Norway’s delegate at the EB.

“We suggest that WHO be mandated to develop a programme for generating knowledge on non pharmaceutical interventions, and how they can be effectively applied,” she said. “We welcome…this solution to strengthen WHO’s work in health emergencies.”

Her comment comes just a day after a study found that a 10% increase in mask-wearing tripled a community’s capacity to keep the virus reproductive rate (R-value) below 1, an important indicator that transmission is slowing. The study, which was published in The Lancet, was based on online self-reports from almost 400,000 Americans aged thirteen years and older. 

“If we don’t understand how those tools work, or when they’re not working, then the tool becomes potentially a banana skin for us in terms of our relationships with our community,” agreed WHO’s head of emergencies Mike Ryan, in response. 

“We do need to work to understand how to implement, how to measure them, how to monitor them, they’re important tools.”

Member States Ask WHO To Explore Modalilties Of “Vaccine Passports” – WHO Offers No Response  

 Multiple delegates have also asked WHO to provide further guidance and clarification about the implementation of COVID-19 “vaccine passports”.  The rules around the implementation of such passports have become a flashpoint of discussion in the travel industry and also in many countries with vaccine campaigns now underway – with some voices saying that a vaccine accreditation would be useful in reopening the gates of international travel – while others saying that they would be discriminatory. 

In a statement last week, WHO’s COVID Emergency Committee said that a discussion on vaccine passports would be premature – since vaccine programmes have only just now gotten underway. 

On Wednesday, however, Canada’s delegate said that WHO should play more of a leading role in the vaccine passport debate, saying that “proof of vaccination for international travel will be important. And we look forward to WHO for leadership in this issue.“

Singapore also raised the issue on Tuesday, saying, “while we are still learning about whether the vaccines provide sterilizing immunity, and the duration of vaccine induced immunity, one of the key IHR challenges in the context of COVID-19 would be the global need to verify the vaccination status of travelers.

“In this regard, an international authentication mechanism may be useful to aid the resumption of global trade and travel,” added the delegate, Janil Puthucheary, senior minister of state in  Singapore’s Ministry of Health. 

WHO leadership at the meeting have so far not responded to member state remarks about the vaccine passport issue, and overall, a mechanism for an internationally recognized COVID vaccine certification so far appears to be one that WHO is reluctant to take up – in line with the Organization’s historic reluctance to support or provide guidance on COVID-related travel restrictions:  

“The introduction of requirements for vaccine passports is not just difficult,” warned PAHO’s incident manager Sylvain Aldighieri in a press briefing earlier this month. 

“It would show a false sense of security and, ultimately, it would have the potential to trigger the relaxation and adherence to personal protective measures, social distancing measures, with possibly dramatic consequences on the dynamic of the transmission of the virus, as well as widening the inequities.”

Image Credits: WHO, WHO.

President Joe Biden and FIrst Lady Jill Biden descend the Capitol steps to the Inauguration ceremony.

Right after the pomp and ceremony of the heavily guarded inauguration of new US President Joe Biden and Vice-President Kamala Harris is over, a deadly serious new war on COVID-19 is due to get underway –  including rejoining the World Health Organization (WHO) as part of the new Administration’s seven point COVID pandemic plan. 

That agenda will also include buying into the WHO co-sponsored COVAX facility for fair global vaccine distribution – a move that is sure to be a welcome shot in the arm of the initiative that has not quite yet gotten off the ground – despite WHO assertions that it is ready to deploy some 2 billion vaccines this year to countries worldwide. 

Thursday’s WHO Executive Board will be the stage for the first scene of the US-WHO reconciliation, featuring an appearance by White House Covid Task Force head, Anthony Fauci, as head of the US delegation to WHO. 

“Dr. Fauci will be the head of the US delegation at the WHO Executive Board and will deliver the remarks,” a spokesperson for the US Mission in Geneva told Health Policy Watch on Wednesday. “I understand that Fauci will be speaking tomorrow at the EB.”

“The combination of rejoining, taking part in COVAX and looking at how we can help make sure the vaccine is equitably distributed is something we’re going to take on,” Biden-designate Secretary of State Anthony Blinken also told the Senate Foreign Relations Committee during his confirmation hearing on Tuesday.

