Emmanuel Macron
The President of France Emmanuel Macron has tested positive for COVID-19, and the Prime Minister is to self-isolate.

The President of France, Emmanuel Macron has tested positive for COVID-19, Élysée Palace has announced.

In a statement published on its website on Thursday, the palace confirmed the diagnosis was made after Macron, 42, performed an RT PCR test, following his developing symptoms.

He will now isolate for 7 days, abiding “health regulations in force applicable to all”. A spokeswoman confirmed they are now assessing where he may have contracted the virus, and told Reuters the President has cancelled his 22 December trip to Lebanon.

France’s Prime Minister Jean Castex, 55, has also been identified as a possible contact case, and will begin self-isolating.

Castex was intended to announce France’s COVID-19 vaccination policy on Thursday, now to be covered by the country’s Health Minister, Olivier Véran.

Macron was at a European Council heads of state meeting held on 10-11 December.

The Guardian has also reported that Macron welcomed the Portuguese prime minister, António Costa, on Wednesday, and met separately with Spanish prime minister Pedro Sánchez on Monday, with European council president Charles Michel and Ángel Gurría, secretary general of the Organisation for Economic Cooperation and Development.

A mother and her new born baby at Karenga Health Center IV.

Three-quarters of COVID-19 trials reviewed specifically excluded pregnant women, despite investigating medications that are already used by expectant mothers.

Authors of an opinion piece published in The Lancet Global Health journal, based on a data review, warned that although pregnant women are among those most in need of effective and safe therapies, they are routinely excluded from the majority of clinical treatment trials.

Ongoing exclusion will actively lose opportunities to investigate and ensure the safety of treatments in pregnant women who may be at extreme risk of severe outcomes from COVID-19, they said.

The full opinion piece can be read here.

Image Credits: UNICEF/Zahara Abdul 2019.

The vaccine developed by Oxford University and AstraZeneca was one of the vaccines included in the study.

Striking through the politicised warnings and potentially hollow gestures, a new study has found that COVID-19 vaccines could remain out of reach until at least 2022 for nearly one- fifth of the global population – despite months of pleas and appeals to ensure their widespread global distribution.

The study, published in The BMJ, is the most systematic yet by researchers assessing publicly announced pre-orders of vaccines ahead of their regulatory approval, and where the doses will go.

On the plus side, in a best case scenario global production next year could create enough vaccines to immunize some 5.96 billion people by December 2021, the paper finds. That’s nearly 80% of the global population

However, current procurement patterns suggest that purchases may be very skewered – with rich countries stockpiling large amounts of vaccines and some poorer countries not receiving any at all, says the study.

The assessment, undertaken by a team of experts from Johns Hopkins Bloomberg School of Public Health, found that more than half of the 7.48 billion doses of the most advanced vaccines, which have already been pre-reserved, would be shipped to high-income countries, whose populations account for just 14% of the world total.

That leaves only about 40% of total doses available for distribution to low- and middle-income countries (LMICs), which comprise more than 85% of the world’s population – if rich countries don’t snap up even more.

Decisions on how equitably the remaining doses are distributed will thus determine whether a significant portion of the global population would be immunized by the end of the next year – other whether some countries still face large immunization gaps.

Peer Reviewed Study on Distribution Issue is a First

Discourse surrounding vaccine nationalism and equitable distribution has so far been delivered in large part through politicised messages or institutional warnings. The appearance of a peer reviewed study – and as the UK and US begin vaccinating their more vulnerable populations – provides a rigorous reminder that the COVID pandemic will linger long past the Global North’s immunisation.

That such a massive portion of the population – realistically, those living in low- and middle-income countries (LMICs) – would be left behind illustrates that the significant steps made this year towards achieving vaccine equity still is not enough.

EU Considers Donating 5% of Its Vaccines to LMICs

In related news, the European Union is considering an initiative whereby LMICs would receive 5% of the COVID vaccines the European Union (EU) has ordered.  However some critics say that the move could also undermine the aims of the WHO-led COVAX Facility to create a global pool of vaccine procurement and exchange, including poor countries.

An internal document drafted up by the French government, and secured by Reuters, set targets for vaccine donations, under the presumpton that EU would wind up with surplus doses – due to its pre-orders with a range of vaccine manufacturers with vaccines that have now been approved or are in advnaced stages of trials.

Donating 5% of the 1.3 billion vaccines the EU has so far secured would mean that up to 65 million vaccine doses could be administered to those living in LMICs.

It is so far unclear, however, whether the EU would donate 5% of its initial 280 million Pfizer/BioNTech and Moderna doses, given its population is nearly double that number – and those vaccines are the first becoming available to the public.

The plan could step on the toes of WHO’s own vaccine procurement program, COVAX, which aims to provide 2 billion shots to countries around the world by the end of 2021.

Dr Tedros Adhanom Ghebreyesus, WHO Director General, urged countries to “honor their pledges” to the COVAX Facility on Friday.

The arm of the COVAX scheme procuring supplies for LMICs, however, is still reliant upon donations in a period where rich countries have also seen big economic setbacks. And despite donation pledges from 64 high-income countries to the facility, which is co-led by Gavi, the Vaccine Alliance, WHO director general Dr Tedros Adhanom Ghebreyesus has said that billions more in support is still needed. At a recent WHO media briefing he urged leading donor nations to turn their pledges of support for the COVAX facility into action.

As one anonymous source working with COVAX told Reuters: “The more governments become active outside the (COVAX) facility, the more the international community as a whole starts to lean towards compromising the basic principles of equitable allocation.”

Image Credits: John Cairns.

Ella Adoo-Kissi-Debrah’s death in February 2013 was initially recorded as being caused by acute respiratory failure. It is now recorded as having been caused by acute respiratory failure, severe asthma and air pollution exposure.

Global health and air pollution advocates have hailed a landmark court case which has recognized air pollution as a factor into the 2013 death of a 9 year-old girl – for the first time in history.

On Wednesday, a Coroner Court in the United Kingdom ruled that air pollution was one of the causes of death of 9-year old Ella Kissi-Debrah, who lived with her mother near a heavily trafficked road in London, the South Circular. Ella has thus become first person in the UK – and potentially in the world – to have air pollution listed as a cause of death.

“Today was a landmark case, a 7 year fight has resulted in air pollution being recognised on Ella’s death certificate,” tweeted the Ella Roberta Family Foundation, that was formed in Ella’s name, and pursued the court battle to win her justice. “ Hopefully this will mean many more children’s lives being saved. Thank you everyone for your continued support.”

https://twitter.com/i/status/1339096906786426880

“Landmark case in UK! Air pollution recognized in Ella’s death certificate. Ella’s light guiding and Rosamund Kissi-Debrah fighting made the miracle. Our heart is full of emotions beating with Ella, Rosamund and the fantastic ‘duo’,” tweeted Maria Neira, WHO Director of Public Health, Environmental and Social Determinants of Health.

