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.

A man struggles with smoke from the Silverado Fire in California, October 2020

As the world’s eyes are fixed on the pending roll-out of new Covid-19 vaccines, a team of 120 leading health and climate experts have called on global leaders to use the momentum of the pandemic response to accelerate climate action, just ahead of the five-year anniversary of the landmark Paris Agreement to limit global warming to “well below 2°C.”

The expert assessments were summarised in the 2020 Lancet Countdown on Health and Climate Change, released Thursday. The report finds that record heat waves and wildfires in Australia, North America and Europe, deadly dengue expansion across Latin America; and undernutrition, floods, and droughts in China, South East Asia and Africa, are creating unprecedented threats to health and wellbeing around the globe.

Still Time For Global Reset

Despite their gloomy assessment, other climate news suggests that there is still time for a global reset. Should China, Japan, South Korea and others deliver on recently-announced net zero emission targets, the 2015 Paris Agreement’s ambitious climate goals could be “within reach”, according to an analysis by the Berlin-based Climate Action Tracker, published on Tuesday.

“The Climate Action Tracker (CAT) has calculated that global warming by 2100 could be as low as 2.1°C as a result of all the net zero pledges announced as of November 2020,” stated the independent scientific group, which measures and models governments’ climate pledges and actions against the goals of the 2015 Paris Agreement.

A recent wave of “net zero” emissions pledges announced this autumn by China, South Africa, Japan, the Republic of Korea and Canada have even “put the Paris Agreement’s 1.5°C temperature limit within striking distance,” states the latest report of the Climate Action Tracker (CAT).

As of November 2020, 127 countries “are considering or have adopted” net zero targets, the group said. Together, those account for some 63 per cent of global emissions. In addition, the incoming US administration of president-elect Joe Biden has pledged to rejoin the Paris Agreement and act more aggressively on climate change. Emissions are, nonetheless, still projected to increase until 2030, despite a small dip this year due to the COVID-19 pandemic.

“The year 2020 can be a global leap year for climate neutrality, so that we can reduce global emissions by 45 per cent by 2030, said UN Secretary General Antonio Guterres, speaking at a major address at Columbia University on the state of the planet. He recalled the vital link between climate, environmental stability and human health, saying, “Nature feeds us clothes us, quenches our thirst”, noting that health impacts from degradation come through multiple pathways, urban, air pollution, and environmental degradation: “Sound chemicals management could prevent some 2.6 million deaths per year.”

Lancet – Forty Global Indicators Still Show Worsening Impacts On Health

Even so, the 2020 Lancet report underscores how global warming that is already occurring is exacerbating the health impacts of the COVID-19 pandemic and vice versa.  The report, which involved 120 experts from 35 institutions like University College London, the World Health Organization and the World Meteorological Organization, found consistently worsening trends in all 40 global indicators that measured the health, social and economic impacts of climate change, revealing that health systems are still ill-prepared to deal with its deadly repercussions.

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

“The pandemic has shown us that when health is threatened on a global scale, our economies and ways of life can come to a standstill,” warned Ian Hamilton, executive director of the Lancet Countdown. “The threats to human health are multiplying and intensifying due to climate change, and unless we change course, our healthcare systems are at risk of being overwhelmed in the future.

“With trillions being invested globally in economic support and stimulus there is a genuine opportunity to align the responses to the pandemic and climate change to deliver a triple win – one that improves public health, creates a sustainable economy and protects the environment,” said the World Health Organization’s Maria Neira, who is at the helm of the Organization’s climate change and health efforts.

”But time is short. Failure to tackle these converging crises in tandem will [end up] moving the world’s 1.5C target out of reach and condemning the world to a future of climate-induced health shocks.”

A Comprehensive Report

This year’s report is more comprehensive than ever, featuring new indicators to measure the extent of heat-related mortality and its devastating economic costs, among other indicators on migration, urban green spaces and low-carb diets.

The authors show that climate change is knocking on Europe’s doorstep as well, triggering thousands of deaths a year from heat-related shock waves, damaging crop yields of staple grains, and facilitating the spread of mosquito-borne infections like dengue, with devastating costs to societies, healthcare systems and economies that are already strained.