WHO’s Dr Tedros Adhanom Ghebreyesus was quick to congratulate the new US Administration, just after the Inauguration, in a tweet that reflected the barely-disguised WHO glee over the new US team: Congratulations President @JoeBiden and Vice-President @KamalaHarris on your inauguration. Here’s to a healthier, fairer, safer, more sustainable world.”

The plan to “immediately restore our relationship with the World Health Organization” is only one element in the larger US effort to “rebuild and expand defenses to predict, prevent and mitigate pandemic threats, including those coming from China” according to the seven point COVID plan, released by the Biden Administration on Wednesday morning.  

Not Perfect, But… 
President Joe Biden signs his first presidential proclamation noting his cabinet appointments – team all masked.

The relationship with WHO “while not perfect — is essential to coordinating a global response during a pandemic,” the plan states.

Other key points on the diplomatic front include plans to rebuild or expand several White House pandemic alert and tracking initiatives that were gutted, ignored or abandoned by the former administration of Donald Trump. These include plans to:

  • Immediately restore the White House National Security Council Directorate for Global Health Security and Biodefense, originally established by the Obama-Biden administration.
  • Re-launch and strengthen U.S. Agency for International Development’s pathogen-tracking program called PREDICT.
  • Expand the number of CDC’s deployed disease detectives so we have eyes and ears on the ground, including rebuilding the office in Beijing.

During the first year of the pandemic, critics decried Trump’s moves that had in fact dismantled important research collaborations with Chinese or other non-governmental groups and institutes into issues such as wild coronavirus variants, which had provided the United States with valuable insights into pathogen trends and risks regionally and globally.

Whether or not US technical experts would be welcomed back into China again in the highly charged atmosphere that has emerged during the course of the pandemic’s evolution is another matter, however – in light of the months that it took to arrange just one visit by a WHO-sponsored team of experts researching the SARS-CoV2 virus origins – which only just landed in Wuhan on 14 January. 

Free Covid Testing & Mask Mandates & Equitable Distribution of Treatments And Vaccines 
Almost 10 million Americans are infected with COVID-19 and 400,000 have died

Other features of the seven-point plan focus mostly on the domestic US COVID threat – which has now claimed the lives of some 400,000 people. Infection rates remain among the highest in the world; mortality rates are higher than those in India, and the vaccine rollout has been plagued by a lack of infrastructures to actually administer the jabs.

The Biden-Harris COVID initiatives would include efforts to double drive-through testing sites and provide free COVID-19 testing. 

In addition, the Administration plans to invest US $25 billion in a vaccine manufacturing and distribution plan that will “guarantee it gets to every American, cost-free,” says the statement, the first to be issued by the new administration under the official rubric: whitehouse.gov 

While Trump and his associates even bragged about the privileged care that they received when struck down with COVID, the Biden plan strikes a distinctly different tone, pledging to ensure that: “everyone — not just the wealthy and well-connected — in America receives the protection and care they deserve, and consumers are not price gouged as new drugs and therapies come to market.”

But the plan also calls for much stricter rules about masking and other non-pharmaceutical measures, saying that the new Administration will implement a national “mask mandates” nationwide. 

The statement is another U-Turn on Republican White House administration policies which were ambivalent about masking at national level – fostering a polarized public debate about masking, which came to be seen as a political, rather than public health, symbol.   

Even so, the new administration has stepped back from a campaign promise to make masking mandatory at the national level – insofar as it lacks the authority to do so without more polarizing legislation. 

And instead, the new Biden plan calls upon average Americans, Governors and local authorities to make wearing masks in public mandatory in their states.  

The White House is also expected to mandate masks in federal buildings and for interstate travel, e.g. airports and air travel routes – where it has direct control. 

Fix PPE Problems For Good 

The Administration will use the Defense Production Act to ramp up production of masks, face shields, and other PPE “so that the national supply of personal protective equipment exceeds demand and our stores and stockpiles — especially in hard-hit areas that serve disproportionately vulnerable populations — are fully replenished.”

The fact sheet notes that this would also build up a “flexible American-sourced and manufactured capability to ensure we are not dependent on other countries in a crisis.”