Ella Kissi-Debrah with her mother Rosamund in a family photo.

Ruling from coroner Philip Barlow stated an early 2014 court finding that had only attributed her death to respiratory failure, should be overturned, as Barlow said, “Ella died of asthma contributed to by exposure to excessive air pollution.”

“So, for the medical record cause of death, I intended to record 1A acute respiratory failure. 1B, severe asthma. 1C air pollution exposure. That is an agreement with the autopsy findings, and also the evidence of Sir Steven Holgate,” announced the Southwark Coroner’s court on Wednesday, reporting that Ella was exposed to nitrogen dioxide and particulate matter (PM) pollution in excess of WHO guidelines.

The initial 2014 inquest into the girl’s death in February 2013 had been recorded as acute respiratory failure, without taking into account any reference to environmental factors that caused the fatal collapse of the girl, who suffered from chronic asthma.

Her mother, Rosamund Kissi-Debrah knew nothing about the health impacts of air pollution, notably from particulate matter and nitrogen dioxide, closely associated with increased severity from asthma, while her daughter was still alive.

It was only when she launched a charity in her daughter’s name, The Ella Roberta Family Foundation,  to improve the lives of children with asthma in south-east London, that she began to stumble across the linkages.

The case was taken up by human rights lawyer Jocelyn Cockburn. Professor Sir Stephen Holgate, an immunopharmacologist and consultant respiratory physician of the University of Southampton and Southampton general hospital, heavily researched the case and produced a report linking air pollution levels to Ella’s death, also testifying in the repeated court hearings.

This Inquiry Played Out Differently Than the One in 2014

In 2019, the United Kingdom’s High Court granted a request from the family for a new inquest over the girl’s death, in light of the new evidence and research that had been gathered – sending the case back to London’s Southwark Coroner’s Court for another round of hearings.

In the 2019 hearing where the new inquest was granted, Judge Mark Lucraft said: “In our judgement, the discovery of new evidence makes it necessary in the interests of justice that a fresh inquest be held.”

The past two weeks in the Coroner’s Court played out a very different inquiry over what took the 9 year-old’s life. Government departments, officials from the local authority, and even Sadiq Khan, the Mayor of London were questioned about what they did – or did not do – to reduce illegal air pollution levels in the area where Ella lived, where levels of nitrogen dioxide air pollution from traffic constantly exceeded annual limits of 40 µg/m3 between 2006 and 2010.

The mayor said the coroner’s conclusion was a “landmark moment” and called pollution a “public health crisis.”

“Today must be a turning point so that other families do not have to suffer the same heartbreak as Ella’s family. Toxic air pollution is a public health crisis, especially for our children, and the inquest underlined yet again the importance of pushing ahead with bold policies such as expanding the ultra low emission zone to inner London.”

According to the WHO, air pollution kills an estimated seven million people worldwide every year, including 4.2 million deaths from outdoor air pollution generated by industry, road traffic, energy production and building heating, among other sources.

The most health-hazardous pollution components include PM 2.5, these fine particles measure 2.5 microns in diameter, meaning that 400 particles can be fit into a single millimetre. These tiny particles can not only enter the lungs but also penetrate into the bloodstream. Excessive levels of nitrogen dioxide, also emitted by vehicles, are closely associated with higher risks of chronic respiratory infections, including asthma.

UK scientists estimate that air pollution shortens British lives by an average of six months. The combined effects of outdoor and household air pollution cause about seven million premature deaths every year – with increased mortality from stroke, heart disease, chronic obstructive pulmonary disease, lung cancer, and acute respiratory infections. Evidence is also growing that it can limit the growth of children’s lungs.

Rosamund Kissi-Debrah told the coroner that had she known the air her daughter was breathing was killing her, she would have moved them away immediately. “We were desperate for anything to help her. I would have moved straight away, I would have found another hospital for her and moved. I cannot say it enough. I was desperate, she was desperate,” she said.

News of the Court Ruling Echos Globally

News of the court judgement echoed quickly around the world, sparking hopes that the landmark ruling may create a precedent that could prevent other children in Ella’s situation from suffering as she did. Advocacy groups for air pollution are already working on ensuring that children are saved from this ‘silent killer.”

Rosamund Kissi-Debrah appearing on television following the ruling.

The NCD Alliance said: “Heartfelt thanks for your tireless work to gain this landmark recognition. You and your family are heroes to so many of us now and to future generations.”

Professor Clare Horwell, an air pollution expert at the UK’s Durham University said: “This is a very important result. I want to say congratulations but that doesn’t feel right. Your enormous dedication has paid off. Ella can never be replaced but her legacy will be remarkable.”

“We celebrate this judgment with a heavy heart. But also huge admiration for a mum who just wouldn’t give up,” tweeted the Indian air pollution advocacy group Care for Air, based in Delhi, which suffers from some of the highest air pollution levels in the world.

Indian groups are already looking at  ways to pursue court claims over health damage wrought by air pollution. One India environmental activist told Health Policy Watch. “We are trying to do something around personal compensation,  and this would be a great precedent,” she said. “Our research is at a very vey early stage and we hope others will beat us to it. Yes, with strong advocates, we could use Indian courts … although with the current dispensation of the government, and compromised judges I am not sure it wouldn’t be dismissed.”

Let Me Breathe, another New Delhi-based platform tweeted:  “Ella died because of air pollution. Thank you [Rosamund Kissi-Debrah] for fighting this fight. It is a step to save many more children.”

Long Journey Though the Court Process

While the journey often seemed quixotic, Ella’s mother did not give up.  And along the way the determination of Rosamund snowballed, gathering her support from not only the world’s most famous air pollution and health experts, but also celebrity figures.

On Tuesday, just before the court case ruling was issued, former California Governor Arnold Schwarzenegger sent her a letter, saying:

“My thoughts are with you and your family tonight, ahead of the release of the coroner’s invest into Ella’s tragic death. I know this is the culmination of years of hard work on your part to have pollution’s terrible impact on your daughter acknowledged.  As a father, I cannot think of anything worse than what you have been through… You are a hero.”

In a statement issued just ahead of the court ruling, Rosamund said: “Professor Stephen Holgate who described the nine-year-old girl’s condition as ‘a canary in a coal mine’. It seems it was always going to end in a disaster no matter how hard we tried to maintain her. When your triggers are spikes in air pollution, I guess it was always going to end in heartbreak.”

“The past six years of not knowing why my beautiful, bright and bubbly daughter died has been difficult for me and my family, but I hope the new inquest will answer whether air pollution took her away from us,” she said in 2019, just after the new court hearing was granted.

“If it is proved that pollution killed Ella then the government will be forced to sit up and take notice that this hidden but deadly killer is cutting short our children’s lives.”

Now that proof has become a reality.

Image Credits: @rosamund_ElsFdn.

Rialto Bridge, Venice, deserted in lockdown – scene from the suppressed WHO report, “An Unprecedented Challenge.”