The incentives to tackle climate change together with Covid-19 seem more enticing than ever, as limiting global warming to 1.5°C by 2100 could generate a net global benefit of US$264–610 trillion, which is at least triple the size of the global economy in 2018.

Higher temperatures are driving dengue spread to new regions

The World Doesn’t Have The Luxury Of Dealing With One Crisis At A Time 

Tackling climate change also bodes well with pandemic preparedness and prevention plans, since human encroachment into wildlife habitats, intensive farming, and deforestation promote both climate change and the emergence of “zoonotic” diseases like COVID-19. In fact, the world doesn’t have the luxury of dealing with one crisis at a time, added Hamilton in a press release on Wednesday night.

To reach the Paris Agreement’s targets by 2030, the world must reduce carbon dioxide emissions by 7.6% every year, which is more than five times higher than current government ambition, found the report. And although such changes seem out of reach, climate change is becoming more expensive to treat every year, given that a five-year delay in action would require a 15·4% reduction in carbon dioxide emissions every year to reach the set targets, representing a ten-fold increase in current government ambition. 

Europe, The World’s Most Vulnerable Region To Heat-Related Shock Waves

Perhaps surprisingly, the authors found that in 2018, Europe was the world’s worst affected region by heat-related shock waves, triggering over a 100,000 deaths that year, mostly in older people, people with disabilities or pre-existing medical conditions, as well as those working outdoors or in non-cooled environments. The costs, say the authors, are equal to a whopping 1.2% of regional gross national income. 

A rise in temperatures in Europe, even by seemingly small amounts, is also facilitating the spread of infectious diseases like dengue to the region. The global climate suitability for the two main mosquitoes that carry dengue – the Asian tiger and yellow fever mosquitoes – have in fact increased by 41% and 25% since the 1950s, found the report.

Meanwhile, rising temperatures have made Africa’s highlands 40% more suitable for malaria transmission, and 150% more suitable in the Western Pacific region, in comparison with the 1950 baseline.

The outlook for food security is rather bleak as well, with consistently dwindling crop yields for staples like maize, winter wheat, soybean, and rice across the world. In Europe, for instance,  the crop growing season for maize was reduced by 20 days in 2019, a 14% reduction compared to the global averages between 1981–2010.

Maize growth duration has decreased since 1981–2010

Huge Losses

Increasingly warm temperatures are also triggering huge economic losses. Just last year the world lost 302 billion work hours due to climate change, or 103 billion hours more than two decades ago. These effects are more strongly felt in the construction sector in high-income countries, in comparison to low- and middle-income countries where extreme heats are most deeply felt in agriculture. In 2018, India and Indonesia lost 3.9 to 5.9% of their GDP because of lost outdoor labour. In India alone, this amounts to 100 billion hours of potential work lost to rising temperatures in 2019, compared with those lost in 2000.

If the world fails to intervene, up to 565 million people living in coastal areas, about three quarters of the total European population, may be forced to leave their homes due to rising sea levels. 

Progress Welcome, But Only 9% of Countries Have The Funds To Implement Health & Climate Adaptation Plans

Fortunately, there is some good news. Coverage of health and climate change in the media has increased by 96% worldwide between 2018 and 2019, and research in the field has increased by a factor of eight. Government engagement in climate change has also increased, especially for small island states and lower-income countries that have led the trend. And in 2019, government spending on health system adaptation rose by almost 13% to $18·4 billion. 

However, governments have a lot of work to do to implement effective multi sectoral strategies, warned the report, noting that governments “remain unable” to fully implement their plans for national health adaptation – even though two thirds of global cities surveyed anticipate climate change to seriously compromise public health infrastructure.

In fact, only half of governments surveyed have drawn up national health and climate change adaptation plans, and only 9% have the necessary funds to fully implement them.

An earlier version of this story was published on Thursday morning in collaboration with Geneva Solutions, a new non-profit Geneva platform for constructive journalism covering International Geneva.

Image Credits: AP, Climate Action Tracker, Maria Neira, The Lancet.

Clinical trial volunteer receives injection of vaccine candidate developed by Pfizer and BioNTech.