Protect Older Americans and Others at High Risk 

Health equity – words never used in the Trump administration, will also figure prominently in the Administration’s approach to the pandemic, with the creation of a new “COVID-19 Racial and Ethnic Disparities Task Force” that had previously been proposed by Vice President Harris. 

The Task Force would “provide recommendations and oversight on disparities in the public health and economic response. At the end of this health crisis, it will transition to a permanent Infectious Disease Racial Disparities Task Force.”

The Administration will also foster the creation of an online dashboard providing real time information about infection rates by zip code – a measure enacted by many countries months ago. 

“This information is critical to helping all individuals, but especially older Americans and others at high risk, understand what level of precaution to take.”

Clear and Consistent Evidence-Based Guidance 

Finally the “Build back Better” Fact Sheet emphasizes that it will provide science-based guidance to communities and the public about social distancing and other non-pharmaceutical measures that can help control COVID – along with emergency support to schools, state and local governments, and a “restart package” for small businesses that can help create a stronger social and economic safety nets, and win public support for such measures, when mandated. 

“Social distancing is not a light switch. It is a dial,” states the fact sheet. “President Biden will direct the CDC to provide specific evidence-based guidance for how to turn the dial up or down relative to the level of risk and degree of viral spread in a community, including when to open or close certain businesses, bars, restaurants, and other spaces; when to open or close schools, and what steps they need to take to make classrooms and facilities safe; appropriate restrictions on size of gatherings; when to issue stay-at-home restrictions.”

Image Credits: Worldometers.

Helen Clark, former Prime Minister of New Zealand and co-chair of the Independent Panel review of the COVID-19 pandemic response

The World Health Organization’s (WHO) response to COVID-19 was too slow, hampered by an antiquated pandemic alert system, lack of resources and a lack of authority with member states, according to an interim report by the Independent Panel on Pandemic Preparedness and Response, presented to the WHO’s Executive Board meeting on Tuesday.

It took the WHO an entire month from the time an alarm was sounded in Wuhan to declare a public health emergency. And it’s alert and response system “seems to come from an earlier analogue era and needs to be brought into the digital age,” panel co-chair Helen Clark, the former Prime Minister of New Zealand told a media briefing. She added: “Modern information systems pick up signals of potential diseases by sifting through hundreds of thousands of data points daily, outpacing formal country reporting and outpacing the procedures and protocols of the International Health Regulations.”

But the human deliberations of WHO also slowed down responses. Although the WHO Emergency Committee was convened on 22 January 2020, WHO only declared a “public health emergency of international concern” on 30 January, and first used the word “pandemic” on 11 March.

“Even when WHO declared a Public Health Emergency of International Concern on 30 January – the loudest alarm possible under the International Health Regulations – many countries took minimal action to prevent the spread internally and internationally,” Clark said in the briefing. 

The brand-new report, mandated by the World Health Assembly in May, when the world was reeling from the initial impacts of the pandemic – was presented at the EB during a second day of the exhaustive EB review of the COVID-19 pandemic. EB members also heard a report from yet another review committee, examining the International Health Regulations framework that governs countries’ obligations to monitor, report and respond to emergencies, which found compliance wanting, due partly to a “lack of teeth” in the IHR’s legal enforcement mechanisms.   

“The absence of a dedicated national entity with sufficient authority and a clear mandate to take ownership and leadership is considered a significant limitation to effective implementation of the IHR at national and subnational levels,” said Professor Lothar Wieler, President of the Robert Koch Institute in Berlin, in a statement.

“The IHR are your instrument, our instrument, of international public health law. Making them work requires giving WHO the tools and the resources it needs to better prepare and protect humanity against public health risks, through an effective, coordinated, multisectoral and evidence-based public health response,” said Wieler, speaking to WHO member states.

Lessons about the past are more relevant than ever today, Clark stressed. Since 1 January, the world is recording almost 12,500 daily deaths and 682,000 new cases, and countries need to urgently implement “basic measures like testing, contact tracing, isolation, physical distancing, and wearing masks,” which are even more pressing as new and reportedly more infectious variants of SARS-CoV2 are detected.