Second in a series: In the wake of the expanding media attention to a suppressed WHO report evaluating the early days of Italy’s COVID-19 pandemic response, WHO has begun circulating guidelines to staff for responding to the media over questions that have remarked about recommendations for Q&A

The internal WHO memo obtained by Health Policy Watch  instructs staff to tell the media that the report An unprecedented challenge was recalled after WHO “found some factual inaccuracies related to the timeline of the pandemic – and that the data had not been properly verified.”

The detailed guidance – entitled “Reactive Q&A in case of media questions” and red-marked “Internal- do not share”  provides no details about what “factual inaccuracies” were in fact unearthed in the report – which had undergone multiple layers of formal WHO review and approval before its publication on 13 May – and subsequent removal. 

Framed as a Mock Q&A 
WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 1

Framed as a  mock Q &A, the WHO guidance  poses questions that the media may ask about the report in forthcoming days – and provides explicit instructions for how WHO staff should respond.  

More than corporate guidance, however, the tone and detail of the mock responses build a corporate narrative that clearly supports the moves made in May by WHO Assistant Director General Ranieri Guerra, a political appointee handpicked by WHO Director General Tedros –  to bury the report – against the views of the career professionals that developed it.    

The WHO recommended media “answers” shape a public narrative supporting Guerra’s attempts to change or remove key report sections that were critical of the Italian government’s preparedness efforts – over the objections of professional staff that said this amounted to political censorship.   

The report, compiled by a large WHO team, under the direction of Francesco Zambon, WHO’s coordinator of  the WHO European Office for Investment for Health and Development, Venice, had undergone multiple layers of scientific review and publications approval prior to being published.

Street vendor in Italy – Scene from the suppressed WHO Report, “An Unprecedented Challenge”

It was withdrawn by WHO just a day later – in what critics say amounted to a worrisome act of political censorship – led by ADG Guerra who had a vested political interest in seeing to the report’s suppression.   

Guerra, a former senior official in Italy’s Health Ministry, was in charge of the country’s prevention activities during his 2014-2017 term in the government. It was a period when a national pandemic plan dating from 2006 was supposed to have been updated according to an 2013 European Commission request. But the plan was not updated.   

WHO Assistant Director General, Ranieri Guerra

Guerra  reportedly sought to blur the WHO record over that omission by ordering Zambon to amend language in the WHO report to state the opposite – that Italy’s pandemic plan had been “updated” in 2016.  

Zambon refused, according to a lengthy series of Health Policy Watch interviews with Italian and WHO insiders. Those were supported by a series of leaked email exchanges between Guerra and Zambon over the censorship issues, first published several weeks ago in Italy’s highly-regarded RAI Report TV series. 

Francesco Zambon,  WHO European Office for Investment for Health and Development

Yet another new email, detailing Zambon’s subsequent protests to his boss, Hans Kluge, head of WHO’s Regional Office for Europe, over the pressures that Guerra had applied, was disclosed in a story Tuesday by Health Policy Watch. 

In the  27 May email to Kluge, Zambon described the pressures Guerra had applied – and warned of the impacts to WHO’s credibility and independence that could occur as a result of political censorship moves.  

Zambon attributed the pressures to Guerra’s own fears of political embarrassment – due to his own failure to update the 2006 pandemic plan.   

WHO Soundbites Deflect Charges that Censorship Was Inappropriate  
WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 2

Over the past weeks, the Italian media obsession with  “An unprecedented challenge” – the report’s origins and suppression – has spread internationally.  Observers also see it as a bellwether for how WHO may also handle other, even more contentious investigations ongoing now into the global pandemic response and the origins of the SARS-CoV2 virus that first emerged in Wuhan, China. 

Critics wonder if those forthcoming WHO reports also be reviewed in light of their politically correctness – and cleansed of language critical of any government in the world or any former national government official with political influence in WHO?  

In the case of the Italian report, the internal WHO media guidance, sets a standard for that – deflecting complaints over Guerra’s attempts to alter the report  – and justifying his attempts to censor unflattering phrases. 

Has WHO been covering up for Italy? 

This is one of the key questions in the mock series that the WHO guidance poses. 

WHO response: No, WHO engages in frank and forthright communications with governments on an ongoing basis. The organization undertakes all activities impartially and without fear of retribution or expectation of favor. 

However, there are emails from WHO staff saying that they were doing that. WHat can you say about this?

WHO response: Those messages refer to avoiding unnecessary criticism of Italy at the most difficult time in the response. This had nothing to do with covering up information.  A pandemic response should focus on saving lives. We have a mechanism for counties to evaluate their respective response and offering guidance for effective response.

The media statements also pin the blame onto Zambon for not involving the Italian government directly in the redaction of what was supposed to be an independent review of Italy’s pandemic response – and one in which Guerra was the named liaison. 

WHO Refuses Italy’s Request to let Staff Testify in Investigation Over Pandemic Response 
WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 3

The WHO memo further states that WHO will refuse Italy’s recent requests to allow Zambon testify in an ongoing Italian investigation into the management of the pandemic’s early days  – in the northern region of Val Seriana – which was particularly hard hit.  

Italy’s Ministry of Foreign Affairs sent the request to WHO’s Director General Dr. Tedros Adhanom Ghebreyesus requesting permission for  Zambon to be interviewed by the legal team investigating the slow and faulty government response to the pandemic in the region.  This is after Guerra did already provide testimony to the prosecutors. 

WHO’s mock response to questions about the legal case states: 

“WHO staff are international civil servants. The organization and its employees undertake all activities impartially and without fear of retribution, expectation of favour. To preserve its objective and independence, the organization does not become involved in any political administrative or legal matters at the national level.”

[If pressed] the guidelines state that WHO staff should add:  “Rainieri  Guerra spoke with the Bergamo authorities in his personal capacity, WHO did not authorize him to speak to the prosecutor.”

With regards to Zambon specifically, the WHO memo instructs staff to state: 

“If Dr Zambon testifies in his personal capacity, he cannot speak about any matters related to WHO, his work or function with WHO, other WHO officials, or disclose or refer to any documents or information owned by WHO, including correspondence or verbal exchanges,” states the guidance from WHO about how to respond to media inquiries about the legal investigation, adding. 

“WHO has requested information from the Prosecutor and the Ministry of Foreign Affairs of Italy and has offered to reply to written technical questions in writing. No reply to these questions has been received.” 

Page 4
WHO Confirms  – Using Guideline Soundbites Word For Word

Asked Tuesday night by Health Policy Watch about the pending Italian request for Zambon to testify, a WHO European Office spokesperson replied, using the memo’s guideline language, almost word for word.  It stated: 

“WHO has requested information from the Ministry of Foreign Affairs of Italy (from the prosecutor) and has offered to reply to written technical questions in writing. No reply has been received.

“WHO staff are international civil servants. The organization and its employees undertake all activities impartially and without fear of retribution or expectation of favour. 