Pfizer’s COVID-19 vaccine, a cutting edge mRNA technology produced jointly with the German firm BioNTech, was authorized for use on Wednesday by the United Kingdom – making it the vaccine the first to be rolled out for commercial public use as early as next week. 

The vaccine was authorised Wednesday morning for emergency use by the Medicines and Healthcare products Regulatory Authority (MHRA), eight days before the US FDA is expected to meet on the Pfizer application for regulatory approval there, while the timeline for broader European approval of Pfizer’s candidate, as well as a similar Moderna vaccine, may not come until early 2021, with the European Medicines Agency set to meet 12 January. 

The timeline for vaccines approval and distribution elsewhere in the world is expected to follow after the US FDA and EMA approvals. But massive distribution of COVID vaccines in many low- and middle-income countries still depends on rapid approval of a much cheaper AstraZeneca  vaccine type, which uses a more conventional immunization strategy, in the form of a weakened adenovirus, to deliver a fragment of SARS-CoV2 viral protein and stimulate immunity. It can also be storaed in a refigerator, unlike the Pfizer and Moderna vaccines that require freezer or deep freezer storage.

The UK’s Department of Health and Social Care announced, its approval of the Pfizer vaccine, following a review of the MHRA’s recommendation. The MHRA was vested with the power to approve new COVID vaccines under special governmental regulations in force ahead of 1 January 2021, when the medicines agency will become fully responsible for medicines authorisation in the UK following  Brexit. 

“The government has today accepted the recommendation from the independent Medicines and Healthcare products Regulatory Agency (MHRA) to approve Pfizer/BioNTech’s COVID-19 vaccine for use,” stated the government announcement. “This follows months of rigorous clinical trials and a thorough analysis of the data by experts at the MHRA who have concluded that the vaccine has met its strict standards of safety, quality and effectiveness.” 

A UK Department of Health and Social Care spokesperson said: “The vaccine will be made available across the UK from next week. The NHS has decades of experience in delivering large-scale vaccination programmes and will begin putting their extensive preparations into action to provide care and support to all those eligible for vaccination.

The Department urged the public to continue to abide by current COVID-19 restrictions, saying: “To aid the success of the vaccination programme it is vital everyone continues to play their part and abide by the necessary restrictions in their area so we can further suppress the virus and allow the NHS to do its work without being overwhelmed.”

UK authorities said that they had some 40 million doses on immediate order and  800,000 doses ready to deploy over the next few days. 

Global Health Leaders in UK and World Welcome Step

The reaction from UK and global health leaders was swift: 

WHO’s Dr Tedros Adhanom Ghebreyesus said in a tweet: “This is the first country to authorize the Pfizer/BionTech #COVID19 vaccine for emergency use and expects to start rolling it out as soon as next week. “

Chris Whitty, Chief Medical Officer, United Kingdom.

England’s Chief Medical officer, Chris Whitty, warned that the approval doesn’t mean that people should begin relaxing social distancing and other COVID-19 prevention measures yet.

“This is excellent news and a step towards normality,” he said, but added, “It will take until spring until the vulnerable population who wish to are fully vaccinated. We can’t lower our guard yet.”  

Professor Sir Robert Lechler, President of the UK Academy of Medical Sciences, called it, “brilliant news and a historic moment providing a light at the end of a gloomy tunnel.

“This vaccine is an example of the extraordinary power of biomedical science demonstrating how medical research has played a vital role in helping us understand and respond to this virus. It will take time to achieve mass vaccination so we must not relax our guard against COVID-19 yet, in fact now is the time to strive to stay safe more than ever.

“The Pfizer-BioNTech COVID-19 vaccine does come with challenges such as storage at around -70C which is why I am pleased that there are other promising vaccines that could be approved for use soon, and I look forward to more good news within the comings months.

“To ensure good uptake of COVID-19 vaccines it is essential that public health messages around vaccination reach all parts of society, regardless of age, socio-economic background, ethnicity or language. The best way to do this is work hand in hand with different communities to understand the questions they have, to co-produce effective messages and understand the best ways to share them.

