The White House, Washington DC. There is currently no clear winner for President
The morning after election day, the winner is still unclear.

With the winner of the presidency and party control of the Senate still unclear the morning after Election Day, the future of the nation’s health system remains uncertain. At stake is whether the federal government will play a stronger role in financing and setting the ground rules for health care coverage or cede more authority to states and the private sector.

As of 4pm CET, Biden has a small lead of 227 electoral votes – compared to Trump’s 213 – having overtaken the incumbent president in key states Michigan, Wisconson and Arizona. Pennsylvania, North Carolina and Georgia are undeclared.

US Presidential Nominee Joe Biden.

Should President Donald Trump win and Republicans retain control of the Senate, Trump still may not be able to make sweeping changes through legislation as long as the House is still controlled by Democrats. But — thanks to rules set up by the Senate GOP — the ability to continue to stack the federal courts with conservative jurists who are likely to uphold Trump’s expansive use of executive power could effectively remake the government’s relationship with the health care system even without signed legislation.

The president has also pledged to continue his efforts to get rid of the Affordable Care Act, and if the Supreme Court overturns the sweeping law as part of a challenge it will hear next week, the Republicans’ promise to protect people with preexisting medical conditions will be put to the test. In a second term, the administration would also likely push to continue to revamp Medicaid with its efforts to institute work requirements for adult enrollees and provide more flexibility for states to change the contours of the program.

If former Vice President Joe Biden wins and Democrats gain a Senate majority, it would represent the first time the party has controlled the White House and both houses of Congress since 2010 — the year the ACA was passed. A top priority will be dealing with the COVID-19 pandemic and the economic fallout. Biden made that a keystone of his campaign, promising to implement policies based on advice from medical and scientific advisers and provide more directives and aid to the states.

Current US President Donald Trump.

But also high on his agenda will be addressing parts of the ACA that haven’t worked as well as its authors hoped. He pledged to add a government-run “public option,” which would be an alternative to private insurance plans on the marketplaces, and to lower the eligibility age for Medicare to 60.

While Democrats will continue to control the House, the final makeup of the Senate is still to be determined. And even if the Democrats win the Senate, they are not expected to come away with a majority that would allow them to pass legislation without support from at least some GOP senators, unless they change the Senate’s rules. That could lower expectations of what the Democrats can accomplish — and may lead to some tensions among members.

But who controls Washington, D.C., is only part of the election’s impact on health policy. Several key health issues are on the ballot both directly and indirectly in many states. Here are a few:

Abortion

In Colorado, a measure that would have banned abortions after 22 weeks of pregnancy — except to save the life of the pregnant person — failed, according to The Associated Press. Colorado is one of seven states that don’t prohibit abortions at some point in pregnancy. It is also home to one of the few clinics in the nation that perform abortions in the third trimester, often for severe medical complications. The clinic draws patients from around the nation, so residents of other states would have been affected if the Colorado amendment passed.

In Louisiana, however, voters easily approved an amendment to the state constitution to say that nothing in the document protects the right to, or requires the funding of, abortion. That would make it easier for the state to outlaw abortion if the Supreme Court overturns Roe v. Wade, which makes state abortion bans unconstitutional.

Medicaid

The fate of the Medicaid program for people with low incomes is not on the ballot directly anywhere this election. (Voters approved expansions of the program in Missouri and Oklahoma earlier this year.) But the program will be affected not only by who controls the presidency and Congress, but also by who controls the legislatures in states that have not expanded the program under the Affordable Care Act. North Carolina is a key swing state where a change in majority in the legislature could turn the expansion tide.

Drug Policy

In six states, voters are deciding the legality of marijuana in one form or another. Montana, Arizona and New Jersey were deciding whether to join the 11 states that allow recreational use of the drug. Mississippi and Nebraska voters were choosing whether to legalize medical marijuana, and South Dakota became the first state to vote on legalizing both recreational and medical pot in the same election.

Magic mushrooms are on two ballots. A measure in Oregon to allow the use of psilocybin-producing mushrooms for medicinal purposes passed, and a District of Columbia proposal to decriminalize the hallucinogenic fungi was leading.

Also approved was a separate ballot question in Oregon to decriminalize possession of small amounts of hard drugs, including heroin, cocaine and methamphetamine, and mandate establishing addiction recovery centers, using some tax proceeds from marijuana sales to establish those centers.

California

As usual, voters in California faced a lengthy list of health-related ballot measures.

For the second time in two years, the state’s profitable kidney dialysis industry was challenged at the ballot box. A union-sponsored initiative would have required dialysis companies to employ a doctor at every clinic and submit infection reports to the state. But the industry spent $105 million against the measure. The measure failed, according to AP.

Voters were also asked to decide, again, whether to fund stem cell research through the California Institute for Regenerative Medicine via Proposition 14. Voters first approved funding for the agency in 2004, and since then, billions have been spent with few cures to show for it. The measure was winning in early returns.

California has been at the forefront of the fight over the so-called gig economy, and this year’s ballot included a proposal pushed by ride-hailing companies like Uber and Lyft that would let them continue to treat drivers as independent contractors instead of employees. Under Proposition 22, the companies would not have to provide direct health benefits to drivers but would have to give those who qualify a stipend they could use toward a premium for health insurance purchased through the state’s individual marketplace, Covered California. The measure was approved.

Finally, voters in the Golden State were asked whether to impose higher property taxes on commercial property owners with land and property holdings valued at $3 million or more, which could help provide new revenue earmarked for economically struggling cities and counties hit hard by COVID-19, as well as K-12 schools and community colleges. Community clinics, California nurses and Planned Parenthood jumped into the thorny political battle over Proposition 15 — taking on powerful business groups — eyeing revenue to help rebuild California’s underfunded public health system. The measure was too close to call in early returns.

Democrats in California, who control all statewide elected offices and hold a supermajority in the legislature, have been positioning for a Biden win, and some were already penning ambitious health care legislation for next year. Should Biden win, they said they plan to crack down on hospital consolidation and end surprise emergency room bills, and some were quietly discussing liberal initiatives such as pursuing a single-payer health care system and expanding Medicaid to cover more unauthorized immigrants.

 

KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.

Image Credits: Library of Congress/Carol Highsmith, Mike Beaty/Flickr, Gage Skidmore.

Protestors stuggle for universal access to anti-retroviral treatment and against AIDS denial, in Cape Town, 2002.

IBADAN, Nigeria – In the wake of George Floyd’s death in June 2020, the decentralized protests initially organized by the Black Lives Matter (BLM) movement triggered an awakening and an echo that has reached well beyond the borders of the United States.

Protest at the 3rd precinct in Minneapolis for the murder of George Floyd by four police officers.

What started as a non-violent movement protesting against incidents of police brutality and racially motivated violence, has also inspired people around the world, including scientists to take a closer look at how colonialist attitudes and structures continue to influence their institutions and career paths. For individuals from comparatively disadvantaged countries, these attitudes often make it difficult or even impossible for them to enjoy equal opportunities and mutually favorable metrics in their chosen careers.

And this is true for global health too. “Little or no attention is being given to the issue. This isn’t something people are funded to look at. Doing it in of itself comes from a position of privilege,” says Dr Mishal Khan, Associate Professor at the London School of Hygiene and Tropical Medicine (LSHTM).

While decolonisation has been discussed in an educational context in the past, in terms of curriculum choices as well as well as the preference of western to indigenious professionals, Khan argues that the fundamental structures underpinning global health should also be closely examined.

“It’s not really researched or taught as much as it should be, and this is why people often don’t think about it so much,” she says, noting that while relics of colonialism remain and debates continue across sectors, the issue has been far less discussed in the context of global health. “The implicit assumption is certain groups are more knowledgeable and better than the others.”

The topic of ‘decolonizing global health’ will be a featured topic on the Geneva Health Forum’s agenda, taking place 16-18 November, where Dr Khan will be a keynote speaker.

“In global health there is an additional element,” Khan adds. “By nature, global health is about higher income countries trying to support low-income countries. It’s not just about teaching global health, but also the practice.”

UN Born With First Decolonialist Wave

According to the United Nations, fewer than 2 million people now live under colonial rule in the 17 remaining non-self-governing territories. out of which only one – Western Sahara – is in Africa.

“The wave of decolonization, which changed the face of the planet, was born with the UN and represents the world body’s first great success,” the UN stated.

HIV activists protesting against patent laws that pushed up costs of essential medicines, in Cape Town, 2014.

The UN’s key global health agencies, such as the UNICEF and the World Health Organization were born in the post-World War II era of 1946-48, in the waning years of colonialism. UNAIDS, on the other hand, came much later, during the worldwide AIDS pandemic, as states in the global south asserted the need for affordable solutions and more recognition of their health challenges. While these international organisations continue to champion and foster partnerships toward achieving global health goals, they are also implicated in these discussions.

In a September 2019 commentary, Richard Horton, editor of The Lancet medical journal said the success of any western institution that was more than hundred years old was built on the savage legacy of colonialism – even if the institution claims to stand for peace and justice.

“Perhaps we deal with uncomfortable pasts by burying them, excusing them, or atoning for them,” Horton wrote.

In their recent commentary on decolonising global health for the British Medical Journal, Ali Murad Büyüm and colleagues noted that histories of slavery, redlining, environmental racism and the predatory nature of capitalism underpin the design of global and public health systems, resulting in structural, racial and ethnic inequities within Black, Indigenous and People of Color (BIPOC) communities globally.

Connecting the inequities to the COVID-19 pandemic, the authors noted that exclusionary colonialist patterns that centre around Euro-Western knowledge systems have also shaped the language and response to the pandemic, which in turn can have adverse health outcomes.

“Decolonising global health advances an agenda of repoliticising and rehistoricising health through a paradigm shift, a leadership shift and a knowledge shift,” the authors state. “While the global response to COVID-19 has so far reinforced injustices, the coming months present a window of opportunity to transform global health.”

The Genesis Of Misconceptions

For her part, Khan notes that the emergence of developed countries as the worst hit by COVID-19 (contrasting earlier predictions that countries in Africa would be the worst hit) is an indication that there is imbalance in the flow of knowledge and resources in global health.