“To preserve its objectivity and independence, the organization does not become involved in any political, administrative or legal matters at the national level. 

“Ranieri Guerra spoke with the Bergamo authorities in his personal capacity. WHO did not authorize him to speak to the prosecutor. If Dr Zambon decides to testify in his personal capacity, he cannot speak about any matters related to WHO, his work or function with WHO, other WHO officials or disclose or refer to any documents or information owned by WHO, including correspondence or verbal exchanges.”

WHO Narrative Justifies Guerra’s Attempts to Suppress Report’s Critical Phrases 

Among the other key points covered in the WHO narrative of the doomed report as it is to be presented to the media, are the following:   

Censorship: “Did Ranieri Guerra censor the report?  “No, that was an internal WHO decision taken at the level of the Regional Office. The document was removed because it contained some factual inaccuracies related to the timeline of the pandemic,” states the memo. 

Official status of document: Although the report, had gone through all the layers of official WHO approval and bore a WHO copyright and logo, the WHO memo instructs staff to say that it “was not an official WHO document” and was “never sent to the [Italian] Ministry of Health, which therefore has never assessed or commented on it” according to the memo. … . 

Deletion of embarrassing phrases: The WHO memo defends Guera’s attempts to remove a report reference to the initial hospital response as “improvised, chaotic and creative?”. 

Pandemic plan update: In a mock question that asks:  “Is it true that Italy’s pandemic plan had not been updated since 2006, and the initial response from hospitals was “improvised, chaotic and creative?” WHO replies stating: “The COVID-19 pandemic has been unprecedented and many countries have faced huge challenges, including Italy. Italy was the first country in the European Region to be hard-hit, with the situation escalating in a matter of days. The initial response was particularly complex.  However, words like ‘improvised, chaotic and creative’ do not do justice to the tremendous efforts of the Government and the regions.”   

Cover-up:  While denying that WHO has been “covering up for Italy,” the memo effectively defends Guerra’s attempts to squash or alter key statements in the report on the basis that they would be embarrassing to the Italian government. If reporters asked about the “leaked emails from the Regional Director appearing to keep the report under wraps” WHO officers should reply as follows: “The message referred to the importance of engaging with the national counterpart, which is a normal practice to check data and facts.. However the Minister of Health of Italy was apparently not informed in an appropriate way and in due time”. 

WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 5
Zambon – Italian Ministry Of Health Could Not Co-Author Independent Report    

The independent review of Italy’s response had passed through all of the usual WHO publications approvals – before Guerra noticed language that he found politically sensitive, and demanded changes in specific texts in a series of emails to Zambon around 11 May.  

In his 27 May email to WHO’s European Regional Director, Hans Kluge, disclosed by Health Policy Watch in a previous story, Zambon had stressed that Guerra was the person who had been tasked with conveying an outline of the report to the Minister of Health Robert Speranza in April.  

And Guerra also was interviewed by one of the report’s co-authors, so he was therefore “fully informed.” If he did not convey the outline to them, “he is directly responsible for the incident with the Minister/President ISS   [Italy’s National Health Institute  (Istituto Superiore di Sanità, ISS)], that he not only created, but ignited,” recounted Zambon.   

However, in order to preserve the independent nature of the WHO review, Zambon said, the report was never intended to be directly co-authored with Italy’s Ministry of Health. At stake, is: “WHO independence – This is an independent review.  I cannot see how this could be written together, nor reviewed by the involved parties such as the MOH, ISS as suggested.” 

Zambon also warned Kluge about the damaging precedent the censorship move could set in light of the recent World Health Assembly mandate to WHO to carry out other politically charged  investigations into the global pandemic response and the origins of the SARS-CoV2 virus – which have already encountered political resistance from China. 

WHO Response to Health Policy Watch  – ‘We Won’t Discuss Factual Inaccuracies’ 

Asked in a follow-up email from Health Policy Watch Tuesday evening to detail what were the factual inaccuracies that led to the withdrawal of the report, a WHO spokesperson declined to say:

Q. Health Policy Watch: What specifically are the errors in the report?  Since the report is online and circulating widely, please be specific with an actual date, number or other factual information that you found, post-publication, to be so incorrect that the report had to be withdrawn – rather than merely corrected?

WHO:  We are not going to discuss factual inaccuracies. 

 

 

The new initiative is intended to support young people who will join a workplace changed by the COVID-19 pandemic, including the 1 billion children worldwide who have missed out on education.

As the dust began to settle in June 2009 in the aftermath of the global recession, 81 million young people found themselves out of work, as the youth unemployment rate rose to 13%.

But unemployment as a result of the COVID-19 pandemic – with 1 in 6 young people worldwide having already lost their job – is expected to far exceed that figure if there is no policy intervention. Even among those still in work, working hours (and subsequently wages) plummeted, with the Americas and Central Asia seeing an 18% and 14% drop respectively.

And for those yet to enter the workforce, 2020’s economic fallout could very likely leave a deeper scar lasting for years to come: more than 1 billion children and young people have been kept out of education this year, as schools and universities closed around the world.

It was up against this backdrop that the World Health Organisation (WHO) and the UN Foundation launched its new initiative to invest in youth-led solutions to the pandemic, in collaboration with the world’s largest youth movements.

Speaking at a press briefing on Monday, WHO director general Dr Tedros Adhanom Ghebreyesus, confirmed the Organization would be providing US$5 million to support the Global Youth Mobilization for Generation Disrupted scheme.

“We hope that it will become a platform for supporting progress towards other health goals, including universal health coverage (UHC),” he said, adding that the youth voice is crucial in creating effective supportive policies.

In January 2021, the initiative will issue a call for proposals from youth groups to determine youth-led COVID solutions, ahead of a Global Youth Summit in April 2021.

The scheme is supported by the Big 6 Youth Organisations, consisting of: YMCA and YWCA, the World Organization of the Scout Movement, the World Association of Girl Guides and Girl Scouts, the International Federation of Red Cross and Red Crescent Societies, IFRC, and The Duke of Edinburgh’s International Award.

The full announcement can be read here.

Image Credits: Source: Allison Shelley/The Verbatim Agency for American Education.

Although world leaders have tested positive for the virus over the past year, Dlamini’s death – within weeks of a positive test – is a first.

Ibadan, Nigeria. Ambrose Dlamini, eSwatini’s Prime Minister, has become the first world leader to die after testing positive for COVID-19. His death sends a clear and chilling message across Africa: the worst days of the pandemic are not behind us.

Dlamini passed away on Sunday 13 December in South Africa, where he was receiving treatment after his condition worsened two weeks ago. This followed a positive test for coronavirus in mid-November. The government’s official statement on its Prime Minister’s death did not state a cause.

The late Prime Minister, who will be buried in a state funeral, had held office since October 2018.

