A map showing the spread of a novel SARS-CoV-2 variant
The “family tree” of sequences of the new variant indicates that it traveled between countries multiple times.

University of Basel. Researchers from Basel and Spain have identified a novel SARS-CoV-2 variant that has spread widely across Europe in recent months, according to an un-peer-reviewed preprint released this week in medRixv. While there is no evidence of this variant being more dangerous, its spread may give insights into the efficacy of travel policies adopted by European countries during the summer.

In Europe alone, hundreds of different variants of the new coronavirus SARS-CoV-2 are currently circulating, distinguished by mutations in their genomes. However, only very few of these variants have spread as successfully and become as prevalent as the newly identified variant, named 20A.EU1.

The researchers at the University of Basel, ETH Zürich in Basel and the SeqCOVID-Spain consortium analysed and compared virus genome sequences collected from Covid-19 patients all across Europe to trace the evolution and spread of the pathogen. Their analysis suggests that the variant originated in Spain during the summer. The earliest evidence of the new variant is linked to a super-spreading event among agricultural workers in the north-east of Spain. The variant moved into the local population, expanding quickly across the country, and now accounts for almost 80% of the sequences from Spain.

“It is important to note that there is currently no evidence the new variant’s spread is due to a mutation that increases transmission or impacts clinical outcome,” stressed Dr. Emma Hodcroft of the University of Basel, lead author of the study. The researchers believe that the variant’s expansion was facilitated by loosening travel restrictions and social distancing measures in summer.

Similar pattern as in spring in Spain

“We see a similar pattern with this variant in Spain as we did in the spring,” advised Professor Iñaki Comas, co-author on the paper and head of the SeqCOVID-Spain consortium. “One variant, aided by an initial super-spreading event, can quickly become prevalent across the country.”

From July, 20A.EU1 moved with travellers as borders opened across Europe, and has now been identified in twelve European countries. It has also been transmitted from Europe to Hong Kong and New Zealand. While initial introductions of the variant were likely from Spain directly, the variant may then have continued to spread onward from secondary countries.

Currently, 20A.EU1 accounts for 90% of sequences from the UK, 60% of sequences from Ireland, and between 30 and 40% of sequences in Switzerland and the Netherlands. This makes this variant currently one of the most prevalent in Europe. It has also been identified in France, Belgium, Germany, Italy, Latvia, Norway, and Sweden.

Travel facilitated the spread

Genetic analysis indicates that the variant travelled at least dozens and possibly hundreds of times between European countries. “We can see the virus has been introduced multiple times in several countries and many of these introductions have gone on to spread through the population,” said Professor Tanja Stadler of ETH Zürich, one of the study’s principal investigators. “This isn’t a case of one introduction just happening to do well.”

Though the rise in prevalence of 20A.EU1 corresponds with the increasing number of cases observed in many European countries this autumn, the study’s authors caution against interpreting the new variant as a cause for the rise in cases. “It is not the only variant circulating in recent weeks and months,” said Professor Richard Neher of the University of Basel, one of the study’s principal investigators. “Indeed, in some countries with significant increases in Covid-19 cases, like Belgium and France, other variants are prevalent.”

SARS-CoV-2 variant line graph indicating a correlation to the opening of borders
It was detected in the EU in August, correlating with border openings.

Analysis of the summertime SARS-CoV-2 prevalence in Spain and travel data show that these factors may explain how 20A.EU1 spread so successfully. Spain’s relatively high number of cases and popularity as a holiday destination may have allowed multiple opportunities for introductions, some of which may have grown into larger outbreaks through risky behaviours after returning home.

The study’s authors highlight the importance of evaluating how border controls and travel restrictions worked in containing SARS-CoV-2 transmissions over the summer, and the role travel has played. “Long-term border closures and severe travel restrictions aren’t feasible or desirable,” explained 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.”

Assessing the phenotype of the new variant

The new variant was first identified by Hodcroft during an analysis of Swiss sequences using the ‘Nextstrain’ platform, developed jointly by the University of Basel and the Fred Hutchinson Cancer Research centre in Seattle, Washington. 20A.EU1 is characterized by mutations that modify amino-acids in the spike, nucleocapsid, and ORF14 proteins of the virus.