Not Laying Blame on WHO – But …

Former Liberian President Ellen Johnson Sirleaf, co-chair, of the Independent Panel’s review of the COVID19 pandemic response, at a media briefing.

Co-chair Ellen Johnson Sirleaf, former President of Liberia, stressed that the panel was not trying to blame the WHO: “The world is more reliant on an effective WHO than ever before. But while member states turn to the WHO for leadership, they have kept it underpowered and under-resourced to do the job expected of it.”

She added: “Member states are looking to the WHO for leadership, coordination and guidance, but are not equipping it with the authority or access to the funding needed to provide this. WHO has no powers to enforce anything or investigate anything of its own volition within a country.

“When it comes to a potential new disease threat, all WHO can do is ask and hope to be invited in. The panel is asking whether this is enough.”

At the same time, the report makes a number of damning observations about how member states had failed to act on “numerous evaluations, panels and commissions which have issued many recommendations for strengthening preparedness and response” of WHO.

And the Panel also criticised the sometimes overly technical nature of WHO’s advice to countries, saying that it had issued over 330 reports to states, which may have confused them about what their priorities should be.

Panel Criticism of China – Receive Rocky Reception From Beijing  

China’s representative to the Executive Board at the 148th session on Tuesday.

The panel report also criticises China, stressing that “public health measures could have been applied more forcefully by local and national health authorities in China in January.”

“It is also clear to the Panel that there was evidence of cases in a number of countries by the end of January 2020. Public health containment measures should have been implemented immediately in any country with a likely case. They were not.”

Clark would not comment further on China, saying that the panel would have a more detailed report on the chronology of events at a later stage. The final report is due to be presented to the World Health Assembly in May.

However, in a later EB debate, China protested about the way that its response had been characterised, saying that it was being unfairly “judged” for early days when authorities were still grappling with “understanding the unknown”. 

“On January 23 2020, when only four countries outside China reported seven cases, China pressed the pause button in Wuhan, a city with a population of over 10 million, which was not taken lightly. But we did it. And we made huge sacrifices for global fight against the virus that has gone way beyond the traditional public health measures. 

“We urge the international community to look at China’s anti-epidemic efforts from a rational and scientific perspective. 

“These extraordinary and forceful public health measures are mass contributions that China made to the world. China suggests that the review committee …should further improve the report and make scientific, objective, fair, comprehensive and balanced assessments on both prevention and response.”

Incentives For International Cooperation Are Too Weak 

Well beyond the WHO or China, however, the panel made it clear that responsibility is shared globally, while the incentives fostering international cooperation between states remain too weak. 

“Our panel report does identify a series of critical early failings in global and national responses to COVID-19. There had been a failure to prepare adequately for a pandemic threat despite years of warnings that better preparation was necessary,” said Clark at a subsequent afternoon briefing with the EB members themselves on the report’s findings.

“Preparedness methods which were being used did not appear to predict how well individual countries would be able to control COVID-19. Perhaps because they couldn’t capture what seems to be a critical dimension of pandemic control: the mix of government effectiveness, concern and leadership, capacity to work with communities, and being able to be guided by science,” said Clark.

“The panel notes with deep concern that the failure to enact fundamental change despite the warnings issued has left the world dangerously exposed, as the COVID-19 pandemic proves,” according to the report, which added that there has been “a wholesale failure to take seriously the existential risk posed by the pandemic’s threat to humanity and its place in the future of the planet”.

Adds the report: “the incentives for cooperation are too weak to ensure the effective engagement of states with the international system in a disciplined, transparent, accountable and timely manner” despite the fact that the pandemic offers “a once-in-a-generation opportunity for member states to recognize the common benefit of a suitably reinforced suite of tools to enable robust pandemic alert and outbreak containment functions.”

Major weaknesses in the Global Supply Chain 

Other problems flagged by the panel include “major weaknesses in the global supply chain,” while the critical funding gap hampering the Access to COVID-19 Tools Accelerator (ACT-A) platform might result in a “two-tier world, divided between countries where COVID-19 is relatively controlled, and those where COVID-19 adds to the overall burden of disease as yet another ongoing, endemic disease”.

“The effective flow and access of new diagnostics, therapeutics, and vaccines to the populations most in need, based on equitable public health criteria, must be the central plank of international co-operative efforts,” the report notes.