Although many world leaders have tested positive for the virus over the past year, including US President Donald Trump and Brazil’s Jair Bolsonaro, Dlamini’s death – within weeks of a positive test – is a first.

eSwatini, formerly Swaziland, is to the northeast of South Africa.
HIV Response Has ‘Lost a Champion’: eSwatini Was First African Country To Meet 2030 HIV Targets

Under his leadership, eSwatini, a small landlocked country adjoining South Africa, became the first on the country to meet UNAIDS’ 95-95-95 targets to end the HIV/AIDS epidemic by 2030.

UNAIDS’ Winnie Byanyima said: “The HIV response has lost a champion.”

95% of people living with HIV in eSwatini know their status, 95% of people who know they are HIV-positive have accessed treatment, and 95% of people on treatment have suppressed viral load. eSwatini and Switzerland became the first in the world to meet these targets, back in September.

At the time, he urged the population not to rest on its success, nor to be discouraged by setbacks. “We must ensure that no one is left behind. We must close the gaps,” he added. “We are aiming for 100–100–100.”

In September, Dlamini told Health Policy Watch that, while his country is not fully equipped to deal with pandemics, it had successfully leveraged its HIV/AIDS response to expand capacity to treat members of the population with COVID-19.

“We’ve developed some capacity that we are going to leverage going forward,” he said. “We are going to use the national response framework which has really done well, providing us with capacity over the years. We want to develop it so the country to deal with future pandemics.”

Speaking about his death, UNAIDS Executive Director Winnie Byanyima said: “The HIV response has lost a champion.

“He was a friend of UNAIDS and helped to steer his country to great successes in the HIV response. We will miss him.”

eSwatini’s Rising COVID Case Rate is a Warning for the African Continent

But despite all of this, eSwatini has struggled to keep COVID cases from rising. The country has the 6th highest infection rates of SARS-CoV-2 on the continent, with 5,855 confirmed cases per million population. The continent’s average is 1,765: three times less.

And although Africa has repeatedly dashed expectations during the pandemic, faring much better than most developed countries, that infection rate in eSwatini is growing aggressively: a trend found in its neighbouring countries.

According to eSwatini’s health ministry, among its population of 1.1 million, the country has recorded 6,768 cases and 127 deaths, leaving a case fatality ratio (CFR) of 1.9%, only slightly lower than the global CFR at 2.2%.

Lizzie Nkosi, the country’s Minister of Health, confirmed reports of recent increases in the number of COVID-linked deaths, flagging that the rise was particularly significant among people with co-existing medical conditions like diabetes, hypertension, cardiac disease and asthma.

“We therefore urge the public to ensure that they do medical check-ups regularly, at least once a year and those diagnosed with a chronic illness should adhere to the treatment as advised by the health workers,” the ministry stated.

This warning came 11 days before the Nigeria Center for Disease Control (NCDC) announced it had recorded “a sharp increase” in the number of COVID-19 cases across the country between 30 November and 6 December, sparking fears of an imminent second wave.

NCDC added that the proportion of people who were COVID-positive among those tested had increased from under 4% to 6% compared to the previous week – still lower than the continental average of 10.7%.

Elsewhere, in Tunisia, more than 1 in 5 COVID tests returned positive results, marking the highest positive test rate in Africa.

Despite the Surge, African Health Leaders Fear They May Not Get Vaccines Until Mid-2021

This all comes as the continent watches countries in the Global North begin their COVID-19 vaccination campaigns. Africa is not expected to have access to vaccines until mid-2021. And as the holidays fast approach, Africa’s national and regional health authorities are concerned that citizens also are ignoring recommended guidelines.

Earlier in December, Dr. John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) told Health Policy Watch that the gains made on the continent regarding the control of the pandemic are being threatened.

To compensate, African leaders need to be more vocal in encouraging citizens to embrace and adhere to guidelines: “My greatest concern and fear is that the gains we’ve worked so hard to achieve may be eroded significantly if we relent [in] our public health and social measures. We need to go back to the basics – washing hands, keeping our distance, and most importantly, wearing masks.”

The daily confirmed COVID-19 cases per millions people, in Nigeria, Tunisia and across the continent.

But the key messages shared by Nkengasong and other public health officials aren’t attracting much attention. Among other political and business leaders and the general public, the widespread feeling is that stricter measures and adherence, as proposed, would extort a significant toll on mental and physical health, and on national economies: as is the case around the world.

In African countries like Nigeria, as well, many people have yet to come to terms with the fact that the pandemic threat is real.  In July, Health Policy Watch reported that the city’s leadership and a significant proportion of the general public do not consider the threat of COVID-19 to be strong enough to halt education or put families out of work.

Despite the surge in cases seen in Nigeria, outdoor events are already returning, with indoor events also potentially on the horizon. On the other side of the continent, elections in Uganda have caused considerable mass gatherings for political rallies, with subsequent infection surges. And this is not deterring Ghanaians, who are now massing for their own election events. Even though regulators are advising against travel, citizens are doing so regardless.

The laissez faire attitude has been attributed by public health experts as a result of the continent’s comparative success in handling the pandemic earlier in the year, as developed countries collapsed under the strain.

Perhaps the news of Dlamini’s death could convince populations across Africa that the sky is yet to fall on the continent. It could be that this visualises the human cost of the pandemic in a way that data can’t. Regardless of the outcome, it is clear that for Africa the worst days are not yet behind it.

Image Credits: World Economic Forum, Johns Hopkins University & Medicine, World Economic Forum.

Piazza di Spagna. Rome – Scenes from the suppressed WHO Report, An Unprecedented Challenge

The World Health Organization’s suppression of an independent report that critically examined both the strengths and weaknesses of Italy’s COVID-19 pandemic response – sets a dangerous precedent that compromises the international organization’s credibility  at a time when WHO’s independence has been questioned – and the Italian national pandemic response is under intense scrutiny as well, longtime WHO observers in Italy are saying. 

The controversy revolves around the WHO report – “An unprecedented challenge – Italy’s first response to COVID-19” – which a senior WHO official, Ranieri Guerra attempted to censor and revise – before the publication was removed entirely by WHO’s European Regional Office from its official online link, just a day after being published in mid-May.   

Guerra, WHO Assistant Director General of Strategic Initiatives, is a former high-ranking official in Italy’s Ministry of Health,  who served as director of the Ministry’s Prevention department between 2014 and 2017.  

As head of the Prevention team, Guerra should have taken the lead in the updating of Italy’s 2006 national pandemic preparedness plan – as per a 2013 European Commission request to EU member states. But the plan was never updated, critics say.  

A series of Health Policy Watch interviews with knowledgeable insiders suggest that Guerra sought the removal of the WHO report – largely to protect himself from claims that he and other senior officials had failed to update Italy’s pandemic preparedness plan in the period he served in the national government.  

WHO has explained the report’s disappearance saying that it had contained “factual inaccuracies” that needed to be remedied.  But the report was painstakingly researched and executed by a large and experienced team of experts, under the direction of a senior figure in WHO’s Venice office, Francesco Zambon.