Though the present state of knowledge does not indicate 20A.EU1’s spread was due to a change in transmissibility, the authors are currently working with virology labs to examine any potential impact the spike mutation, known as S:A222V, may have on the SARS-CoV-2 virus’ phenotype. They also hope to soon receive access to data that would allow them to assess any clinical implications of the variant.

The study’s authors emphasized the importance of monitoring the rise of new variants like 20A.EU1 closely: “It is only through sequencing the viral genome that we can identify new SARS-CoV-2 variants when they arise and monitor their spread within and between countries,” added Neher, “But the number of sequences we have varies widely between countries, and we might be able to identify rising variants sooner with faster and more regular sequencing efforts across Europe.”

Image Credits: University of Basel, Iñaki Comas.

Pandemic risk can be lowered by reducing human activities that drive the loss of biodiversity.

IPBES Media – Future pandemics will emerge more often, spread more rapidly, do more damage to the world economy and kill more people than COVID-19  – unless there is a transformative change in the global approach to dealing with infectious diseases, warns a major new report on biodiversity and pandemics by 22 leading experts from around the world.

The report, the product of a recent workshop convened by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), examines the links between degradation of nature and increasing pandemic risks. It argues that escaping the era of pandemics is possible, but that this will require a seismic shift in approach from reaction to prevention. IPBES is an independent organization supported by some 94 governments around the world, and housed at the UN Environment Programme.

COVID-19 is at least the sixth global health pandemic since the Great Influenza Pandemic of 1918, the report notes.  Although it has its origins in microbes carried by animals, its emergence has been driven by human activities, says the new report, which was released on Thursday. It is estimated that another 1.7 million currently ‘undiscovered’ viruses exist in mammals and birds – of which up to 850,000 could have the ability to infect people.

The study suggets plans for ecological restoration should integrate health considerations

“There is no great mystery about the cause of the COVID-19 pandemic – or of any modern pandemic,” said Dr. Peter Daszak, President of EcoHealth Alliance and Chair of the IPBES workshop that produced the report. “The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment. Changes in the way we use land; the expansion and intensification of agriculture; and unsustainable trade, production and consumption disrupt nature and increase contact between wildlife, livestock, pathogens and people. This is the path to pandemics.”

Pandemic risk can be significantly lowered by reducing the human activities that drive the loss of biodiversity, by greater conservation of protected areas, and through measures that reduce unsustainable exploitation of high biodiversity regions. This will reduce wildlife-livestock-human contact and help prevent the spillover of new diseases, says the report.

“The overwhelming scientific evidence points to a very positive conclusion,” said Dr. Daszak. “We have the increasing ability to prevent pandemics – but the way we are tackling them right now largely ignores that ability. Our approach has effectively stagnated – we still rely on attempts to contain and control diseases after they emerge, through vaccines and therapeutics. We can escape the era of pandemics, but this requires a much greater focus on prevention in addition to reaction.”

“The fact that human activity has been able to so fundamentally change our natural environment need not always be a negative outcome. It also provides convincing proof of our power to drive the change needed to reduce the risk of future pandemics – while simultaneously benefiting conservation and reducing climate change.”

The report says that relying on responses to diseases after their emergence, such as public health measures and technological solutions, in particular the rapid design and distribution of new vaccines and therapeutics, is a “slow and uncertain path”, underscoring both the widespread human suffering and the tens of billions of dollars in annual economic damage to the global economy of reacting to pandemics.

Pointing to the likely cost of COVID-19 of $8-16 trillion globally by July 2020, it is further estimated that costs in the United States alone may reach as high as $16 trillion by the 4th quarter of 2021. The experts estimate the cost of reducing risks to prevent pandemics to be 100 times less than the cost of responding to such pandemics, “providing strong economic incentives for transformative change.”