He also urged that people continue practicing measures to prevent infection, saying: “This vaccine is a fantastic new tool in our defences against the virus, but we all still have a part to play in preventing the spread of COVID-19. I urge everyone to keep sticking to the measures, including the use of face coverings, social distancing, following the guidance on tier restrictions and isolating when sick. It is vital we all stay healthy to enable the NHS to support the roll out of this new vaccine.”

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) called it “good news for people in the UK, especially the health care workers, the elderly and people who have underlying medical conditions… It is also good news in terms of scrutiny that the vaccine is safe and effective; based on clinical trial testing designed to represent all races, genders and ages, as well as people with medical conditions.”

UK Approval is ‘Huge Step’ –  But For The Entire World – We Will Need A Range of Vaccines That Work Across Different Groups & Settings 

Dr Charlie Weller, Head of Vaccines at the UK-based Wellcome Trust, described the announcement as “historic day and an important moment at the end of an incredibly difficult year. For a vaccine to be developed, receive emergency approval and be ready to roll out in less than a year for a new virus is completely unprecedented. The speed of development for this and other vaccine candidates is testament to an extraordinary, collaborative, global research effort.

“As normal for any vaccine, there will be a need for close and continued monitoring for safety and efficacy as it is delivered. We will also need to continue tracking and improving our understanding on how long the protection lasts. We must recognise that not everyone will have a vaccine immediately or even early next year. It is critical that groups most at risk, such as the elderly and frontline healthcare workers, are prioritised to receive the first doses.

But while the decision “clears the path for this vaccine to be rolled out to a wider population, there are now important considerations and significant logistical hurdles ahead. We have never attempted to roll out any vaccine at this sort of scale and at this sort of speed anywhere in the world,” Weller said. Wellcome is a major player in the WHO’s ACT Accelerator global drugs and vaccines distribution initiative, as well as funding R&D on a range of other COVID-19 vaccines, considered necesary to attain broad global coverage:

And while the UK decision signals: “a huge step forward to end the pandemic… if we are to have enough doses for the entire world, we will need a range of vaccines that work across different groups and settings. It is therefore vital there is continued global investment in developing a wide range of candidates. Alongside vaccines, we will need effective treatments, tests and most of all global collaboration, to overcome COVID-19.”

“Ït’s going to be extremely frustrating, Modern CEO Admits – There Won’t Be Enough for Most People In the World Right Away  
Stéphane Bancel, Chief Executive Officer, Moderna.

Said Stéphane Bancel, Chief Executive Officer, Moderna, in an interview with the World Economic Forum late Wednesday afternoon, his company is on track to produce 500 million to a billion doses of its mRNA vaccine next year. The vaccine, which has less demanding cold storage requirements than Pfizers, is suitable to be shipped and used in many, if not, most places of the world.

And in terms of the trial results, “the piece I got the most excited about when I got the data from my team was that we had 30 severe cases, and all 30 were in placebo – meaning that if you get the vaccine, you probably will have no disease symptoms, but if you have any sign of the disease, it will be a very mild disease…. And as we know, what has had a big impact on human life, public health and economy is a cascade of severe diseases, and death, which has driven the lockdowns, social distancing and all the suffering and mental suffering that that we know as is going on as we speak.”

He also publicly credited the US$ 1 billion in US government funding that supported Moderna’s clinical trials as “being very helpful” in lowering the price the company will finally charge for the drug.  “It is going to help, of course, in terms of affordability and access around the world, because the US basically picked up the tab to pay for the development of a product.”

Still, while Bancel said his company was on track to have “20 million doses” of the Moderna vaccine ready to go before the end of the year, he also admitted that the speed at which global vaccine distribution unfolds is likely to be initially “extremely frustrating for the general population, how slow it is going to feel . .. because there won’t be enough for most people in the world, definitely in the first quarter, definitely in the second quarter, and most probably for the entire year – if you are worrying about people around the world and not only in rich countries.

“We know that in rich countries, not only people have cash, but they also have less people,” Bancel said. “Aand so it’s a math problem… of just numbers of people that you need to vaccinate, and so I think that around the world, it is going to be very frustrating that people will want to get the vaccine… I think there’s going to be a lot of people wanting a vaccine very quickly to get back to normal life.”