A series of email exchanges between Guerra and Zambon as well as a new email disclosure, from Zambon to WHO’s European Regional Director, Hans Kluge that was obtained by Health Policy Watch, underline that the controversy swirling around the report was quintessentially political. Guerra even admitted in one email to Zambon that the report’s factual content was solid – but it needed to be alterered or removed because it would embarrass the Italian government. 

WHO Assistant Director General, Ranieri Guerra

Critics say that Guerra was in fact acting to protect himself and other Italian government figures for alleged shortcomings in updating preparedness plans in the years just before the COVID-19 pandemic erupted. 

It is the narrative around those facts that Guerra sought to blur, they say, leading to the mysterious and disquieting removal of An unprecedented challenge, from the WHO website, on May 14, only a day after it had been published.  

The concern about the report’s suppression is all the more relevant today – insofar as a number of highly sensitive WHO-led investigations are underway to evaluate the global pandemic response, as well as performance of China and other countries worldwide.  

Wonders one longtime WHO observer: “If this is the situation with a European country with middling powers, what will be the outcome in the future when the Chinese role in the pandemic will have to be assessed?”

Updated Pandemic Plan Could Have Saved 10,000 Lives 

An adequate pandemic plan, and its implementation at the regional level, could have saved 10,000 Italian lives among the 65,000 deaths recorded as of 14th December, according to one report of on Italian bio-emergency expert, Pier Paolo Lunelli. 

No such plan was in place when the mysterious coronavirus got its foothold in northern Italy in early 2020.  And the WHO report describes the early days of hospital response in unflinching terms, stating:  

“Unprepared for such a flood of severely ill patients, the initial reaction of the hospitals was improvised, chaotic and creative.” 

In a series of emails on 11 May, recently aired on the investigative news programme, RAI Report of Italy’s public TV channel, Rai3, Guerra demanded that the references to chaos and improvisation be deleted. 

He also ordered Zambon to amend a reference to the 2006 national pandemic response plan, so as to say that had been  “updated” in 2016 – a revision that Zambon refused to make – because it was untrue.   

Guerra demands a change in the report to say that the pandemic preparedness plan was “updated” in 2016. Zambon, lead coordinator refused, saying that would have been untrue.

In late May, just after the WHO account had been withdrawn from the WHO publications data base and officials were debating what to do next, Zambon sent an email to Hans Kluge, director of WHO’s Regional Office  protesting Guerra’s censorship moves – which he said had been politically motivated – and accompanied by threats against him of “dismissal” from his job.  

In Zambon’s email of May 27 to Kluge, Zambon warned that the pressures being applied by Guerra to modify the report could backfire – compromising WHO’s “independence and transparency.” 

“If a second revised version is issued with tailored ‘depurations’ of the text, consequences to the already compromised image – on this very point – of WHO will be, I am afraid, inevitable,” stated Zambon, who is Coordinator of WHO’s Venice-based European Office for Investment for Health and Development. 

Instead of being amended, the report was simply buried by WHO.  But the Italian public and media, still restlessly sifting through the events that led up to the nation’s pandemic debacle, won’t let it die.  

Was Guerra Protecting WHO’s Reputation – Or His Own?
Francesco Zambon, Coordinator of the WHO European Office for Investment for Health and Development in Venice, Italy

By seeking the removal of the references to Italy’s lack of preparedness in the pre-pandemic period, Guerra was protecting himself from criticisim over his own performance during the years in which he would have been responsible for updating those same plans, Zambon also suggested to Kluge.

“On 11 May, before seeing the sentence about the lack of a pandemic plan (which is a mere fact) Guerra emailed me saying that the publication is fantastic….” said Zambon. 

“Then he saw the sentence about the pandemic plan (first sentence 2.1 chapter), he first intimated me to remove it (email proving that) and then calling saying that if I had not removed it, he was already on the doorstep of the DG, saying that I was putting WHO under attack.”  

Already in May, Italian television was beginning to investigate the matter – and one TV report was “fully devoted to Guerra on the pandemic plan, as he was director of prevention at the MoH 2014-2017 – a second episode of the documentary further elaborated the point by showing that the text of the pandemic plan has not been updated since 2006,” Zambon informed Kluge. 

“As Guerra is a WHO advisor in Rome, should there be legal/administrative investigations on him, implications for the organization might be severe,” he further warned. 

Since May, the mysterious chain of events leading up to the report’s suppression have been the focus of further investigation by RAI Report, led by director Sigfrido Ranucci and lead reporter Giulio Valesini. 

The narrative illustrates how Guerra’s censorship efforts not only blurred the record over critical moments in pandemic response – it also breached the traditional “separation of powers” that has traditionally existed between WHO’s international staff – and their former roles and careers in national governments.   

Appointment of High Level Officials From National Governments – A Common Practice

Guerra’s move from a high level position in Italy’s Ministry of Health to WHO headquarters in Geneva in 2017, was not at all unusual.  

There is a long tradition of WHO Director Generals recruiting high-ranking WHO officials from countries that are major WHO donors or supporters – and Italy is one of those countries in the EU bloc.

There had also been friction between Italy and WHO during the previous WHO administration of Director General Margaret Chan – centering around Rome’s opposition to new WHO guidelines on limiting sugar intake which rankled some of Italy’s powerful food industries. 

And so incoming Dr Tedros Adhanom Ghebreyesus was also keen to repair those bridges – and the appointment of an experienced and high ranking Italian in his administration signaled a turning of the page. Shortly before the report on Italy’s pandemic response was completed, Italy also made a major US$ 10 million voluntary contribution to the WHO. 

Even so, once such high-level appointments are made, the Organization has traditionally maintained a firewall against deeply involving those same officials in WHO reports or activities involving their country of origin. 

“Traditionally, once professional staff or senior staff are recruited internationally in Geneva they are not supposed to be involved with, or reassigned back to their countries of national origin,” notes one longtime observer familiar with WHO’s employment protocols. 

Guerra’s case, however, was unusual. After being recruited by WHO to Geneva office in 2017, he was “seconded” back to Italy’s Ministry of Health in March, 2020. But he also retained his WHO title as an Assistant Director General, and with it, the implicit affiliation with WHO headquarters and senior management.  

That, say insiders, is a clear breach of traditional WHO protocols for its international staff.  

“No ToR for his function to be found in Italy at the MoH,” said one observer close to the situation.  “Whereas it is a common practice  to have Member States second their staff to the WHO as a form of institutional support to the agency – this time it was a WHO staff to seconded to the staff of a national government – and to his country of origin – contrary to common practice.” 

Report’s Repression Has National and International Implications  
St. Marks Square, Venice, devoid of tourists and pilgrims during lockdown

The supression of the WHO report on Italy’s pandemic response reverberates on both the national and international level, commented Italy’s Deputy Health Minister Pierpaolo Sileri on an Italian TV programme last Sunday, focusing on the WHO imbroglio.  