The report also offers a number of policy options that would help to reduce and address pandemic risk. Among these are:

Jungle burned for agriculture in southern Mexico
  • Launching a high-level intergovernmental council on pandemic prevention to provide decision-makers with the best science and evidence on emerging diseases; predict high-risk areas; evaluate the economic impact of potential pandemics and to highlight research gaps. Such a council could also coordinate the design of a global monitoring framework.
  • Countries setting mutually-agreed goals or targets within the framework of an international accord or agreement – with clear benefits for people, animals and the environment.
  • Institutionalizing the ‘One Health’ approach in national governments to build pandemic preparedness, enhance pandemic prevention programs, and to investigate and control outbreaks across sectors.
  • Developing and incorporating pandemic and emerging disease risk health impact assessments in major development and land-use projects, while reforming financial aid for land-use so that benefits and risks to biodiversity and health are recognized and explicitly targeted.
  • Ensuring that the economic cost of pandemics is factored into consumption, production, and government policies and budgets.
  • Enabling changes to reduce the types of consumption, globalized agricultural expansion and trade that have led to pandemics – this could include taxes or levies on meat consumption, livestock production and other forms of high pandemic-risk activities.
  • Reducing zoonotic disease risks in the international wildlife trade through a new intergovernmental ‘health and trade’ partnership; reducing or removing high disease-risk species in the wildlife trade; enhancing law enforcement in all aspects of the illegal wildlife trade and improving community education in disease hotspots about the health risks of wildlife trade.
  • Valuing Indigenous Peoples and local communities’ engagement and knowledge in pandemic prevention programs, achieving greater food security, and reducing consumption of wildlife.
  • Closing critical knowledge gaps such as those about key risk behaviors, the relative importance of illegal, unregulated, and the legal and regulated wildlife trade in disease risk, and improving understanding of the relationship between ecosystem degradation and restoration, landscape structure and the risk of disease emergence

Speaking about the workshop report, Dr. Anne Larigauderie, Executive Secretary of IPBES said: “The COVID-19 pandemic has highlighted the importance of science and expertise to inform policy and decision-making. Although it is not one of the typical IPBES intergovernmental assessments reports, this is an extraordinary peer-reviewed expert publication, representing the perspectives of some of the world’s leading scientists, with the most up-to-date evidence and produced under significant time constraints. We congratulate Dr. Daszak and the other authors of this workshop report and thank them for this vital contribution to our understanding of the emergence of pandemics and options for controlling and preventing future outbreaks. This will inform a number of IPBES assessments already underway, in addition to offering decision-makers new insights into pandemic risk reduction and options for prevention.”

Image Credits: The IPBES Media Team, Jami Dwyer.

The Food Aid System of Milan – Dispositivo di Aiuto Alimentare initiative

First in a Series: While COVID continues to cast a long shadow over our everyday lives, from Baku, Azerbaijan to Bogota, Columbia, there are also countless examples of how cities and communities have mobilized to respond to the social and economic fallout from the pandemic – building new forms of cooperation that also promote a wide range of longer-term social and health benefits.  

The stories cut across cities of all regions, income levels and sizes.  Some of the examples are captured in a series of case studies released yesterday by WHO ahead of World Cities Day, which is observed on Saturday, 31 October. Innovations include the dramatic expansion of cycle lanes in Bogota, Colombia; safe bus transport in Baku, Azerbijian; upgrading informal settlements in Buenos Aires, Argentina and new, city-wide food bank efforts in Milan, Italy and Freetown, Sierra Leone that linked up existing food charities to ensure more systematic coverage of people needing support, and also put an emphasis on healthy, nutritious foods.

Safe, Sustainable Public Transport in Baku and Bogota    
In Baku more than 2000 buses operate on 150 routes, carrying more than 2 million passengers daily across the city.

In Baku, the Baku Transport Authority (BTA) has more than 2000 buses operating on 150 routes. The BTA became a key member of the government’s coordinated pandemic response plan, which included acting as the primary transport providers after the suspension of operations of the Baku metro. There were also awareness raising campaigns implemented by the BTA in a show of solidarity for the government, with posters and educational booklets on how to protect against the virus distributed in stations and the city’s main transport exchange. 