AstraZeneca Says Its Vaccine Will be Low Cost & Sturdy
Mene Pangalos, Executive Vice-President, Biopharmaceutical Research and Development, AstraZeneca.

On a more positive note, Mene Pangalos, Executive Vice-President, at AstraZeneca, said that the company’s vaccine, which is less temperature sensitive and is to be priced as low as $US 3 per dose, is poised for deployment early in 2021, and “will make a dent” in the pandemic, along with the Pfizer and Moderna vaccines.

Said Pangalos: “We have, as part of our commitment to helping deal with a pandemic, committed to doing and delivering and supplying the vaccine during the pandemic, not for profit. And we have around 3 billion doses, ready to go. By the end of, 2021, many of those several hundred million of those doses available in the first quarter of next year.

“So I do think with the data we have, we have a vaccine that is approvable that will make a dent in the pandemic along with vaccines from from Pfizer and Madonna. And I think the supply as early in the year as possible around the world is going to be very important to try and make the dent that we need, on this virus and getting us all back to some normality,” he said.

Henrietta Fore, Executive Director, United Nations Children’s Fund (UNICEF).

Along with vaccine costs and production, the logistics of mass, worldwide vaccine distribution are unprecedented, said UNICEF’s executive director, Henrietta Fore, also appearing at the WEF event. She spoke about the importance of supporting the WHO co-sponsored COVAX vaccine initiative to reach the highest risk groups worldwide with new COVID vaccines by end 2021:

“Currently, UNICEF procures and delivers about 2 billion vaccines doses, a year,” Fore said. “And that is to cover primarily childhood diseases… but COVAX is now asking us to double that number for next year,” she said, referring to the COVAX goal to distribute up to 4 billion vaccine doses, so as to reach 2 billion people next year with the two-dose vaccines. “And it’s to the lowest and the middle, low income countries so it’s the hardest places. So the challenge is enormous. It’s got to be a big public private partnership.”

Help is needed to streamline supply chains and as well as cold chains, she added:

“Currently we are used to vaccines that can move in relatively cool temperatures but not ultra-cold,” she said referring to the Pfizer vaccine that needs -70 C storage along with Moderna’s counterpart, which requires at -20 storage long term, and -2 to -8 C for a month. “We need supply chain logistics and transportation sectors that are all working together, we need to prioritize the transportation of vaccines, so that in the lessened amount of cargo space that we can get the vaccines out there and across the boundaries and into the countries.”

Fragile health systems also need to be bolstered, said Fore, “we really have to think about the fragility of many of these countries, health systems. We’ve been just working on that in Sudan recently.. in the poorest countries it’s particularly important – financial support, technical support and equal investment in the systems that will deploy COVID-19.”

Public Funds Also Poured Into Pfizer/BioNTech Vaccine

While more attention has been given to the public funding accorded to the startup Moderna, the German government in September paid up to € 375 million to  BioNTech to help speed up the development of the Pfizer-BioNTec mRNA vaccine.  That followed a European Investment Bank loan of  €100 million in June to “allow the company to expand its manufacturing capacity in order to supply the vaccine fast worldwide in response to the pandemic.”   

As a result of the public funding, the price per dose for the BioNTech/Pfizer vaccine in Europe will reportedly be about US$ 18.34, according to a recent Reuters report. That is about a US$1.20  less than the reported US$19.5 the United States reportedly agreed to pay in July, when it purchased 100 million doses, with an option to buy a further 500 million under terms to be negotiated separately. 

Pfizer said only that the company is using a tiered pricing formula based on volume and delivery dates, and that the EU deal had represented the largest initial order of its vaccine candidate to date. “We are not disclosing further details of this agreement,” it added.

Medicines access advocates are quick to point out that despite the hundreds of millions of dollars in public funds that have been poured into both the Pfizer BioNTech project, as well as a similar Moderna vaccine, prices of both that will be charged to governments have remained closely guarded secrets.    