“That was the mindset with which the global health organisations were working: ‘we need to do something to help these countries or they will crumble. But you can see how countries like Nigeria have brilliantly handled things. The political leadership has been much better’,” Khan says.

A map indicating Africas comparatively low number of cumulative COVID-19 cases.

She adds that the experience of African and Asian countries that are avoiding poor outcomes in COVID-19 are not included in the writings and independent reviews on COVID-19 – often because the authors of such publications are largely people in the Global North: “It is as if the reality can be ignored. Those expertise and the skills are there and there is a lot to learn in both directions, rather than in just one direction.”

Questionable metrics for Public Health Careers

Beyond ignoring and under-representing the achievements of low-income countries in the fight against COVID-19, the need for decolonisation is also evident in the attachment of institutional brand names to successful careers in public health.

Lilian Mutua, WHO Kenya Health Promotion Coordinator, reaching out to nomadic communities to ensure people know how to protect themselves from COVID-19 in May.

Khan notes that young scientists in developing countries have to incur exorbitant costs to be able to afford an education

that would bring them closer in line with their contemporaries in Western countries.

“For instance, the schools of global public health, and the brands that are associated with them, are largely concentrated in western countries. Employers look for those names,” Khan says.

“If you don’t have the brand name from one of those top universities, it’s much harder to progress. People from low-income countries have to pay massive fees, advancing the cycle of inequality.”

In a similar vein, she argued that papers submitted by individuals from developing countries who are not products of the elite institutions will be judged much more harshly by white reviewers.

“You will get more scrutiny, you might not be able to write very well, you might not get invited for presentations: those things that grant you credibility as an expert are much harder for people of color. So those structures are there,” Khan tells Health Policy Watch. “To get promoted, they ask for how many papers published, how many grants. Naturally, people of color will have less because to have one paper, you have to work much harder to get one grant.”

She also drew attention to the existence of an unchallenged system that ensures that people of color do not progress as quickly as their colleagues from elsewhere: “When you look at organisations, there are a lot more people of color at the bottom doing the groundwork than people at the top in senior positions.”

Changing the status quo – Equity in Career Advancement Metrics

In spite of evidence that supports of the existence of unfavorable metrics that disenfranchise BIPOC and other marginalised groups from making bigger impact in global health, there appears to be a deafening silence among the key organisations in the ecosystem – a development Khan attributed to those in charge of the organisations who favour the status-quo.

Dr Mishal Khan spoke to Health Policy Watch on decolonisation in global health.

“For a long time, they’ve been able to get away with not addressing it. If you’ve got a leadership that is predominantly white and not from the country you serve, you think that’s not important. If that’s what you like because if it benefits you, why would you change it?

“There has been a lot of media attention lately so there has been a lot more scrutiny. We need to create the incentives for change,” Khan argues. “I don’t think the incentives are necessarily in there, we need to know that the change will be opposed. Nobody gives up power willingly.”

One of the changes that Khan is advocating for is a comprehensive review of the metrics being used for career advancement in global health. She tells Health Policy Watch that current metrics are such that certain people will rise to the top and others will struggle to rise to the top.

“The system doesn’t value skills,” she notes. “A good example is connection with the local context in which research or service delivery work is being conducted. Being able to speak the local language – being from the country – is given a lot less rating than it should, whereas being able to write and speak really well in English is given a lot more. And that’s why certain people will score more highly than the rest. I think the metrics do matter.”

Timing concern and what can work

The deafening silence from those who would be beneficiaries of moves to decolonise global health raises concern regarding the timing of the call, especially considering the global health ecosystem is largely preoccupied with controlling COVID-19. But Khan said the situation will not change unless it is compelled to change:“The people in power are essentially not going to change the metrics and therefore reduce their power so it favors people that do not look like them.

“I think we have to be conscious of that. People will not consciously or unconsciously reduce their own power,” Khan affirms.

To truly decolonise global health, Khan is calling for a review of the governance system in a number of global health organisations. “Broader than issues of racism and decolonisation, we are also seeing massive governance failure in terms of sexual abuse of some to these international organisations. That’s another symptom that there are people who are being exploited within these organisations that are supposed to be believing in justice and implementing justice. It just has to be done with political will,” Khan says .

Although it would take a while to systematically uproot colonisation, Khan argues that individuals have roles to play to address the narrative.

“One thing about COVID-19 is that it has shown us that if you’re okay in your bubble while other countries are not okay, it will soon spread to your little bubble,” Khan tells Health Policy Watch.

“We need resources to be spread out more equitably.”

Geneva Health Forum 2020 logo

Image Credits: Louis George 2011 , Jenny Salita, Louis George 2011 , Johns Hopkins University and Medicine, WHO African Region, Geneva Health Forum.

Dr Maria Van Kerkhovem warned the northern hemisphere to continue influenza testing
WHO’s technical lead, Dr Maria Van Kerkhove, warned the northern hemisphere to continue influenza testing.

As predictions of a difficult winter pour in, projecting rapid increases in COVID-19 infections, the World Health Organisation (WHO) has urged countries in the northern hemisphere to test for influenza alongside coronavirus.

WHO reassrerted today that surveillance systems are in place to help identify which influenza viruses are circulating, and suggested that countries be proactive in testing for the virus during the COVID-19 pandemic to prevent overwhelming healthcare systems with late or misdiagnoses.

The warning comes as the United States and countries across Europe reached record numbers of cases detected.

“There is also substantial work underway to ensure that patients enter the correct clinical care pathway as they enter the public health system,” stated Dr Maria Van Kerkhove, COVID-19 Technical Lead at the WHO, asserting that entering the clinical care pathway earlier will save lives. Some of these steps include detecting cases that may have been imported from overseas, identifying case clusters and investigating outbreaks.

Restrictions that have been implemented to restrict the spread of SARS-CoV-2 will also be beneficial in curbing the spread of influenza, but diagnosis of these illnesses could present a significant challenge as both viruses share similar symptoms. Because of this, testing and identifying which virus a patient has will be vital in making sure they receive appropriate care.

“We don’t yet know how the influenza season will unfold,” said Dr Van Kerkhove, COVID-19 Technical Lead at the WHO, speaking at a media briefing. Referring to a vaccine rollout, she added: “The good news is that we are prepared for this.”

‘Virtually no Influenza Circulation’ During Southern Hemisphere’s Winter

WHO’s warning for countries continuing to test for influenza comes despite the southern hemisphere’s relatively low number of cases seen during its winter, which recently concluded.

When the pandemic began in March, the southern hemisphere was entering its flu season. But flu cases dropped significantly compared to previous years, with the US Centers for Disease Control and Prevention stating there was “virtually no influenza circulation” in the southern hemisphere.

According to WHO, which tracks influenza activity around the globe, only 0.1% of people who were tested for flu in the southern hemisphere proved positive. This is contrasted to a typical rate of 5 in 10. The cause behind the sharp drop was attributed to COVID-19 restrictions and guidance like social distancing and hand washing.

Children and Pregnant Women at More Severe Risk from Influenza
People over 65 are currently prioritised for vaccination given double COVID and flu risk.

While some at-risk categories for the two viruses do overlap, there are unique groups at risk for each. One of the most notable examples is young children. COVID-19 poses very little risk among younger children, however they are at increased risk for severe disease with influenza. Pregnant women are also at risk of severe disease with influenza but are not with COVID-19 – even two weeks after delivery.

“If [you know] someone with an acute respiratory infection and they are a young child or they are pregnant, that patient does need to be tested,” said Dr Janet Diaz, Head of Clinical Care at the WHO.

Current recommendations indicate that healthcare workers and people over 65, who are at double risk, need to be prioritised for vaccination. Pregnant women and children under 5 are to be offered vaccinations as supplies allow. WHO is due to publish further guidance on influenza soon.

Dr Diaz also noted that while corticosteroids are currently being used for treating patients with severe and critical COVID-19, as it reduces mortality, those drugs may not be suitable for influenza. With flu, there is concern that corticosteroids can increase viral replication.

She warned that governments must “understand when influenza starts to circulate in the community” in order to remain on top of cases.

Image Credits: Flickr: Joseph Gage.

Supporters of President Donald Trump at a “Make America Great Again” campaign rally last week in Phoenix Arizona. Supporters are crowding with no masks.

New COVID-19 cases reached record worldwide peaks in the United States over the weekend,  hitting 98,583 new cases on Friday – as debates over management of the pandemic also fueled intense political duels in the last, heated days of campaigning between US President Donald Trump and his Democratic Party contender, Joseph Biden. 

Hospitalizations were also rising across most of the country, and health experts, including those who have tried to remain out of the political line of fire, were breaking ranks with the increasingly blatant White House disregard for infection trends and infection control protocols, including at President Trump’s blitz of events. . 

“We’re in for a whole lot of hurt. It’s not a good situation,” said top White House infectious disease expert and advisor, Anthony Fauci in an interview with The Washington Post. “All the stars are aligned in the wrong place as you go into fall and winter season, with people congregating at home indoors. You could not possibly be positioned more poorly.” 

Trump, speaking at a rally on Sunday morning suggested that he might soon fire Fauci, the director of the National Institute of Allergy and Infectious Diseases. 

“Don’t tell anybody, but let me wait until a little bit after the election…He’s been wrong a lot,” shouted out Trump, before a crowd chanting “Fire Fauci.” 

Fauci hasn’t spoken with Trump in more than a month. And although Trump doesn’t have the power to directly fire Fauci, the president could dramatically restrain his role as a member of the White House’s coronavirus task force, observers say.

On Monday, new COVID-19 cases cases dipped slightly again, to 77,398 according to the US Centres for Disease Control – but the seven day US average remained at an all time high of 81,336.  

“We’re at a point where the epidemic is accelerating across the country. We’re right at the beginning of the steep part of the epidemic curve,” Dr. Scott Gottlieb, the former U.S. Food and Drug Administration commissioner, told CNBC.

“You’ll see cases start to accelerate in the coming weeks,” he said, predicting the height of the country’s new surge will be reached around Thanksgiving, adding that: “December’s probably going to be the toughest month.”

This upward trend in cases makes this the pandemic’s third peak in the United States, as cases were growing by an average of 5% or more in 43 states accoring to Johns Hopkins University. There are now more than 9 million reported COVID-19 cases in the United States. There have been more than 230,000 deaths.  