Firstly, the involvement of an influential Italian official in censoring a WHO report that was critical of his country – sets a bad precedent for the much broader WHO investigations that are just getting underway  into the global pandemic response and the origins  of the SARS-CoV-2 virus. 

That latter investigation is particularly sensitive as China so far has refused to even allow a visit to the country by the independent WHO committee charged with investigating the SARSCoV-2 virus origins – effectively barring investigators from the place where the first human infection clusters appeared in Wuhan in late 2019. 

Secondly, suppression of the report stands to potentially harm the communities in northern Italy that were the worst hit by the virus – and are still waging a legal battle to get to the roots of why their hospitals and factories remained open – even as infection rates were exploding. 

Just recently, WHO legal officials also have resisted appeals by Italian legal officials to let  Zambon and others involved in preparing the report to testify in an ongoing legal investigation over the government’s  slow and faulty pandemic response.

Mapping of the initial phases of the COVID-19 outbreak in the WHO report, “An unprecedented challenge.”

The legal investigation is centered around the northern Italian town of Bergamo, in the Val Seriana  region. The area, which has very close business and manufacturing ties with China, was one of the first epicenters of the outbreak. 

National government officials were slower to lock down the area than other nearby locales. Rather than shutting Bergamo and neighboring communities down quickly, as per the decisions taken for some other hotspots in northern Italy, the central government’s response in the Val Seriana region was marked by a series of zig-zags that remain unexplained until today.   

After WHO rebuffed a number of subpoenas from local legal officials requesting Zambon and other members of his team to testify in the local investigations, citing a 1947 UN Convention that grants staff of international agencies immunity to many forms of legal proceedings, Italy’s Ministry of Foreign Affairs last week  submitted a formal request to WHO to allow Zambon and others involved to allow them to testify.  

“In view of the excellent collaboration between Italy and the WHO, further strengthened during the Covid19 pandemic, I ask you to consider – in the spirit of Section 22 of the 1947 Convention – the possibility of allowing the WHO officials and experts to comply with the Attorney’s request to appear for interview as persons informed about the facts,” states the Italian MFA letter to WHO’s Dr Tedros delivered in Geneva last week.  

Breaches Of Good Practice Are Institutional – As Well As Individual 

Guerra’s initial attempts to alter the report prior to its publication, were described in detail by the Italian investigative news series Rai Report. A brusque email reportedly sent by Guerra to Zambon on 11 May, and aired on the TV programme over the past two weeks, stated [in Italian]: 

“You need to correct the text immediately: national influenza pandemic preparedness and response plan; Ministry of Health; 2006 (…) And report what is available on the Ministry of Health website (…) last update in December 2016. Don’t mess me up on this one. …I begged you to let me read the draft before printing… damn it…Now I’m blocking everything with Soumya,” it states – a reference to WHO Chief Scientist Soumya Swaminathan. 

“Get me the modified version as soon as you can. It simply can’t come out this way. Please no bullshit. Thank you and excuse the tone, Ranieri.”

WHO ADG Ranieri Guerra explains why WHO criticism of Italy would harm the current government – which just gave the organization 10 million Euros.

In a follow-up mail, also aired by RAI Report, Guerra assured Zambon that “there are no doubts or criticisms about a work that is certainly valuable from the point of view of content,… but I don’t think you fully realize what political issues are overlapping at the moment.” Guerra went on to say that a critical WHO account of Italy’s pandemic response would be perceived as undermining the current Minister of Health, Robert Speranza and thus not be “doing the country a good service” – particularly in light of the fact that Italy had just given WHO a major voluntary donation amoungt to €10 million.

But the intrusion of politics and related breaches of practices in technical activities are not Guerra’s alone, informed observers point out. An institutional pattern of conflicts that has also emerged out of the narrative.  

Whether it was Kluge or WHO Director General Dr Tedros himself who made the decision to pull the WHO report on Italy’s response – after it had already been formally approved and issued – Zambon’s job is also now on the line, sources say. This is despite his longtime tenure in WHO and six years of “outstanding” performance evaluations. 

He has reportedly been obliged to engage a lawyer in Italy as well as one in Geneva – as well as placing a case before the WHO Ombudsperson. 

Zambon Warns Of Harm to WHO’s Reputation – Impacts on Other Investigations 

In his lengthy email of 27 May, Zambon also warned Kluge about the potential reputational and organizational impacts of Guerra’s attempts to censor the report and interfere in its final publication.

“Dear Hans, I received your message yesterday and understood that Guerra is “negotiating” with counterparts in Italy about the Italy report,” reads the email from Zambon to Kluge. 

“I am puzzled he was given this role as a) he disassociated himself from the report and b) I am the coordinator of the report,” said Zambon. The moves were compromising WHO’s independence and transparency, he added: 

“WHO independence. – This is an independent review.  I cannot see how this could be written together, nor reviewed by the involved parties such as the MOH, Italy’s National Health Institute  (Istituto Superiore di Sanità, ISS) as suggested. 

“WHO transparency.  Publication was disseminated to 15,000 contacts.  If a second revised version is issued with tailored ‘depurations’ of the text, consequences to the already compromised image – on this very point – of WHO will be, I am afraid, inevitable. 

Zambon added:  “The independent review of WHO, decided at WHA [the World Health Assembly] on how WHO reacted to COVID will certainly include products produced by WHO, and cleared by HQ. 

“Being this publication the only one with China reporting on MSs’ [member states} response of one of the hardest hit countries, it will certainly not go unnoticed,” added Zambon.  

He concluded noting that WHO has  “strict procedures for clearance of published products. All approvals were obtained, including HQ clearance.”

But more than that, “A large team of experts worked literally days and nights with one motivation, making sure that what happened in Italy is not repeated in those countries behind in time in the epidemic curve. The report contains important messages, extrapolated from facts on what worked (many things) and the blind spots of the system. No accusatory tone at all is used in the publication. Furthermore it contains a wealth of subnational practices with the unique regional profiles…. 

“I find it difficult to understand how an ad hoc created diplomatic incident (with a specific purpose as mentioned above) can withhold what could surely be of benefit to a large number of MSs {member states],” Zambon concludes. 

After Withdrawing Report – WHO Issues Video Praising Italy’s Response  

WHO did not stop with the withdrawal of a painstakingly detailed and substantive report. In late September the Organization also posted a video on Italy’s pandemic response, which contained nothing but praise. No mention was made of the delayed response to the initial clusters of outbreak in Bergamo –  or the failure to update the 2006 preparedness plan.  Rather,  events were framed as entirely unexpected and unavoidable: “We woke up like in a bad dream” one official, Flavia Riccardo, is quoted in the video as saying.

On Monday, WHO”s European office published a press statement about the report, stating the following: 

“On 13 May 2020, the WHO Regional Office for Europe published a document titled “An unprecedented challenge: Italy’s first response to COVID-19.”