Vaccine Rollout Also Criticized by Panellists  

Related to that, the unequal pattern of vaccine rollout also came in for sharp criticism by the panel’s leaders at the EB session: “The panel is discouraged and frankly disappointed by the unequal vaccine rollout. Tens of millions of vaccines are already available in some of the wealthiest countries, but based on current plans, vaccines will not be widely available across the African continent until 2022 or even 2023,” said Sirleaf.

“It is unacceptable for wealthy countries to be able to vaccinate 100% of their population, while poorer countries may do with only 20%. It is no exaggeration to say that we are at risk of creating a vaccine distribution system grounded in inequity. We cannot let this happen.

“This is a unique opportunity, born out of the gravity of this crisis, to reset the system. Real change in global and national health systems will benefit every country and every citizen,” Sirleaf added. 

EB Members Frame Reviews As Buildup to WHA Resolution Strengthening Emergency Response  

Garett Grigsby, director of the Office of Global Affairs, US Department of Health and Human Services

Despite resistance from China, member states in Europe, the Americas and elsewhere framed the findings of the three reports as useful inputs to a planned resolution to strengthen WHO’s Emergency Response mechanisms, that will go before the World Health Assembly in May.

“It is our duty to provide the WHO and the broader international system with the tools to do its work effectively, efficiently, independently and transparently,” said Garett Grigsby, director of the Office of Global Affairs at the United States Department of Health and Human Services, speaking at Tuesday’s EB session. 

“We must rise to the occasion, even as we combat the pandemic and resurrect our economies,” said Grigsby. “That is why we need to be sure that the recommendations put forward will be given thoughtful consideration, and any additional funding requests for WHO will be justified and directed at areas where strengthening is necessary, such as pandemic preparedness and response. The United States will work with other member states to strengthen the WHO to make it fit for purpose.”

Grigsby also said that the United States was joining the European Union and a wide range of other member states to advance a resolution for the World Health Assembly strengthening WHO’s Emergency Response. 

The statement represented the first sign of other substantive shifts in policy that can be expected from the White House after President-elect Joe Biden is inaugurated in Washington, DC on Wednesday. 

Biden is expected to work rapidly to restore the previously close relationship between WHO and Washington – which was shattered by the maverick policies of outgoing Donald Trump – who leaves the White House in disgrace after igniting the emotions of rioters who charged the Capitol on 6 January in a failed attempt to violently overturn the election results.  

WHO Reaction – We All Have To Learn Lessons 

“We all have lessons to learn from the pandemic, every member state and the Secretariat….We are committed to accountability and we will continue to learn, to change, and to listen,” said Dr Tedros Adhanom Ghebreyesus, responding to the report at the EB’s afternoon session. 

While the report remains an interim one, countries should act immediately on some of the lessons learned, the Independent Panel Co-chairs underlined:

“We are building the necessary evidence base required for the comprehensive, impartial and independent review of the international health response to COVID-19 with which we were tasked,” Clark told delegates. “While our evidence gathering continues, the progress report before you now does have an unequivocal message that course correction of the handling of the pandemic is needed now.

“The panel does strongly recommend that all countries immediately and consistently adopt and implement those public health measures which will reduce the spread and the impact of COVID-19. Simply put, we must do all we can to stop the pandemic now.” 

Image Credits: WHO.

Health care workers administered the COVID-19 vaccine on 16 January at Chacha Nehru Bal Chikitsalaya (children’s hospital) in Delhi.

The Indian government began the world’s largest COVID-19 vaccination program this weekend aiming to vaccinate more than 300 million people, beginning with 10 million health workers, but in the three days since, it appears there has been low uptake among that key demographic.

Based on Health Policy Watch’s estimate, only slightly more than half of the people registered have received their vaccine in the three days since the launch. 100 people are registered per session, with 7,860 sessions held. Despite this, only 4,54,049 have been vaccinated as of Monday night.

Additionally,  vaccination rates in three states  — Tamil Nadu, Punjab and Puducherry — were 40% lower than expected.

“It is sad that members of our medical fraternity – our doctors and nurses – are declining the vaccine,” said Dr VK Paul, member of Indian government think-tank Niti Ayog, said in a press conference on Tuesday.