Trump Rallies Accelerated COVID-19 Cases In States Where He Appeared – Says New Study 
US President Donald Trump at recent rally

Researchers at Stanford University estimated that at least 30,000 COVID-19 infections and 700 deaths could be attributed to the 18 campaign rallies that Trump held between June and September; 15 of the events studied took place indoors. Trump has drawn criticism for continuing to hold events with large, tightly packed crowds in states that are currently experiencing outbreaks, such as Pennsylvania, Minnesota, and Wisconsin. Many in attendance, including Trump, have no worn masks. 

In the Stanford study, the spread of the virus after each event was compared to parts of the country that didn’t host rallies, illustrating risks of not heeding public health warnings to wear masks and avoid large gatherings to mitigate the risks of COVID-19. 

“The communities in which Trump rallies took place paid a high price in terms of disease and death,” authors of the study, including B. Douglas Bernheim, the chair of Stanford’s economics department, reported.

List of Trump rallies included in the Stanford University analysis

Berhneim said he hoped  the study will help inform policymakers the tradeoffs that come with holding large public gatherings during the pandemic. 

 “There’s currently this very important debate going on about the costs and benefits of lockdowns, restrictions and so forth,” Bernheim was quoted as saying. “It’s important that debate be informed by good information.”

The White House has reportedly called this study “flawed” in its attempt to shame Trump supporters. “As the President has said, the cure cannot be worse than the disease and this country should be open armed with best practices and freedom of choice to limit the spread of Covid-19,” said spokesperson Judd Deere in a statement made Saturday.

Biden’s campaign has used the study as evidence that Trump hasn’t been taking the pandemic seriously. “He’s even costing hundreds of lives and sparking thousands of cases with super spread rallies that only serve his own ego,” said Biden spokesperson Andrew Gates. 

US Presidential Nominee Joe Biden has consistently worn a mask and held “socially-distanced” drive-in rallies

Former vice president Joe Biden and Senator Kamala D. Harris have consistently worn masks in public and have held socially distanced events. When two people close to Harris tested positive for coronavirus in October, the senator canceled travel for several days. 

When asked about the differences between Trump and Biden’s campaign approaches, Fauci has said, Biden “is taking it seriously from a public health perspective” and Trump is “looking at it from a different perspective.” That different perspective is “the economy and reopening the country.” 

“It’s not a major stretch,” to say that large unmasked gatherings are likely to spread the virus, said Dr. Amesh Adalja, an infectious disease expert at Johns Hopkins Center for Health Security. Adalja called the Stanford paper “suggestive” of spread from the events, but not definitive because it was not based on an investigation of actual cases. 

Minnesota public health officials have also blamed four COVID-19 outbreaks and more than 25 cases to Trump rallies held in the state in September and October. 

Rigorous contact tracing from large events such as these could help predict how infectious rallies could be. However, the United States has fallen behind other countries in this regard, due to the lack of funding and coordinated efforts to support contact tracking by the Trump administration. 

“The problem is we’ve not done anything to get real numbers,” said Dr. Eric Topol, a genomics expert and director of the Scripps Research Translation Institute in La Jolla, California. 

“If we even had one rally where there was definitive tracing, then you could extrapolate. But we’ve had none. Our country has performed as if contact tracing doesn’t exist,” Topol said.

Europe
Active cases of COVID-19 around the world and COVID-19 deaths globally (top right) as of 12:24PM EST 2 November 2020.

Meanwhile, Europe surpassed 10 million confirmed COVID-19 cases on Sunday, as more and more countries applied increasingly stricter lockdown measures. 

Britain closed pubs, restaurants and retail shops, requiring that people stay home unless they are seeking medical care, going grocery shopping, or employed at an essential business. 

“We’ve got to be humble in the face of nature,” said Boris Johnson, Prime Minister of the United Kingdom, at a news conference on Saturday. “In this country, alas, as across much of Europe, the virus is spreading even faster than the reasonable worst-case scenarios of our scientific advisers.”

The scientific models “suggest that unless we act, we could see deaths in this country running at several thousand a day, a peak of mortality, alas, bigger than the one we saw in April,” warned Johnson. 

Germany entered a ‘light lockdown’ on Monday, restricting gatherings to 10 people, advising against non-essential travel, and closing recreational facilities and restaurants. 

“We are seeing an exponential rise in numbers, with the number of cases doubling in an ever shorter time,” said German Chancellor Angela Merkel after a meeting with state premiers of Germany’s federal states last week. “We know now that we must further restrict person-to-person contacts and thus reduce the risk of becoming infected.” 

“I am very optimistic that we can now, in November, bring the virus under control. I will say it again: we have done it before, I am very sure we will do it again,” said Jens Spahn, German Federal Minister of Health, in an interview with ZDF Heute. 

In Switzerland, Geneva also instituted a partial lockdown, which will go into effect from 7pm on Monday until November 29. Bars, restaurants, and non-essential businesses will be closed, gatherings of over 5 people in public spaces will be banned, and public and private events with more than 5 people will be restricted. 

Nationwide, Switzerland has reported 21,926 new cases since Friday, with 497 hospitalizations and 93 deaths, making its new case rate one of the highest in Europe. Geneva is one of the hotspots in Switzerland. “Over the past few days, more than 1,000 people have tested positive for coronavirus on a daily basis (peaking at 1,338 positive cases on October 30),” said the Geneva Cantonal government in a statement released on Sunday. 

“One of the challenges that we’re seeing across North America and Europe is that the increase in cases and the increase in hospital admissions to ICU are happening at the same time,” said Maria Van Kerkhove, WHO Health Emergencies technical lead at a Monday press conference.

“Health systems are becoming overwhelmed so that poses challenges for countries that were able to facilitate their workforce around managing the most intense areas,” she added.  

Dr. Michael Ryan, WHO Executive Director of Health Emergencies

As Europe also faced a rising wave of civil protests over the new government-imposed imitations, governments in Europe face “very limited options” in getting the COVID surge under control, underlined WHO Health Emergencies Executive Director, Mike Ryan.

“We need to push this virus down, we need to take the heat out of this epidemic right now in Europe, and governments have limited options right now in how to do that. Their options are limited,” Ryan said. “People have every right to question when authorities indicate that certain measures need to be taken, but we would prefer that to be a dialogue between governments and communities,” he added, stressing that protests should not, however, put more people at risk of infection. 

Virus Variant Prevalent – But Not Any More Dangerous

Although speculation has been rife about whetehr the surge is also being fueled by a novel SARS-CoV-2 variant,  named 20A.EU1, that has spread widely across Europe in recent months one of the, lead authors of the study on the newly identified variant, said that so far, it does not appear to be any more deadly or infectious. 

“We do not have any evidence that the new variant is more transmissible or has a different clinical outcome,” Dr. Emma Hodcroft of the University of Basel, told Health Policy Watch. “We think the main factors here were the rising cases in Spain, travel over summer, lack of screening/successful quarantine, and failure of countries to contain rising cases.

While there are hundreds of different variants of the new coronavirus circulating in Europe alone, only few of these variants have spread as successfully and become as prevalent as the newly identified 20A.EU1, which likely originated in Spain. 

From July, 20A.EU1 moved with travelers as borders opened across Europe, and it has been identified so far in twelve European countries. Currently, 20A.EU1 accounts for 90% of sequences in the UK, 60% of sequences in Ireland, and between 30-40% of sequences in Switzerland and the Netherlands, making it one of the most prevalent variants in Europe. 

Though this rise in prevalence of 20.EU1 corresponds with the increasing number of cases being observed in Europe this autumn, the authors of this study caution against interpreting the new variant as a cause for the rising numbers. 

“Long-term border closures and severe travel restrictions aren’t feasible or desirable,” explains Hodcroft, “but from the spread of 20A.EU1 it seems clear that the measures in place were often not sufficient to stop onward transmission of introduced variants this summer. When countries have worked hard to get SARS-CoV-2 cases down to low numbers, identifying better ways to ‘open up’ without risking a rise in cases is critical.”

The global COVID-19 death toll surpassed 1.2 million on Monday and global COVID-19 cases reached 46 million. 

 

 

 

Image Credits: Gage Skidmore/Flickr, GPA Photo Archive/Flickr, B. Douglas Bernheim, et al , Mike Beaty/Flickr, Johns Hopkins, R Santos/HP Watch.

Regeneron’s lab developing antibody medicines.

Regeneron Pharmaceuticals suspended enrollment of critically ill and hospitalized patients in its COVID-19 antibody cocktail treatment clinical trial on Friday, due to what it said was a safety concern. 

The pharma company’s independent data monitoring committee (IDMC) recommended this pause “based on a potential safety signal and an unfavorable risk/benefit profile,” advising on the collection and analysis of further data. 

Eli Lilly’s antibody treatment clinical trial, examining the efficacy of bamlanivimab, was meanwhile halted altogether for hospitalized COVID-19 patients, after initial trial data suggested that the drug was unlikely to help them recover. 

The Regeneron decision to pause applies to hospitalized patients receiving mechanical ventilation or high-flow oxygen and was taken following the recommendation by the IDMC. The trial will continue the enrollment of patients requiring no or low-flow oxygen. 

Some experts suggested that biologically the treatment could attack the virus better earlier on, but an overactive immune response could reduce the efficacy of the drug cocktail. The safety issues in patients severely ill with COVID-19 do not necessarily raise concerns about the safety for those with mild to moderate illness. 

“There is a tiny window and it’s the earlier the better,” said Eric Topol, director of the Scripps Research Translational Institute, in an interview with Financial Times. He emphasized the need to treat COVID-19 early or preventatively.

Regeneron’s announcement comes after the company revealed early results on Wednesday that their drug cocktail reduced COVID-19 related medical visits by 57 percent overall and 72 percent in patients with one or more risk factors. 

George Yancopoulos, CEO of Regeneron

“Today’s analysis…prospectively confirms that REGN-COV2 can indeed significantly reduce viral load and further shows that these viral reductions are associated with a significant decrease in the need for further medical attention,” said George Yancopoulos, President and Chief Scientific Officer of Regeneron. 

“We continue to see the strongest effects in patients who are most at risk for poor outcomes due to high viral load, ineffective antibody immune response at baseline, or pre-existing risk factors,” he added. 