In addition to the late-stage research grants and loans, the foundational research into the mRNA vaccine delivery mechanisms was also publicly supported, access advocates have pointed out. That work, carried out by two researchers, Katalin Karikó and Drew Weissman, at the University of Pennsylvania, received US government funding, according to an analysis of the R&D funding by Knowledge Ecology International (KEI).  

Karikó and Weissman later licensed their inventions “non-exclusively” to Moderna and BioNTech RNA,  the company that has been collaborating with Pfizer for the development of a mRNA vaccine.  But due to its investment, the US government still holds some rights to six of the 11 patents that were instrumental in developing the mRNA vaccines of both companies, 

KEI’s Thiru Balasubramaniam observed that the transparency of COVID-19 vaccine prices could also emerge as a flashpoint in discussions that will get underway Thursday among WHO member states, in light of the streams of public funding that has gone into vaccines development, . The member states are meeting to discuss pharma’s R&D costs and medicines shortages, in the context of a renewed push to implement the WHO’s Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property.

 “President Trump prides himself on being the consummate negotiator. He wrote ‘The Art of the Deal’; he didn’t get such a good deal here,” observed Balasubramaniam. Meanwhile, he said, referring to the UK’s approval today:  “the heirs of Hengist and Horsa are first in the queue.”

Image Credits: Pfizer, BioNTech, Number 10, WEF.

Special Representative for Global Health Diplomacy, Ambassador Deborah Birx.

Ibadan. While this year’s media coverage of the HIV epidemic has largely focused on COVID-related disruptions of services, deeper running trends and attitudes that stigmatize people found to be HIV-positive need greater attention, said US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, Ambassador Deborah Birx, in a special media briefing on the occasion of World AIDS Day. 

Stigma and discrimination are not specific to HIV/AIDS, she emphasized, but they are particularly insidious in the case of people living with HIV. Stigmatization deters people from seeking life-saving testing and treatment on the one hand, and on the other can lead to the transmission of infections to others.

“We have to create an environment where individuals do not see that there are barriers to their ability to access either prevention, or treatment service. This is the work that we have to still do,” Birx told Health Policy Watch at a briefing organized by the South Africa-based Africa regional Media hub of the US Government.

The year 2020 marks nearly 40 years since the discovery of the AIDS virus in 1983, and 32 years since the first World AIDS Day in 1988. In contrast to the 1990s, when the first available anti-retroviral treatments were expensive and out of reach to most people in parts of Africa and the developing world where the AIDS pandemic was raging, some 26 million people living with HIV/AIDS today are now regularly using ARV therapies. But that still falls short of the 30 million target for 2020, that was set before the COVID pandemic began.

Overall, it’s estimated that some 12.5 million people worldwide still don’t have access to lifesaving ARVs.

Since 2003, the US government has invested more than $85 billion in the global HIV/AIDS response through its PEPFAR initiative (President’s Emergency Plan for AIDS Relief), which extends across more than 50 countries today.

That has saved 20 million lives, preventing millions of HIV infections, and moved the HIV/AIDS pandemic from crisis toward control, Birx said. But it has not stopped the disease from being a source of stigma for people living with it.

“So it tells me that there’s still a stigma around keeping people healthy and prevention programming versus treatment programs, no matter where we work around the globe,” she observed.

She added that there remains great disparities in the means by which countries and policies address stigmas around HIV/AIDS. Great progress has been made in some countries, notably South Africa, where the epidemic raged two decades ago, but the situation has worsened elsewhere in Sub-Saharan Africa.

LGTBQ+ Groups At Particular Risk From Stigmatization- Freedom of Association Under Attack 
Winnie Byanyima, Executive Director UNAIDS.

While access to treatment has improved in many parts of the world, things have actually gotten worse in many parts of Sub-Saharan Africa, as a result of stigmatization against key at-risk groups, said Onyekachi Onumara, Nigerian-based senior program officer at the Rural Health Foundation, in a separate interview with Health Policy Watch.

“There is much more stigma around key populations in Sub-Saharan Africa than there was five or six years ago. We have to work on this comprehensively. We also have to remember that economic fragility also brings additional risk to women and children,” Onumara told Health Policy Watch.

Gay men and sex workers are among the groups most often targeted by legal as well as social pressures that prevent them getting acces to HIV services, noted UNAIDS Executive Director Winnie Bynaymia, during the launch of last week’s 2020 Global AIDS Update.