“Public transport professionals are part of the front liners in these critical times and our first priority is to keep the citizens safe and healthy”, said Vusal Karimli, Chairman of BTA. “We are proud to be serving our people by providing continuous mobility services for essential travelers.”

Bogotá’s Ciclovías (bike lanes)

In addition to public transportation, Bogotá’s world-famous Ciclovías (bike lanes) have been expanded even more to promote the use of active, alternative, and sustainable transport during pandemic times.  Bogota has long had a reputation as a pioneer in sustainable bus rapid transport as well as cycle transport, with 550 kilometers of bike lanes in operation even before the pandemic began. During the pandemic, the city added another 84 kilometers,  making Bogotá’s Ciclovías network among the largest in the world, and giving people a safe, healthy and sustainable way of getting around during the  lockdown and its aftermath. Workshops are also offered to Ciclovía users to remind them to keep their hands and bikes sanitized, and to remain a safe distance from other cyclists, in an effort to stop the spread of COVID-19. 

Creating Stronger and Healthier Food Safety Nets in Milan and Sierra Leone 
Freetown, Sierra Leone, has been working with partners to provide healthy, nutritious food to its citizens during the pandemic

Food security has been a big concern in the midst of the pandemic from the wealthiest to the poorest cities. In Freetown, the capital city of Sierra Leone, which survived a decade-long civil war (1991-2002) civil war only to be hit brutally hard by the 2014-16 West Africa Ebola epidemic, the municipal government has been providing its most vulnerable residents with food packages so they can stay safe and healthy in quarantine. Around 30% of Freetown’s 1.2 million residents have a family income of less than 1 USD per day, and 47% do not have direct access to running water. Food insecurity was highlighted in a national survey conducted in April, where only 12% of respondents said that they had sufficient foodstocks to last even one week. 

The city government provided food to 6000 households across three informal settlements; an urban farming initiative also has been created to support sustainable access to nutritious food while helping city residents become more prepared for future crises. 

The Food Aid System of Milan, or the Dispositivo di Aiuto Alimentare, sought to organize more systematic distribution of food stocks during the spring 2020 lockdown, in partnership with many public and private organizations and charities that operate food banks and similar programmes.  A longer-term feature of the initiative is the ambition to ensure vulnerable households can access  fresh produce, and not only processed food. 

“Milan Food Policy has once again become an instrument to face emerging needs of citizens. By building alliances with many players in the city we built the Food Aid System, in order to get close to families and fragile people who, in addition to a health emergency, were also going through a food crisis, ” says Anna Scavuzzo, Vice Mayor of Milan in charge of Food Policy

The “Lethbridge Helping Organizations COVID-19 Response” was launched by city authorities to strengthen collaboration by local groups to serve the needs of all residents.

Other cities have also partnered with organizations to assist their citizens. In the Canadian province of Alberta, the city of Lethbridge launched “The Lethbridge Helping Organizations COVID-19 Response” to strengthen collaboration with local groups in order to serve the needs of city’s residents. Community members offered to pick up medications, offered rides, lent out house supplies, etc, on a Facebook COVID-19 support page. Other programmes supplied volunteer wellness checks and the delivery of food boxes to older people. 

Buenos Aires, Argentina  – Strengthening Pandemic Resilience in Informal Settlements

The City Housing Institute (IVC) of Buenos Aires, collaborated with local grassroots organizations to strengthened resilience in the Villa 20 neighborhood. In this informal urban settlement, home to 30,000 people, 14% of families have at least one household member with a disability, and 30% with a chronic or pre-existing health condition. 

Under the authority of the Ministry of Social Development and Housing and the Ministry of the City Government of Buenos Aires, IVC implemented prevention and protection measures and provided assistance to families in need. The interventions covered five areas: food security, health, urban hygiene, and communication. The quick action also helped curb the spread of the virus, resulting in fewer COVID-19 cases.