Regeneron’s decision to pause enrollment is seen as the second recent setback for a COVID-19 antibody therapy. The first was the suspension of Eli Lilly’s monoclonal antibody trial on hospitalized patients last week.  

Eli Lilly’s Clinical Trial Halted by NIH
Eli Lilly researchers developing a COVID-19 antibody treatment.

The independent Data and Safety Monitoring Board recommended to the National Institutes of Health (NIH), the sponsor of the Eli Lilly trial, that no further hospitalized COVID-19 patients receive the drug, because of a “low likelihood that the intervention would be of clinical value in this hospitalized patient population.” 

The discontinuation of the trial “tells us they stopped the trial due to futility” and “suggests that the timing of monoclonal antibody administration – early – will be important,” said Topol to the New York Times. 

Trials of the drug will continue in patients with mild to moderate COVID-19. 

“While there was insufficient evidence that bamlanivimab improved clinical outcomes when added to other treatments in hospitalized patients with COVID-19, we remain confident based on data from Lilly’s BLAZE-1 study that bamlanivimab monotherapy may prevent progression of disease for those earlier in the course of COVID-19,” said Eli Lilly in a statement. 

Both Eli Lilly and Regeneron submitted emergency use authorization requests to the US Food and Drug Administration (FDA) in early October to treat patients with mild to moderate COVID-19. 

Front-runner Moderna in COVID-19 Vaccine Race Prepares for Global Launch 

Meanwhile, Moderna announced on October 22 that their Phase 3 clinical trial for a potential COVID-19 vaccine completed the enrollment of 30,000 participants. The biotechnology company is preparing for the global launch of its potential vaccine. 

Stéphane Bancel, CEO of Moderna

Among the trial participants, 37 percent are from diverse communities and 42 percent are at high risk of severe COVID-19 disease, either over the age of 65 or with co-morbid risk factors. All participants have received their first shot of the vaccine candidate and the majority have received the second. 

Moderna is currently on track to file an emergency use authorization to the FDA in late November, if they gather sufficient safety and efficacy data, as announced by Moderna CEO, Stéphane Bancel, in early October. 

“We are actively preparing for the launch of mRNA-1273 and we have signed a number of supply agreements with governments around the world,” said Bancel in a press release on Friday. “Moderna is committed to the highest data quality standards and rigorous scientific research as we continue to work with regulators to advance mRNA-1273.”

Britain Health Regulator Began Rolling Review of AstraZeneca’s COVID-19 Vaccine

In Britain, the Medicines and Healthcare Products Regulatory Agency (MHRA) started an accelerated rolling review of AstraZeneca’s potential COVID-19 vaccine, produced in collaboration with researchers at the University of Oxford.

“We confirm the MHRA’s rolling review of our potential COVID-19 vaccine,” said an AstraZeneca spokesperson to Reuters on Sunday. 

AstraZeneca scientist developing potential COVID-19 vaccine.

The health regulator will analyze trial data and potentially accelerate the approval process, if the data reveals that the vaccine is safe and effective. This review helps fast track potential vaccines and drugs in ongoing trials. 

On Wednesday, the MHRA began a rolling review of Moderna’s vaccine candidate and a review of Pfizer’s vaccine candidate also started recently. These three pharmaceutical companies, along with Johnson & Johnson, are leading the race to develop a COVID-19 vaccine. 

Image Credits: Regeneron, Regeneron, Eli Lilly, Moderna, AstraZeneca.

Cyclists in Bogota take advantage of car-free roads

Third in a series – Cities are major drivers of public health and the COVID-19 pandemic has brought increasing and urgent necessity for effective, innovative leadership and collaboration within and between cities.

“The COVID-19 pandemic has upended lives around the globe and nowhere has the impact of this virus been more evident than in urban areas, home to more than 50 percent of the world’s population,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, at the COVID-19 and Beyond: Cities on the Front Lines of a Healthier Future event on Thursday. “Many [cities] have fought back, with people and leaders uniting to suppress the virus and save both lives and livelihoods.” 

The event on Thursday, co-sponsored by Partnership for Healthy Cities, WHO, Bloomberg Philanthropies, and Vital Strategies, highlighted and celebrated the critical leadership provided by mayors and city governments. The event followed the release of a portfolio of case studies exhibiting efforts by urban leaders to develop a course of action to combat the pandemic, and occurred ahead of the upcoming World Cities Day on October 31. 

“Mayors and other urban leaders around the world have risen to the challenge of responding to COVID-19 and continue to make incredibly difficult decisions to protect people’s health, while maintaining economic stability and social cohesion,” said José Luis Castro, President of Vital Strategies. “City leaders entered the COVID-19 era in many cases without a playbook. They have nevertheless mounted a remarkable pandemic response.” 

The mayors of Bogota, Colombia, Athens, Greece, and Kampala, Uganda shared their experiences tackling the unique challenges facing their cities and populations. The mayors – who Dr Tedros referred to as urban health champions – detailed their actions to impose lockdowns, provide support to vulnerable communities, and implement forward looking health policies. 

Bogota, Colombia
Bogota also expanded its bike network during the national lockdown for healthy, safe transport.

Controlling the spread of the pandemic and increasing the capacity of the health system was prioritized early on with a six week lockdown in Bogota, implemented by the city government and Mayor Claudia López. The national lockdown in Colombia was promoted by the collaboration between 500 mayors, including López, to institute city-wide lockdowns. 

The rapid response by city leadership enabled the health system capacity to double between April and August, from 935 intensive healthcare units to 2,200, and from 200 tests per day to 15,000. 

In order to deal with the economic hardship and rising poverty levels that accompanied the lockdown, the city government collaborated with the national government to provide cash transfers to more than 700,000 families. This network of income and social support has been incorporated into Bogota’s long-term development plan to assist with social and economic recovery. 

Investment in small businesses, which delivers 60 percent of employment in the city, kept them in business and contributed to reducing unemployment from 26% in July to 19% in August. 

“I think we have an incredible opportunity during this pandemic, and then afterwards, to change things definitively for the better for cities. To improve sustainable mobility and to leave in place the social contract for women, for youth, for poor families,” said Mayor López. 

Athens, Greece
Staff from Hellenic Liver Patients Association
“Prometheus” in Athens delivers essential supplies to vulnerable community members.

The city government of Athens, led by Mayor Kostas Bakoyannis, took strategic actions to prioritize disenfranchised people who were vulnerable to the health and economic effects of the pandemic. The pandemic is not only a health issue, but a huge socioeconomic issue also, said Mayor Bakoyannis. 

The pandemic reveals and exacerbates existing inequalities and structural injustices. To address these inequalities and those at high risk, shelters were set up for homeless Athenians and those struggling with drug addiction, providing protection and medical attention. 

A system, Health at Home Plus, was established to deliver food, medicine, and aid to the homes of tens of thousands of residents during the lockdown. The system has continued until today, providing services and meeting needs of the population. 

“[Local authorities’] strength is working bottom up and our true power is in the street,” said Mayor Bakoyannis. “In order to be able to respond to the needs of the city, we understood that the city organization had to change. That’s why for us the pandemic was also an opportunity to move forward with long overdue reforms. It was a catalyst.”

Kampala, Uganda
Kampala Capital City Authority staff provide food relief and healthcare aid.

Kampala, one of the most densely populated cities in Uganda, has had 37% of total COVID-19 cases reported in the country. While the city-wide lockdown implemented in March slowed transmission of the virus, it also brought numerous challenges for workers relying on daily jobs to survive. 

The leaders of the Kampala government established a food distribution system to assist residents during the lockdown. A stimulus package was introduced to support small businesses and address some of the economic challenges. 

“As leaders, at times we need to take firm decisions regardless of the consequences,” said Deputy Mayor Doreen Nyanjura. “And we have seen this work in Uganda, where some attempts even had to involve the police because they are looking at saving the lives of our citizens.

“We need to unite as leaders with our citizens.”

The collaboration between the city government and national government hasn’t run smoothly during the COVID-19 pandemic, Deputy Mayor Nyanjura noted. The efforts of local authorities were constrained by the lack of funding from the national government. As a result, the city government has faced increased pressure to support medical teams, increase the capacity of health systems, and educate and empower the public with a limited budget. 

Advice For Other City Leaders

The three mayors provided advice for leaders of cities currently dealing with effectively tackling the pandemic and meeting the needs of residents: 

“We prioritized facts, science, and truth over politics and partisanship. We placed expertise over populism. It worked. It worked on a national level and it worked on a city level” to get cooperation from citizens for the lockdown and for compliance with pandemic prevention measures, said Mayor Bakoyannos. 

“Follow the facts and science. I think it’s amazing that in the 21st century we’re still seeing this debate in some very prominent democracies about science…follow the facts and tell people the truth [about] the risks that they are facing,” said Mayor López. “As long as we have science, leadership, decisions, and assertiveness…we will learn how to save lives.”

“Unite and take firm decisions, and consider the lives of those that [the government] represents,” said Deputy Mayor Nyanjura. “We need to unite with our citizens, we need to unite with our technical team…[and] with the government.”

Image Credits: Climate and Clean Air Coalition , Fernanda Lanzagorta, OPS Columbia, Partnership for Healthy Cities, Partnership for Healthy Cities.

A demonstration in Bangkok against the US-Thailand free trade agreement which would have raised prices for medicines that underpin Thailand’s AIDS treatment program.

Two competing approaches to promote access to medicines were born during the HIV/AIDS pandemic in the year 2000. Today, at the height of the COVID-19 pandemic, these same approaches are once more on a collision course. 

On the one side is the ‘international’ COVID response, led in name by WHO, but in fact by what is now the world’s largest and most powerful global health institution, the Gates Foundation – with the backing of the pharmaceutical industry and high-income countries.

On the other side is the access-to-medicines movement, led by civil society alongside low- and middle-income countries (LMICs) such as India and South Africa, with the backing of hundreds of grassroots, civil society groups and non-governmental organisations that are challenging monopolies on medicines and promoting generic competition to successfully expand supply and lower prices of COVID-19 drugs, tests and equipment, and future vaccines.

These groups argue that meeting the COVID-19 pandemic requires broad use of the same strategies that revolutionized access to antiretroviral medicines (ARVs) during the AIDS crisis. Can we learn from the successes and mistakes made the last time around?