Byanyima cited her home country, Uganda, where both groups are targeted by serious stigmatisation, backed with state legislation, including the 2014, Anti-Homosexuality Act, making homosexual acts punishable by life in prison. Such laws are common in conservative cultures of Africa as well as the Middle East and Asia. And in some countries, a backlash by conservative cultural and religious groups has seen them reinforced only recently.

“For LGBTQI laws, that’s where our criminal laws are hardest, and are not being unwound. So we have to understand this conservative backlash and see how to address it. I think such forces can only be rolled back through movement building. We cannot hope to have an open space unless we mobilize people and change attitudes,” Byanyima said last week.

“Sometimes [we] think we can solve the problem of HIV AIDS through a biomedical approach. We can’t. There is no treatment, no pre-exposure prophylaxis, ARV or whatever, that will reach the hands of a gay man in my country Uganda where the criminal law is being enforced in a harsh way,” she said.

She said the world needs to push back against conservatism that is making it harder to move forward on women’s rights or the rights of all sexual identities.

“I say this really sincerely,” she said. “Free media, freedom of association, freedom of speech, these are also under attack. And I think that for us, if we want to fight AIDS, we do need to protect those core tenants of a liberal democracy.”

Invest in Peer-Led HIV/AIDS Services 

As one means of overcoming stigma, Birx said more money needs to be invested in supporting and protecting peer-led HIV/AIDS services.

“We need to overcome the structural barriers that really plague key population programs, particularly in Sub-Saharan Africa. In many places around the globe, peer-led service delivery is much more successful outside of the public sector for many reasons.

Peer led services are more able to cope with “Stigma discrimination – It’s how people are dressed and how people are seen and spoken to and spoken with,” Birx said.

Global AIDS Response Off Track Before COVID-19

While the global AIDS response was off track before the COVID-19 pandemic, the onset of lockdowns and travel restrictions created additional setbacks. While services have since “rebounded” in many countries, according to the World Health Organization, UNAIDS has warned that the the world may still see an estimated 123,000-293,000 more HIV infections and 69,000-148,000 more AIDS-related deaths between 2020 and 2022.

“The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” said Byanyima. “Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”

 

 

Image Credits: UNAIDS .

The plan aims to support 160 million people, including those disproportionately affected by the COVID-19 pandemic. In Soweto, South Africa, poverty and crowded conditions made lockdowns much harder.

More than 235 million people worldwide will require humanitarian protection next year: an increase of 40% in 12 months.

The United Nations (UN)has announced an appeal for US$35 billion, which it estimates will be required to support 160 million of those most in need of support, across 56 countries.

The Global Humanitarian Overview (GHO) 2021, published on Tuesday 1 December, has outlined 34 appeals designed to support vulnerable populations who are disproportionately affected by conflict, displacement, and the impacts of climate change and the COVID-19 pandemic.

“In 2020, COVID-19 altered the landscape of humanitarian response,” the abridged report stated. Analyses of the impact of the pandemic have been considered alongside pre-existing crises.

UN Under-Secretary General for Humanitarian Affairs and UN Emergency Relief Coordinator, Mark Lowcock

In a press briefing on Tuesday, UN humanitarian chief Mark Lowcock said that money will be used from the UN’s Central Emergency Relief Fund (CERF) to curb the increase in violence against women and girls caused by or linked to the pandemic.

Lowcook said in a statement: “The rich world can now see the light at the end of the tunnel. The same is not true in the poorest countries. The COVID-19 crisis has plunged millions of people into poverty and sent humanitarian needs skyrocketing. Next year we will need $35 billion to stave off famine, fight poverty, and keep children vaccinated and in school.

“A clear choice confronts us. We can let 2021be the year of the grand reversal –the unravelling of 40 years of progress – or we can work together to make sure we all find a way out of this pandemic.”

70% of the people targeted for aid in 2020 were reached, but total donations reached $17 billion – less than half of what is required in 2021.

The report can be read here. The UN statement is available here.

Image Credits: UN Photo/Mark Garten, Matt-80.