Ahmedabad, India – Reducing Tobacco Use That Breeds COVID-19 Infections 

In the largest city in India’s western state of Gujarat, the city government of Ahmedabad made a decision to reduce the use of tobacco products during the COVID-19 pandemic period. Smokeless tobacco, in particular chewing tobacco products such as gutka, khaini, zarda, and paan, induce salivation and trigger the urge to spit. Spitting can, in turn, facilitate the spread of infectious diseases, potentially including the SARS-CoV-2 virus that causes COVID-19. In March, a ban on spitting on roads and in public places was implemented as an effort not only to reduce the spread of the virus but is acting on continued efforts to prevent tobacco-related cancers and other noncommunicable diseases in the city. 

These cities and more are part of the Partnership for Healthy Cities – a global network supported by Bloomberg Philanthropies in partnership with WHO and Vital Strategies. This initiative enables cities around the world to deliver high-impact policy or preventative intervention to combat noncommunicable disease and injuries in their communities, and has since expanded its support during the COVID-19 pandemic. 

Says WHO Director Dr. Etienne Krug, who leads the effort for WHO:  “These case studies show how cities are innovating to protect the health and well-being of their citizens, while under the stress of the pandemic. They show how city leaders are addressing challenges in food security, city planning, or safe mobility by taking a longer-term sustainable approach.” 

“The legacy of these innovations and programmes will last beyond COVID-19.  They are great examples of strong local actions during the pandemic and beyond.”

Image Credits: Pietro Baroni , Baku Transport Agency, Fernanda Lanzagorta, OPS Columbia, WHO , Trevor Page.

Researchers in Sanofi’s laboratory in France.

Sanofi and GlaxoSmithKline, two drugmakers, announced that they would provide 200 million doses of their potential COVID-19 vaccine to the WHO and Gavi Alliance co-sponsored COVAX procurement facility, which more than 180 countries have joined.  

“To address a global health crisis of this magnitude, it takes unique partnerships. The commitment we are announcing today for the COVAX Facility can help us together stand a better chance of bringing the pandemic under control. This moment also reflects our long-term commitment to global health and ensures our COVID-19 vaccines are affordable and accessible to those most at risk, everywhere in the world,” said Thomas Triomphe, Global Head of Sanofi Pasteur. 

Sanofi and GSK began their Phase 1/2 clinical trial in September and they expect to start late-stage testing by the end of the year. Although Sanofi and GSK aren’t leading in the race to develop a COVID-19 vaccine, compared to Pfizer, Moderna, or Johnson & Johnson, their recombinant protein-based vaccine could become an important player in the long-term push for a COVID-19 vaccine.

Mortality Rates Decreasing, Even As Many Countries Experience Rising COVID-19 Cases, Finds Study

Meanwhile, although COVID-19 infection rates are rising globally, a recent report published last week in the Journal of Hospital Medicine found declining rates in mortality. The study conducted in New York among COVID-19 patients observed a significant drop in mortality rates from 25.6 percent in March to 7.6 percent in August. 

The other trends in COVID-19 hospitalization and infection were shifts in demographics and severity of the illness. The median age of COVID-19 hospitalization dropped from 63 years old in March to 49 in August. The comorbidities of patients diagnosed with COVID-19 has also decreased from 80.7 percent to 71.6 percent. 

The researchers adjusted for the demographic changes and found that the results represented actual improvements. The 18.2 percentage point decrease between March and August could be attributed to improved treatment of COVID-19 in hospitals. 

“This is still a high death rate, much higher than we see for flu or other respiratory diseases,” said Leora Horwitz, director of NYU Langone’s Center for Healthcare Innovation and Delivery Science. “I don’t want to pretend this is benign. But it definitely is something that has given me hope.” 

Developments in care of patients with SARS-CoV2, including using ventilators, blood thinners, steroids, and knowing what complications to watch for, contributes to better illness outcomes, said Horwitz. “We don’t have a magic bullet cure, but we have a lot…of little things that add up.”

SARS-CoV2 Antibodies decline within Two Months of Exposure, New Study Finds

At the same time, results from recent study by Imperial College London found declining rates of antibody prevalence among individuals in England from June to September 2020. The results suggest rapidly decreasing population immunity and increasing risk of reinfection. 