The Gates Foundation has leaned into the COVID-19 pandemic

Two decades after its establishment, the foundation that boasts a total endowment of US$ 50 billion dollars, has rededicated its entire organizational focus to the pandemic.

Gates has spent or committed to spending hundreds of millions of dollars on the development and procurement of COVID-19 medical technologies, partnering with both global health agencies and pharmaceutical corporations to accelerate the development and deployment of technologies. The Foundation’s leaders have also used their ‘moral voice’ to respond to the predictable health technology nationalism that has taken hold.

Sounds amazing, right? 

But on a more careful examination, what still emerges is a set of narrow, inefficient, and inadequate solutions that are exclusively based on what charity or the market will allow. This means prioritizing pharma monopolies of technology and intellectual property (IP) and secretive, technocratic, and top-down approaches that mostly exclude LMICs from decision making as well as avoiding public scrutiny.

Moreover, the Foundation’s role and outsized voice threaten to undermine the role involvement of civil society groups in decision-making that was effective at the height of the HIV/AIDS epidemic – and which is urgently needed again today.

As evidence of that, just look at how the money flows.

The Gates Foundation is the second largest funder of the World Health Organization, the global health agency of UN member states, which sets standards and issues public recommendations working on an annual budget that is just a fraction of Gates’ own. The Gates Foundation also is a leading funder of, as well as a Board Member on, most of the world’s other leading global health agencies and public-private partnerships (such as Gavi The Vaccine Alliance, The Global Fund to fight HIV/AIDS Tuberculosis and Malaria, and Unitaid). This provides the Gates Foundation with decision-making power on the most salient issues with respect to research, development and delivery of health care systems in developing countries.

The Gates Foundation is, moreover, heavily invested in the development and finance of new technologies, including direct investments into many pharmaceutical corporations. This has included R&D of technologies to address infectious and neglected diseases, and financial and institutional support to expand immunization.

The COVID-19 solutions proposed by the Gates Foundation are thus anchored in this world view. And in terms of health products, they trap most countries into a system that primarily benefits pharmaceutical corporations and high-income country governments, which can subsidize these corporations with both billions of dollars in upfront subsidies and paying high prices for treatments and vaccines. These practices and trends will likely endure even after the pandemic recedes.

What are the key problems?

1. A lack of transparency

The Gates Foundation is neither discouraging nor overcoming an enduring problem within the pharmaceutical system – secrecy. For the last two decades, there have been concerted efforts by governments, international agencies, regulators, and investors, to improve the transparency of the pharmaceutical system in the areas of public contributions to funding R&D, research priorities, patent status, clinical trial data, price, and overall cost of R&D. There have also been efforts at improving transparency of terms and conditions of licensing agreements between multinational and generic companies, primarily due to the publication of licensing agreements by the Medicines Patent Pool.

Yet throughout this pandemic, and well before it, the Gates Foundation has not been transparent. It does not share the terms and conditions of the agreements it signs with companies (much less provide a clear picture of what it is funding) and does not demand transparency of the businesses that the foundation funds or for which it has made investments. It seems that the Foundation considers transparency should be limited to information about its grants, which are published on its website.

This insistence on secrecy encourages the worst tendencies of the pharmaceutical industry to hide information, and places decision-making power in the hands of only two parties – the Gates Foundation and a pharmaceutical corporation.

On September 28 2020, the Gates Foundation signed a new agreement with two diagnostic manufacturers to supply just 20% of their new diagnostic tests to 133 LMICs. This announcement raises many questions. Why only 20%? Which 133 countries are eligible? Who selected the countries and how? Were the governments of the countries involved in decision making and the planning of the delivery of the tests? What is the number of tests in relation to the population size of the countries? Will tests be equitably distributed? Is there an agreement to expand production through other sources? Who bears liability if the tests are faulty? Who knows the answers?

The Gates Foundation signed a similar, secretive agreement with Eli Lilly for the provision of its monoclonal antibody candidate (to treat COVID 19) on behalf of LMICs. Many of the same questions should be asked. There is a capacity reservation, but how did the parties agree on the number of doses? What is the expected price and is it based on a cost-of-goods analysis (and will that analysis be made public)? Who decides the countries? All these details are shrouded in mystery.

In fact, the Foundation is entering into many “partnerships” with industry where the public only gets the headlines of ‘commitments’ to innovation and access.

2. A dogmatic defender of intellectual property rights and monopolies

Those who own intellectual property (IP), hold power. There are three primary holders of IP over technologies to fight COVID-19 – government research institutions and agencies that are paying for or developing COVID-19 technologies, companies that are developing these technologies (admittedly often with IP accrued before the pandemic), and the Gates Foundation. The Gates Foundation has invested in many of these technologies – before and during the pandemic – and in doing so is able to negotiate certain rights in the technology. That gives it some authority as to how the technology is managed.

Why does IP matter?

In 2000, as the HIV/AIDS epidemic accelerated across Africa and parts of Asia and Latin America, pharmaceutical corporations, armed with IP monopolies and the backing of the United States and European Union, charged outrageous prices for HIV medicines, even in poor countries. Moreover, they filed lawsuits to deter developing countries from using legal measures to promote competition and reduce medicine prices.

Nelson Mandela visiting a Médecins Sans Frontières project in South Africa in 2002, one of the pioneers in providing inexpensive antiretroviral treatment.

High prices for HIV medicines were reduced only because of measures taken to overcome strict IP rules that forbid generic competition. Owing to generic competition, prices for HIV medicines are now more than 99 percent lower than they were two decades ago. Generic competition, or in the case of vaccines, the entry of multiple competitors onto the market, has been largely responsible for the availability of affordable medicines and vaccines around the world, including in the US and Europe. Flexible intellectual property rules have also been critical to enabling third parties to develop appropriate formulations of new medicines and vaccines, whether for children or those in resource poor settings.

During the COVID-19 pandemic, the use of flexible IP rules is a critical step to expanding supply of new tests, medicines and vaccines required by all countries to address COVID-19. No one company can supply a test, medicine or vaccine to the whole world, and therefore maximizing production is critical to control COVID-19. Not only would overcoming IP barriers allow expanded supply to speed up equitable distribution, it would introduce competition that could lower prices. One mechanism to overcome IP barriers is the COVID-19 Technology Access Pool (C-TAP), a government and WHO-led initiative for the sharing of data, know-how, biological material and IP in order to facilitate low-cost production and increased supply of medicines, vaccines and tests.

More recently, India and South Africa submitted a proposal to the TRIPS Council at the World Trade Organization (WTO) to suspend enforcement of COVID-19-related IP rights until an effective health response to the pandemic has been realized. Unfortunately, a consensus was not achieved amongst WTO Members during discussions held in mid-October at the WTO, but it will come forth for further discussion and decision by the end of the year.

Yet the Gates Foundation has not publicly supported the C-TAP and is instead undermining it by messaging in discussions with civil society organizations (and apparently in discussions with other global health agencies) that IP is not a barrier and simultaneously that overcoming IP is not sufficient to enable expanded and competitive supply.

It also argues that technology transfer is too difficult to do on a large scale and should instead be done with a small set of Big Pharma partners or pre-vetted contract manufacturers. In doing so, the Gates Foundation ignores the fact that C-TAP also calls for sharing of know-how and access to cell lines, technology transfer measures that are essential to entry by generic suppliers, issues addressed in a limited way among companies working with the Coalition for Epidemic Preparedness Innovations (CEPI). Gates has also said nothing in support of the India/South Africa WTO waiver proposal, even as several other global actors have come out in support.

This defence of the IP status quo, including both rights in inventions and data, as well as proprietary control over know-how and cell lines, means that power over COVID-19 health technologies rests almost entirely with a handful of large corporations – subsidized by public and philanthropic funding that develop these technologies. It has also enabled the Gates Foundation itself to act as a heavy weight broker to facilitate secret deals between pharmaceutical companies and vaccine producers in developing countries. These agreements, negotiated out of reach of governments and the wider public, mean that the Gates Foundation and pharmaceutical companies decide who gets limited rights to make vaccines and who ultimately gets access to medicines, tests or vaccines.

The most concrete example of the consequences of the Gates Foundation approach to IP has been the decision of the University of Oxford to sign an exclusive agreement with AstraZeneca to complete development of a leading COVID-19 vaccine candidate.

In April 2020, when the vaccine was under development by the University, the institution had posted guidelines for organizations seeking to license or otherwise access University of Oxford IP relevant to the COVID-19 pandemic. When the University initially announced it was moving ahead with a vaccine candidate, it had committed to working non-exclusively with multiple partners on a royalty-free basis to support a vaccine that would be “free of charge, at-cost or cost-plus limited margin as appropriate” for the duration of the pandemic. Then, only weeks later, an agreement was signed on an exclusive basis between pharma giant AstraZeneca and the University of Oxford; this was inconsistent with the university’s commitment to an open license, which could have allowed other companies to manufacture the vaccine and expand supply. This outcome is, in large part, because Bill Gates had pushed the University of Oxford to sign an exclusive agreement, thereby limiting worldwide production of the vaccine to reach more people.

The result? The accord has provided AstraZeneca excessive power in setting the price of the vaccine worldwide, including a unilateral power to declare the ‘end of the pandemic’ in July 2021, thereby freeing up the corporation to charge unaffordable prices even if the virus is not under control at that point.

3. A marriage with large pharmaceutical corporations 

Without transparency and without open access to IP, the only way forward is to leave decisions to pharmaceutical corporations and the Gates Foundation.

Thus, at the UN General Assembly on 30 September 30 2020, the Foundation and sixteen pharmaceutical corporations announced new ‘commitments’ to expand global access to COVID-19 diagnostics, vaccines and medicines. The declaration – described as a landmark by pharmaceutical corporations such as Johnson & Johnson – is anything but.

Consider the signal it sends. The responsibility for how pharmaceutical corporations should act is no longer the domain of governments, but the decision of a single philanthropy accountable only to itself. The irony of the Declaration is that while corporations and the Gates Foundation call for diversified representation from LMIC governments in decision-making, their framework for global access has been designed by a single foundation and pharmaceutical corporations without any such representation.