“The document, written by experts based at the WHO European Office for Investment for Health and Development, in Venice, Italy, focused on the Government of Italy’s pandemic response. It was intended for use by other countries who might wish to learn from Italy’s early experience fighting COVID-19.

“Following publication, factual inaccuracies were found in the text and the WHO Regional Office for Europe removed the document from the website, with the intent to correct errors and republish it. By the time corrections were made, WHO had established a new global mechanism – called the “Intra-action Review” – as a standard tool for countries to evaluate their responses and share lessons learned. The original document (“An unprecedented challenge”) was therefore never republished.

“At no time did the Italian government ask WHO to remove the document.”

Asked about the announcement at the Monday WHO press briefing, WHO referred reporters to WHO’s European Regional Office for further comment. 

 

Image Credits: WHO, An Unprecedented Challenge .


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UK Health Secretary Matt Hancock.

Sixty different local authorities in England have reported around 1,000 infections caused by a new COVID-19 variant.

The variant is not thought to have an impact on disease severity or mortality, or on the efficacy of a vaccine. It has been reported to WHO.

Health Secretary Matt Hancock said in Parliament today: “We have identified a new variant of coronavirus which may be associated with the faster spread in the South East of England. Initial analysis suggests that this variant is growing faster than the existing variants.”

“WHO [is] working together with scientists around the world, evaluating each of the variants that are being identified,” said Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead, in a press briefing on Monday.

She added that studies designed to understand the “virus’ behaviour, its ability to transmit or its ability to cause different forms of disease” are “underway in the UK”.

The UK is currently experiencing a sharp rise in cases, notably in London, the South East and South Wales.

“Above all, this is a reminder that there is still so much to learn about COVID-19 … The speed at which this has been picked up on is also testament to this phenomenal research effort,” said Dr Jeremy Farrar, Director of Wellcome. “However, there is no room for complacency. We have to remain humble and be prepared to adapt and respond to new and continued challenges as we move into 2021.”

He added that there will be surprises in how the virus “evolves and [in] the trajectory of the pandemic in the coming year.”

The full statement delivered by Matt Hancock is available here.

In the world’s 47 least-developed countries, 50% of healthcare facilities lack basic water services and 60% lack sanitation services. The former is the first line of defence against any infectious disease.

One out of every four health facilities worldwide lacks even the most basic access to water supplies. And in the world’s 47 least developed countries, one in every two facilities lacks such access, according to a new WHO report, co-authored with UNICEF, on access to water, sanitation and hygiene (WASH) in health care facilities.

The report also found that one out of every 10 health facilities, including hospitals, lack sanitation services, and one out of three lack facilities basic waste management services to dispose of health care waste – waste that has exploded during the pandemic with the expanded use of personal protective equipment, SARS-CoV2 testing materials alongside the large amounts of disposable waste that is routinely generated.

The dearth of safe water and sanitation facilities is most dire in the world’s 47 least-developed countries (LDCs), where three in five health facilities lack basic sanitation services, and seven out of 10 facilities fail to segregate and manage infectious healthcare waste management adequately.

The net result is that nearly 2 billion people who rely on those health services, as well as the healthcare workers employed in them, are at heightened risk of infections, including from COVID-19, in the midst of the current pandemic.

The new report Fundamentals first: Universal water, sanitation, and hygiene services in health care facilities for safe, quality care, published on Monday, comes only days after Universal Health Coverage Day was observed.

WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“Working in a healthcare facility without water, sanitation and hygiene is akin to sending nurses and doctors to work without personal protective equipment” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General on Monday.

“Water supply, sanitation and hygiene in health care facilities are fundamental to stopping COVID-19. But there are still major gaps to overcome, particularly in least developed countries.”

The report follows an initial baseline analysis last year of WASH in healthcare. The new report is far more comprehensive than last year’s analysis, providing a more robust profile of the situation around the world, Tom Slaymaker, Senior Statistics & Monitoring Specialist at UNICEF, told Health Policy Watch.

Specifically, this year’s report includes data from 165 countries and 794,000 facilities, compared to last year’s data from 125 countries and 560,000 healthcare facilities.

But large gaps in data remain, he stressed, in global estimates for sanitation, hygiene and environmental services coverage.

Countries Are Off Track When it Comes to Universal Access

Despite some pockets of progress, the report warns that countries are “significantly” off track to achieve universal access to basic WASH services within a decade.

While 85% of the 47 least developed countries surveyed undertook situational analyses on access to WASH services, less than a third have costed out new national strategies to improve the situation. And only 10% have integrated WASH indicators into monitoring of national health systems. This includes just 5 countries: Benin, Serbia, Lebanon, Thailand and Nigeria.

Every dollar invested in hand hygiene alone in health care facilities can generate a return of US$15, OECD found in 2018.

“During these unprecedented times, it’s even more clear how fundamental WASH is for prevention of infections and improving health outcomes,” said the World Bank’s Global Director of Health, Nutrition and Population, Muhammad Pate. “We must work even closer together to ensure that WASH is included in all interventions and at scale.”

Funding WASH in healthcare facilities is among the most cost-effective investments that governments can make, emphasized Jennifer Sara, Global Director for Water at the World Bank Group. Every dollar invested in hand hygiene alone in health care facilities can generate a return of US$15, the Organisation for Economic Co-operation and Development (OECD) found in 2018.

“For millions of healthcare workers across the world, water is PPE,” she said. “It is essential that financing keeps flowing to bring water and sanitation services to those battling the COVID crisis on the front lines.”

WASH is Fundamental to Sustainable Development Goals & COVID-19 Response

As populations around the world anticipate a COVID-19 jab, access to WASH services in healthcare facilities has become more critical than ever before. For healthcare workers – who have borne about 15% of the global COVID-19 case toll, even though they account for only 3% of the world’s population – this is especially pressing

“Many [healthcare workers] have fainted after wearing PPE for a long time,” one nursing officer in India was quoted as saying in the report. “We are dehydrated and not drinking enough water. Nurses are being diagnosed with urinary tract infections – it starts leaking and you want to talk about dignity!”

healthcare workers constitute about 3% of the world’s population but have borne about 15% of the global COVID-19 case toll.

Inadequate WASH services can also fuel neglected tropical diseases, which affect 1 in 5 people worldwide, mostly in low- and middle-income countries (LMICs). They also account for 11 million sepsis deaths a year, a preventable life-threatening condition, predominantly affecting newborn children, pregnant or recently pregnant women, as well as those living in LMICs.

In Malawi, where maternal mortality is 30 times higher than in high-income countries, a midwife said in the report: “I remember vividly [when] we had to take women who had just given birth to a nearby river to wash. It would take 45 minutes. Some would collapse along the way. I felt sad for them. But there was no running water at the health facility.”

Apart from infection control and prevention, access to WASH services can also curb antimicrobial resistance, improve quality care, and bolster health system resilience.

Image Credits: UN Water, UNECE, Government ZA.