“I request them to please take the vaccine. We do not know what shape this pandemic will take.”

The country, which began its rollout on Saturday 16 January, is distributing two vaccines: the Oxford/AstraZeneca candidate, known as Covishield, manufactured by India’s own Serum Institute, and Covaxin, developed by Indian-based Bharat Biotech in collaboration with the Indian Council of Medical Research.

Earlier this month, India’s chief drug regulator granted the Serum Institute vaccine an emergency use license based on Phase 3 data from trials in Brazil and the United Kingdom, where the vaccine has already been approved.

But the decision to authorize Covaxin, a vaccine developed by the local firm Bharat Biotech together with the Indian Council of Medical Research, was made without final Phase 3 data. And the lack of transparency around that approval process may also be fuelling vaccine hesitancy.

Anyone receiving a Covaxin shot will be asked to fill in a consent for which notes that “the clinical efficacy of Covaxin is yet to be established and is still being studied in Phase 3 clinical trial” – although Phase 1 and 2 trials indicated the vaccine produces antibodies.

Two people, aged 43 and 52, have reportedly died following their vaccination. It has been confirmed that these deaths were both due to cardiopulmonary disease, and were unrelated to the vaccine.

Dr Manohar Agnani, additional secretary with Indian Ministry of Health and Family Welfare, said: “So far no case of serious or severe adverse events following immunisation attributable to vaccination till date.”

Confusion over Rollout Of Experimental Covaxin Vaccine Fuels Hesitancy

Many doctors employed in national hospitals have been cautious as to go on record about the mixed sentiments the campaign is thus generating.  As one senior doctor in Safdarjung Hospital told Health Policy Watch: “There is a little bit of confusion over Covaxin. Everybody does not want to become part of a trial (as the vaccine is being administered under clinical trial mode). It would have been better if I was given a choice. I would have taken Covishield.”

He later clarified he would be taking his Covaxin shot when offered, however his colleague also expressed apprehensions due to the lacking Phase 3 data.

Each vaccination site has only been provided with one of the two authorized candidates, meaning that people who are registered in that hospital have no choice but to take the vaccine available at the center.

Of the 37 states and union territories in India, 12 received the Covaxin vaccine.

On Saturday, about 22 million health workers were vaccinated were vaccinated across India.

In the Dr Ram Manohar Lohia Institute of Medical Science in Delhi, resident doctors wrote a letter to their hospital’s authority on Saturday,outlining why they were not comfortable taking Covaxin.

The letter read: “The residents are a bit apprehensive about the lack of complete trial in case of Covaxin and might not participate in huge numbers thus defeating the purpose of vaccination.”

Signatories then requested to be vaccinated with the Serum Institute-manufactured vaccines.

But Dr D R Meena, Registrar of Safdarjung Hospital, Delhi, took the Covaxin vaccine on Saturday, saying he “had mild myalgia” – or muscle pain – and that he “did not even need paracetamol”.

There have also been some cases of death following vaccination that were widely reported in the media – although these have so far been attributed to pre-existing conditions.

‘A Proud Moment’: Vaccination As A Lifeline

For some doctors, however, the launch of the vaccine campaign process was still an emotional moment.

Dr Prashant Lohmore, 28, is a resident doctor working in the emergency ward at Max Smart Superspeciality Hospital, a private hospital in Delhi. He received his Astra/Zeneca vaccine on Monday.

“I saw a lot of patients facing respiratory distress after Diwali,” he said. “We did not have enough beds at the time.”

That the country’s vaccination program has now begun “is a proud moment for us”, he added.

Dr Meena – the doctor who said he experienced only mild muscle pain from Covaxin – spent 2020 working as an anaesthetist in the Intensive Care Unit. His wife, also a doctor, works about 80km out of Delhi, and was gone for several months.

Their two children – a nine-year-old daughter and a 17-year-old son – both had little contact with their parents. Dr Meena and his wife both received their vaccine on the same day.

“I used to isolate myself in a room. My daughter would insist on talking to me. She is a small girl,” he said.

“Those were the hardest months of my life. Vaccination provides hope to us.”

Image Credits: Press Information Bureau, India.