It also tries to institutionalize improper commercial practices of the pharmaceutical industry – in particular the unregulated use of price discrimination (tiered pricing). This is when corporations will charge different prices depending on inexact and often completely inappropriate measures of ability to pay (especially in a pandemic), without regard to the relationship between global sales and (risk and subsidy adjusted) development costs. A pledge to secure the lowest prices for low-income countries means that many countries that are at a slightly higher level of Gross National Income per capita (but are struggling under debt and devastation of their health system) will be forced to pay a higher price, decided unilaterally by corporations armed with monopolies. This will have a significant impact on the majority of poor people, because they live in middle-income countries.

The Foundation neglects to require drug corporations to make commitments to critical demands – notably transparency – as per a consensus resolution amongst governments at the World Health Assembly in 2019, as well as forging a commitment from corporations to share IP, data and know-how that has been promoted by many, including 41 governments that support the C-TAP.

A demonstration against the US-Thailand free trade agreement which would have raised prices for medicines that underpin Thailand’s AIDS treatment program.

Finally, the Gates plan does not address the need for and benefits of building out manufacturing capacity in more countries, so that the world is better prepared for what could be a long-term fight against COVID and other future epidemics and pandemics. This means vulnerable governments may have to continue relying on the supply/price charity of both the Gates Foundation and pharmaceutical corporations during subsequent pandemics.

In an interview in September 2020, Bill Gates noted: “[Pharmaceutical corporations’] response to the pandemic and this great work that pharma people are doing has reminded many of their capacities and how they can be helpful to the world – as opposed to the industry being viewed as kind of selfish and uncooperative.”

This faith and belief in the world’s largest drug corporations is hard to fathom. Even if we all believe that these corporations have a critical role to play in developing new technologies and ensuring access to such technologies, we are not so naïve to believe that they will take the necessary steps on their own to ensure that they are meeting global public health needs. Pfizer, one of the signatories to the Gates Foundation’s declaration, may earn up to $3.5 billion in just 2021 from the sale of its COVID-19 vaccine. In fact, just as the Gates Foundation was announcing its new partnership with pharmaceutical corporations in New York, the US House of Representatives Oversight Committee was holding its own hearings, in Washington D.C., just 200 miles away, to reveal a range of egregious practices by pharmaceutical corporations to overcharge patients, extend and abuse IP rights, pay executives excessive compensation and avoid taxes.

How the Gates Foundation funds Civil Society in the Pandemic Stifles Real Debate Over Hard Choices

It is normal today to look at any discussion in global health and see the Gates Foundation in the voice of almost every ‘independent’ actor. Even if there may eventually be concerns with the strategy of the Gates Foundation, there is no mechanism to hold the Foundation accountable to people and countries affected by its choices and influence.

The Gates Foundation, to its credit, is a major funder of civil society and advocacy. But this can also minimize or prevent non-governmental organizations from publicly criticizing the Foundation due to fear of losing funding or undermining access to funds in the future: critical in an environment of decreased government funding of advocacy-based NGOs. The Gates Foundation is also a major funder of journalism (including health and development journalism), raising concerns of the independence of the media to investigate and evaluate the Foundation’s activities.

The Foundation is funding new civil society organisations and networks that may simply mirror its own belief system or promote the views of non-governmental organisations that are both funded by the Gates Foundation and that do not challenge its worldview with respect to pharmaceutical corporations. Early in the pandemic, for example, a new network called the Pandemic Action Network – funded in part by the Gates Foundation and pharmaceutical companies, such as Johnson & Johnson – was created to represent civil society on the important question of pandemic preparedness and response. During the announcement of the Gates Foundation and sixteen pharmaceutical corporations at the UN General Assembly in September, the featured civil society speaker was the CEO of the ONE Campaign, whose organization has received at least $135 million from the Gates Foundation.

The Gates Foundation echo chamber is a concern because international health has become less about activism and human rights and more about power-point slides delivered from conference rooms in Geneva and Seattle. The response to the HIV/AIDS epidemic has always been just as much about what can be done through science, technology and money as about what can be accomplished through communities and civil society groups pressuring their governments and corporations to be accountable for their apathy or harmful decisions.

Activists Denied Seats at the Table 

Seasoned access to medicines activists from civil society organizations and affected communities have had a hard time gaining seats within the Access to COVID-19 Tools Accelerator, a collection of health agencies, public-private partnerships and foundations that is powered in large part by the Gates Foundation. The lack of civil society and community engagement and inclusion in decision making has been especially evident in the ‘Vaccines Pillar’ – which is primarily managed by Gavi and CEPI, two public-private partnerships that are closely tied to the Gates Foundation. Only after months of persistent advocacy did Gavi and CEPI agree to civil society representation, and yet still wanted to control the selection of representatives.

Even those civil society representatives that are integrated in the ACT-Accelerator are having a difficult time with involvement in the higher reaches of the Diagnostics and Therapeutics Pillars – where decisions are made and often brought pre-baked to work-stream meetings. Most commonly, the projects advanced in ACT-A are those that have been incubated and promoted by the Gates Foundation without any involvement by civil society and developing country governments. The capacity reservation for monoclonal antibodies previously described is one such Gates project.

Should governments cede management of a crisis to an unelected and unaccountable foundation? 

Even if we hypothetically agreed with some of the steps the Gates Foundation is taking, we question the self-appointed role that the Gates Foundation has assumed during the pandemic response. Many of the decisions the Gates Foundation, and the health agencies it works with, exclude the LMICs that are being left behind in the pandemic. These are the governments where people have received 4% of the diagnostic tests made available to people in rich countries. These are the governments that have not received allotments of Gilead’s remdesivir, a warning of what will happen when effective medicines and vaccines are eventually approved (recent clinical trial data indicates remdesivir may not provide a therapeutic benefit). These are the governments that have not been able to reserve vaccines, where instead over 50% of COVID-19 vaccine supplies have been hoarded by rich country governments with just 13% of the global population. Shouldn’t LMICs have a greater say in creating the architecture of the global response and in pounding out the policies needed to tackle this viral plague?

The Gates Foundation’s role, and the lack of leadership of governments, will have repercussions beyond the pandemic. We worry that donor governments, mostly unaffected by the practices of the Gates Foundation, are willing to let the Gates Foundation put its money into global health and other development priorities, thereby decreasing the moral and financial accountability of donor governments. It may also be that the sheer size of the Gates Foundation, its accumulation of information and ‘expertise’, as well as its investments in global health agencies, civil society, the media and companies, means that governments may no longer feel that they can challenge the Gates Foundation’s influence.

Developing countries see the Foundation as an integral part of the global health decision making architecture for these same reasons or may themselves not wish to challenge the overriding influence of the Gates Foundation. The result is a vicious circle of reduced government engagement and investment in global health, contributing and leading to even more Foundation intervention and influence, which leads to even less government influence and engagement.

Conclusion – Can We Avoid the Mistakes of the Past?

The COVID-19 pandemic is decimating health systems, economies, and communities around the world. Like the AIDS epidemic, COVID-19 is marked by injustice in the pharmaceutical system. Wealthy countries and philanthropies are paying for research and development and leveraging their investments to cut in line and hoard new vaccines, drugs and tests. In exchange, these same countries are allowing pharmaceutical corporations to control the supply and price through IP monopolies on technology. These policies are undermining any possibility of expanding manufacturing and supply of low-cost medicines, vaccines and tests that could save lives and livelihoods.

It is a moment made for a wider global movement to stop the pandemic in its tracks, to share medicines, tests, vaccines and other medical technologies fairly around the world. It is a moment to imagine and build a new pharmaceutical system that relies less on IP, monopolies and secrecy, and more on approaches to medical R&D that is driven by public health, openness, collaboration and sharing.

At the pinnacle of desperation in 2000, when medicines to treat HIV were unaffordable and pharmaceutical corporations were blocking access, a movement emerged – of people with HIV and AIDS, government officials and politicians in developing countries, treatment advocates, students, non-governmental organizations, health care workers, lawyers, and academics, to overcome the constraints of an IP-based pharmaceutical system that would leave millions of people without medicines.

Thanks to the efforts of this movement, public pressure encouraged developing countries to use legal measures to foster generic competition for antiretroviral medicines and forced pharmaceutical corporations to stop interfering with the efforts of developing countries to save lives. Today, over 90 percent of all medicines used in HIV treatment programs to treat an estimated 25 million people are low-cost generic medicines, including those supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR). Without generic competition, low-cost medicines, and increased funding, the global AIDS response would not have been possible.

The Gates Foundation, and its founders, are the most powerful force in global health today. As a philanthropy, the Gates Foundation may believe that the most we can expect of those with wealth and power is to do things that make sense for them, and not what they must do to best advance global health justice. But to have so much influence and authority means that the Gates Foundation cannot be secretive, cannot prefer monopolies over competition, and cannot applaud pharmaceutical corporations instead of holding such corporations accountable. When the Gates Foundation behaves this way, it excuses all other parties, whether corporations or governments, to fall back on their worst impulses and practices, while trapping everyone within a pharmaceutical system that works best for pharmaceutical corporations and the world’s most powerful countries.

The world cannot rely uncritically on the voice and ideas of billionaires, who made their own fortunes through intellectual property rights, to pull us out of this pandemic. We learnt from the HIV/AIDS epidemic twenty years ago and until today, that only by people around the world holding their governments to account, demanding transparency, and ensuring that corporations are not allowed to put profits ahead of people, will we succeed during these extraordinary times.

_______

Rohit Malpani

Rohit Malpani is a public health consultant and advocate, and also represents non-governmental organisations on the Board of Unitaid.

 

Brook Baker

Brook K. Baker is a professor at Northeastern University School of Law, USA; an honorary research fellow at the University of KwaZulu Natal; and a senior policy analyst with Health GAP (Global Access Project).

Mohga Kamal-Yanni

Mohga Kamal-Yanni MPhil MBE is a consultant in global health and access to medicines.

 

 

 

 

The views expressed here are solely those of the authors and not of the institutions with which they may be affiliated. 

 

Image Credits: Mohga Kamal-Yanni, Médecins Sans Frontières.

Local authorities in Lima, Peru promote cycling as part of a sustainable mobility effort.

Second in a series– Cities that clean up their air quality, and promote other urban sustainability measures can help reduce residents’ risks during the COVID-19 pandemic as well as going forward, say a growing number of urban air quality and sustainability experts.

That message was highlighted in two events last week and today, which were co-hosted by the World Health Organization, UN Habitat, UN Environment and others, in observance of World Cities Day, on Saturday 31 October.  

While of course infectious diseases can spread anytime people fail to take the appropriate individual precautions, the risks of COVID-19 infection in high-density cities drop when cities are well planned, organized and managed, as those kinds of cities are better able to facilitate social distancing and deliver health services, said Eduardo Moreno, Head of Knowledge and Innovation at UN Habitat, at last week’s event on “People-Oriented Urbanization: Planning and Public Health Working Together to Generate Healthy Urban Environments.”

The event was co-hosted by UN Habitat, WHO and the Norwegian Ministry of Foreign Affairs. Said Moreno: “What we can see is there is no correlation [in disease spread] with density.. what is strongly correlated is overcrowding, which is completely different….Cities with high level densities that are well-planned and well-organized will have more capacities to better organize delivery of health services and the possibility of affordable housing.”  

Eduardo Moreno, Head of Knowledge and Innovation at UN-Habitat, at the “People Oriented Urbanization” event.

Jens Aerts, a senior urban planner at the World Urban Campaign, described it as “urban planning as a spatial vaccine” for COVID-19. 

Lockdowns Brought Respite from Health-Harmful Air Pollution – What Next?

Meanwhile, lockdowns, however painful, also created a respite in heavy air pollution levels in many cities around the world as well as bringing to the fore sustainability innovations, like the rapid and massive addition of bicycle lanes in some cities, to provide people with safe transport options – which are also much cleaner over the long-term.

“The pandemic is really…demonstrating to some degree, how cities and countries are able to act swiftly and, in many parts of the world, collaboratively to address a global public health crisis,” said Glynda Bathan, Deputy Executive Director of Clean Air Asia at a BreatheLife into Cities for Clean Air, Climate and Health event on Friday. “In the aftermath [of the pandemic], we must focus on harnessing that same spirit and energy in continuing to fight the climate and air crisis as the next imminent existential threat.” 

The BreatheLife event was co-organized by the United Nations Environment Program (UNEP), the Climate and Clean Air Coalition (CCAC) and WHO. 

The BreatheLife initiative was established by WHO, CCAC, UNEP, and the World Bank as a venue for collaboration and exchange between cities in order to achieve safe air quality levels by 2030, based on the WHO Air Quality Guidelines, a goal that would also reduce pollutants like black carbon particles that contribute heavily to climate change. It has a network of over 70 cities, regions, and countries. 

Unhealthy Air in Cities and Air Pollution Solutions

Nine out of 10 people worldwide, and over 98 percent of people living in large cities in low-income regions breathe unhealthy air. Globally, air pollution leads to an estimated 7 million deaths every year from respiratory and cardiovascular diseases as well as lung cancer.

A growing body of evidence has also suggested that people who live in cities with high levels of air pollution may also be more at risk from serious illnesss with COVID-19, either directly or indirectly because they already suffer from chronic respiratory or heart conditions, which increase their risks of serious COVID-19 illness. Experiences from three cities were shared in the BreatheLife webinar, showing the actions cities are taking to implement air pollution solutions.

COVID-19 Accelerated Air Pollution Awareness – And Mitigation Measures
Nathalie Roebbel, WHO Coordinator for Air Pollution and Urban Health, speaking at the BreatheLife event.

In London, United Kingdom, which was the first mega city to join the BreatheLife campaign, the city has committed to reaching WHO air quality guideline levels. To that end, improved air quality monitoring measures and data assessment have been put in place to both inform the public and policymakers about how progress is advancing. Another programme has supported a shift to electric vehicles for the city iconic taxi system, an effort that has been embraced by London cab drivers.  

In Quito, Ecuador, meanwhile, priority has been placed on the use of cleaner bus technologies as part of a long-term plan, including shifting from diesel to electric vehicles to improve air quality. In addition, cycling and pedestrian lanes are being constructed across larger parts of Quito to incentivize everyday ecological means of mobility.

In Accra, Ghana, where open waste burning is a major air pollution source, measures to encourage domestic waste separation and control ad-hoc waste burning on street corners and in front of businesses are now being implemented. These should achieve multiple benefits for air quality and health. Community outreach and engagement programs have been put in place to inform individuals about the environmental and health risks of burning waste. Through partnerships with local community and religious leaders, and private waste disposal companies, city leaders have been making inroads on the behavior of individuals and households and contributing to cleaner air. 

“In Accra, most of our pollution…was from waste,” said Desmond Appiah, Chief Sustainability and Resilience Advisor to the Mayor of Accra. “There were over 46 waste dump sites in Accra. And we mapped it out, we were able to, through the leadership of the mayor, to close about 37 of these illegal dump sites. Some of these areas were created because of poor waste management in some communities.

Illegal waste dump site near Agbogbloshie, Accra, Ghana.

“We picked two communities that we believed had a very high incidence of burning of waste as a means of disposing of the waste, and we focused on those communities,” he added. To build support for the initiative, the city reached out to local community figures and launched school education programs to inform children, who would then inform their parents and households about the separation of waste and proper disposal of waste.

Cities are increasingly developing new visions for more equitable and sustainable urban systems, prompted by COVID-19 to reform national and city government organization, economies and fiscal priorities. The enormous range of efforts made by cities and cities leaders is captured in the hundreds of BreatheLife campaign stories, and specific to the COVID response, in the portfolio of case studies released by the WHO on Wednesday. 

“Addressing air pollution will have a benefit…on multiple levels of risk factors and health outcomes,” said Nathalie Roebbel, WHO Coordinator for Air Pollution and Urban Health. “If, for example, we change the…structur[ing] of the cities, [it] will maybe increase the opportunity for people to use bicycles or walking. Certainly this will not only have an impact on reduced car use, and therefore reduced air pollution, it will also have benefits in better physical activity and reduction of obesity.”

“[Communities] play a vital role in building economically, socially and environmentally sustainable cities,” said António Guterres, UN Secretary-General, in a statement about World Cities Day. “As we rebuild from the pandemic and engage in the Decade of Action for Sustainable Development, we have an opportunity to reset how we live and interact…Let’s put our communities at the heart of the cities of the future.” 

Moving from Reaction to Prevention 

Overall, collaboration between city planners, development and health sectors is key to curbing pollution emissions, promoting clean energy, and designing neighborhoods and cities that enhance the overall health of residents, and thus reduce fundamental risks associated with the  transmission of diseases, which can lead to the explosion of pandemics.

“The health sector is largely focused on curative and medical results through health infrastructure, ignoring preventative health…A lot of determinants that actually affect health are outside the control of the health sector: housing, air quality, etc.,” said Virinder Sharma, senior urban development specialist at the Asian Development Bank. 

“There is clear evidence that the health sector needs to be [more] knowledgeable on the health effects of air pollution, so capacity building needs to be done in order to have the healthcare workforce itself being able to inform patients, treat them, but also influence decision makers in other sectors,” said Roebbel. 

Image Credits: Partnerships for Health Cities, WHO, Accra Metropolitan Assembly.

Dr Matshidiso Moeti, the regional director for Africa voices support for Iweala
The regional director for Africa of the World Health Organisation, Dr Matshidiso Moeti, voiced the organisation’s support for Iweala.

IBADAN – Nigeria’s former finance minister and board chair of Gavi, Ngozi Okonjo-Iweala, was on track to be named World Trade Organization’s (WTO) first female and first African Director-General (DG) until the US government blocked her appointment, throwing the final decision to a November 9 meeting of the WTO Council of Ministers.

Nigerian government’s official statement on WTO DG election.

 

Shy of an all-out public confrontation with the US government, African governments and key stakeholders across the continent are subtly pushing back on the decision of representatives of the Trump-led administration to oppose the declaration and emergence of Dr Ngozi Okonjo-Iweala as the elected Director General of the WTO.

In a public statement, the Nigerian government said it will do everything it can to ensure the emergence of Iweala as WTO’s next leader.

“Nigeria will continue to engage relevant stakeholders to ensure the lofty aspiration of her candidate to lead the WTO is realised,” Nigeria’s foreign ministry spokesperson, Ferdinand Nwonye, said in a press release on Thursday.

Iweala secured cross-regional backing from WTO members, with only the United States opposing the consensus at a meeting of 27 delegations on Wednesday.

The stalemate occurred after David Walker of New Zealand and his two co-facilitators in the selection process told the delegations that based on their consultations with all WTO members, Iweala was best poised to receive majority support as its 7th Director-General.

“She clearly carried the largest support by members in the final round and she clearly enjoyed broad support from members from all levels of development and all geographic regions and has done so throughout the process,” Walker was quoted as saying. “I am therefore submitting the name of Ngozi Okonjo-Iweala as the candidate most likely to attract consensus and recommending her appointment by the General Council as the next Director-General of the WTO until 31 August 2024.”

WHO Regional Director for Africa Expresses Support 

Iweala, board chair of Gavi, The Vaccine Alliance, is also being quietly supported by global health leaders who know that WTO will play a pivotal role in guiding policies about the application of patent-related trade rules for health products in the sensitive COVID-19 pandemic.

Speaking on Thursday, World Health Organisation’s Regional Director for Africa, Dr Matshidiso Moeti, has said that she is confident about Iweala’s capacity — and hopeful that the majority choice of WTO’s 164 member governments will ultimately prevail.

Co-facilitators in the selection process to choose the WTO’s next Director-General.

“We believe in her competence and capacity for this position and we wish for an outcome, and resolution that will be based on the outcome of the election, which was an open process as we understand,” Moeti told Health Policy Watch, at a press briefing.

Moeti described Iweala as a strong promoter of global health, experience all the more relevant for navigating the trade organization at a critical moment in the COVID-19 pandemic in which health and trade protocols are inextricably intertwined. 

“I’m certain the WTO will find the means to have the outcome of this election respected and Dr Ngozi confirmed,” Moeti added.  “We will be extremely proud to have the first woman, an African woman, be the head of this very important organisation that is so critical for international trade. We know there are many important changes that need to happen to put in place a framework for the international trade system for countries in Africa to benefit.”

US Government’s Opposition — What’s the Real Source?

Although Iweala has twice served as Nigeria’s finance minister, she is also a citizen of the United States, having spent many years in Washington DC in the senior ranks of the World Bank.

Despite that, the US opposition to her candidacy has been blunt.  On Thursday, the WTO’s formal statement directly referred to the US position, saying that Washington would continue to support the candidacy of Yoo Myung-hee of the Republic of Korea.

 

“The assessment [of the elections committee] was challenged by the United States which said it would continue to support Minister Yoo and could not back the candidacy of Dr Ngozi Okonjo-Iweala,” the WTO stated.

Various explanations are emerging regarding the US position. Most revolve around the Trump Administration’s stance regarding specific WTO trade policies — but also extending to the nature of the organization as a whole.

Notably, the US government has been blocking the appointment of new judges to the Appellate Body of the WTO. The Body has seats for six judges but needs a minimum of three to function. 

Since one of the WTO’s most important functions is to resolve trade disputes between countries, through its Appellate Body, these appointments are critical, and by blocking the appointment of new judges, the White House has effectively paralyzed the global organisation.

With a functioning WTO, trade conflicts are resolved with legal arguments but when it is unable to function, conflicting sides may choose to resolve their disagreements by engaging in tariff wars, trade barriers, and beggar-thy-neighbor protectionism — these are approaches that the US government under Trump has preferred since he took office.

US President Donald Trump has been a public critic of the WTO and the global trade system.

“When you listen to the rhetoric from the Trump administration, they argue that the United States is better off in a power-based, law of the jungle system,” said Jennifer Hillman, the senior fellow for trade at the Council on Foreign Relations. “I think the last three years have shown how wrong that is.”

In an interview with Foreign Policy, Keith Rockwell, WTO director of external relations opined that the global trade ecosystem is approaching a point where it could soon prove a counterfactual: “We have the WTO essentially because of economic nationalism, and the lessons of the Smoot-Hawley tariffs, and all those destructive policies.”

The US government played a critical role in the founding of the WTO in 1995, when it emerged from the more ad-hoc General Agreement on Tariffs and Trade (GATT) that had governed global trade rules since 1948. Its creation effectively codified the trends of the late 1990s favoring  trade liberalization.

But the Trump administration has embarked on unilateral trade wars thus defeating the original purpose of the WTO, and it appears to be seeking to keep it defeated — at least until the presidential election is completed and a clearer picture emerges regarding who is in charge at the White House.

Ngozi Okonjo-Iweala: ‘I Have the Skills that are Needed’

Despite the US attempt to block at the goal post, Iweala has responded with aplomb, expressing her satisfaction regarding the success and continued progress of her WTO leadership bid.

Writing on Twitter, she said that she was, “Very humbled to be declared the candidate with the largest, broadest support among members and most likely to attract consensus.

“We move onto the next step on Nov. 9, despite hiccups. We’re keeping the positivity going.”

Former World Bank exec, Gavi board chair and Nigeria’s former finance minister, Ngozi Okonjo-Iweala.

Opponents Include US Trade Representative 

Not only the White House, but also U.S. Trade Representative Robert Lighthizer’s opposes Iweala’s emergence as the next DG of the WTO, Bloomberg reported, due to his view of her as too close to pro-trade internationalists like Robert Zoellick.

But in Lighthizer’s official statement, he merely cited the US government’s continued support of Republic of Korea candidate Yoo Myung-hee to her 25-year career as a successful trade negotiator and trade-policy maker.

“This is a very difficult time for the WTO and international trade. There have been no multilateral tariff negotiations in 25 years, the dispute-settlement system has gotten out of control, and too few members fulfill basic transparency obligations. The WTO is badly in need of major reform. It must be led by someone with real, hands-on experience in the field,” said Lighthizer.

Iweala has cited her experience at the top at the World Bank and as Nigeria’s finance minister as training enough for the position:

“I am a development economist and you cannot do that without looking at trade. Trade is a central part of development,” Iweala stated. “So, I have been doing it. My whole career at the World Bank, I was working on trade policy reform in middle and low-income countries at the bank.”

She added: “Those who say I don’t have trade, they are mistaken. I think the qualities I have are even better, because I combine development economics with trade knowledge, along with finance, and you need this combination of skills to lead the WTO. I think I have the skills that are needed. I am a trade person.”

Iweala’s emergence as WTO director general would make her the first African as well as the first woman to lead the Organization.

During her career, she served for 25 years at the World Bank, two terms as Nigeria’s finance minister, as well as currently serving as a board chairperson of the Global Vaccine Alliance (Gavi) and a board member of social media giant Twitter.

Another slight on Africa

While African countries remain officially quiet regarding the plight of Iweala, for now, diplomats note that this is not the first time that the continent’s experts will be at loggerheads with the US government.

The US government’s decision to exit from the World Health Organisation (WHO) happened at a time when an African, Ethiopias Dr Tedros Adhanom Ghebreyesus was leading the global health body for the first time.

Iweala is not the first Nigerian, either, to be elected or appointed to a major global role that the Trump Administration has attempted to undermine. A similar development occurred during the re-election of Akinwumi Adesina to lead the African Development Bank earlier this year.

All in all, said Judd Devermont, director of the Africa Programme at the Center for Strategic and International Studies, Iweala is “extraordinarily qualified” to lead the WTO.

Image Credits: Paul Adepoju, Ministry of Foreign Affairs, Abuja, WTO, Wikipedia Commons.

WHO director-general Dr. Tedros Adhanon Ghebreyesus

It is “imperative” that governments recognize the long-term effects of COVID-19 and ensure that affected people can access health services, including primary health care as well as rehabilitation, emphasized the World Health Organization on Friday.

“Although we are still learning about this virus, what’s clear is that this is not just a virus that kills a significant number of people,” warned the Organization’s director-general Dr. Tedros Adhanom Ghebreyesus, just hours after a deadly earthquake jolted Turkey and Greece, killing over a dozen people and leaving some 400 injured. 

“This virus poses a range of serious long-term effects. While people do recover, it can be slow, sometimes [taking] weeks or months,” he added.

In past months, mounting evidence has revealed that COVID-19 can trigger a nasty array of long-term effects that range from fatigue, shortness of breath, inflammation and injury of major organs like the heart or lungs, as well as neurological and psychological effects, warned the director-general.

While it is still unclear how many COVID-19 patients experience such long-term effects, it has become strikingly apparent that young people, male and female, with seemingly mild disease, are also affected by long COVID. Several direct testimonies by people who had COVID were aired at the press briefing: 

Patients Testimonies – Eight Months And Still Ill 

Lih Hismeh, 26-year old with long COVID

“It’s been eight months, almost eight months now,” said 26-year old Lih Hismeh, as he recounted his painful experience of long COVID at Friday’s press conference. “I’m still suffering from fatigue, brain fog, chest pain, palpitations, digestive issues, short-term memory loss. There is no system in my body that hasn’t been affected.” 

“I went back to work on reduced hours, but I couldn’t even cope with that because of the brain fog,” added Hismeh, who is a member of the UK’s long COVID SOS patient advocacy group. “I used to be a software engineer. I can’t do that. I also used to do research in artificial intelligence. And now I can’t do that either. I just want my mental focus back.”

As the world itches for a vaccine, governments and societies must do “all they can” to suppress transmission using the tools that are available, including testing, contact tracing and isolation of COVID-19 cases, emphasized the director-general. He noted that such simple measures are still the “best way” to prevent the long-term consequences of COVID, but “commitment” and “hard work” are required to follow through.

“It’s not rocket science, but it requires commitment,” added WHO’s head of emergencies Mike Ryan. “It requires sustained commitment and hard work. It requires bringing people together and not tearing them apart. It requires humility, not hubris. 

“I wish the answers were simple, and there was a magic solution,”said Ryan. “But like everything in our lives that’s complicated. It takes hard work and commitment to work our way out of it.”

Mike Ryan, WHO’s head of emergencies

IHR Emergency Committee Urges Governments To Focus On Measures That Work

This Thursday also marked the fifth meeting of the Emergency Committee on COVID-19 to review the current COVID-19 climate, and to assess how well its temporary recommendations from early August were implemented. 

The Committee’s advice, which was accepted by the WHO’s director-general, urged countries to focus on proven responses and strong science, and unanimously agreed that the pandemic still constitutes a public health emergency of international concern. 

“The take home message is that it’s important for governments and citizens to keep focused on breaking the chains of transmission,” Dr. Tedros noted.

The Committee also commended the WHO’s sustained efforts to bolster national, regional, and global responses to the COVID-19 pandemic through its evidence based-guidance, technical assistance, clear communication, and for convening the Solidarity Trials and the Access to COVID-19 Tools (ACT) Accelerator.

However, the Committee’s Chair Didier Houssin, who also spoke on Friday, said the WHO Secretariat should revise its guidance on international travel to ensure that it is evidence-based and coherent with the International Health Regulations – the WHO’s legal framework that governs countries’ behaviour during health emergencies. He also urged politicians to avoid using the pandemic to acquire or keep power, instead calling for national unity and evidence-based responses.

Didier Houssin, Chair of The Emergency Committee on COVID-19

A Global Mechanism For Rapid Sharing Of COVID-19 Genetic Data

Meanwhile, the WHO emphasized the need for a global mechanism to rapidly share COVID-19 genetic sequence data, as media attention focuses on the fact that a a novel variant of the SARS-CoV virus, which originated in Spain, is now spreading across Europe.  The virus mutation has been identified by a team of researchers from Spain and the University of Basel. 

WHO’s technical lead on COVID-19 Maria Van Kerkhove

WHO’s technical lead for COVID-19 Maria Van Kerkhove emphasised that although ‘mutations’ sounds like a “very scary word”, these are natural changes, noting that the SARS-CoV-2 virus is “relatively stable” with a relatively slow mutation rate in comparison to other viruses.

However, mutations must be monitored regularly to ensure that SARS-CoV-2 is not becoming more deadly or infectious, as this would have important implications for diagnosis of the coronavirus and vaccine development.

 “We must monitor genetic changes in SARS-COV-2 to determine if the virus behaves differently,” Van Kerkhove warned. “We need researchers and scientists to continue to share those full genome sequences.”

Image Credits: NIAID.