The “REACT-2” study included 365,104 adults in three random, non-overlapping samples, and tested for antibody prevalence at three points after the peak of COVID-19 in England in April. 17,576 tested positive for SARS-CoV2 antibodies. The prevalence of antibodies was highest in individuals aged 18-24 and lowest in the 75 and over age group. 

The first round of testing in June found that six percent of those tested had detectable antibodies. In August, the prevalence had reduced to 4.8 percent, and September recorded a rate of 4.4 percent. The highest decline in antibody prevalence was in the oldest population group, 75 and over. 

Image Credits: Sanofi.

Ngozi Okonjo-Iweala, in her former role as Nigerian Finance Minister, speaking at French-African economic conference

Ngozi Okonjo-Iweala, board chair of Gavi, The Vaccine Alliance, on Wednesday was named as the favored candidate to be the next World Trade Organization director-general  – after a months-long WTO campaign process and in a decisive moment of the COVID-19 pandemic.

But as the United States came out in favor of the Republic of Korea’s Yoo Myung-hee, stalling the final consensus-building process, WTO officials said that a final decision will have to go before the full 164-member General Council of member governments on November 9 – a week after the US presidential elections.

The US opposition to a recommendation by the WTO’s “Troika” selection committee, is a double slap in the face since Iweala is a dual US-Nigerian citizen. She also comes to the table with strong global health credentials at a time in which the WTO is being asked to broker sensitive issues of patent rights versus medicines access.

The new WTO Director General will play a critical role in negotiating the rough waters ahead between countries in the global South that want to create a broad “patent waiver” for COVID-19 health products and high-income countries in the G7 and the European Union that oppose such a move. Iweala, a former Nigerian Trade Minister, is serving as a special African Union envoy charged with mobilizing economic support for the fight against the pandemic.

In the final, late September round of her campaign, Iweala made it clear that she sees WTO as playing a pivotal role in pandemic response, saying that “trade can contribute to public health and the WTO can lead”.  While she has also issued positive signals to business leaders, she also   tweeted that “the health of populations is the business of the WTO… The world can’t wait WTO must play a central role in the COVID-19 supply chain.”

India and South Africa’s Bid for A WTO “Waiver” on COVID-related Intellectual Property

Not since the HIV/AIDS crisis of the late 1990s, has the WTO been so much in the health limelight. India and South Africa recently proposed that the WTO agree to a blanket “waiver” on the WTO trade-related agreements (TRIPS) rules regarding patent and copyright restrictions and trade secrets related to any COVID-19 health products and equipment for the duration of the pandemic. This, they argued, would enable easier production, export and access to generic versions of not only drugs but vital equipment like respirators and diagnostic tests.

The fact that the European Union has lined up in favor of Iweala’s candidacy reflects widespread confidence among skittish developed countries that she will be able to steer contentious WTO debates in a fair and balanced manner.

“I am pleased to announce that the European parliament is endorsing @NOIweala as the Director-General of the WTO,” said EU parlimentarian Sven Simon in a tweet last week. “After our joint hearing on Monday, we are convinced by her vision for the future of multilateralism and advise WTO members to support her bid.”

Indeed, among the 27 delegations that spoke at today’s WTO meeting, only the US went on record opposing Iweala’s candidacy – saying that her Korean rival had more trade experience and could “hit the ground running.”.

“The Troika presented to the membership their assessment of the candidate that had th best chance of attaining the consensus of the [WTO] membership — that candidate is Dr. Ngozi Okonjo-Iweala of Nigeria,” said said WTO’s director of information, Keith Rockwell, at the Wednesday briefing. “One delegation could not support the candidacy of Dr Ngozi, and said they would continue to support South Korea’s Yoo Myung-hee. That delegation was the United States of America.

”The US says that they supported Minister Yoo because of her 25 years of trade experience – that she would be able to hit the ground running,” Rockwell said. “They said that they could not endorse Dr. Ngozi.”

He added: “There will be a General Council meeting held on the ninth of November, at which we hope to take a decision on this very important matter.”

“This [meeting] was never intended to make a final decision,” Rockwell underlined at the Wednesday afternoon briefing,  delayed for nearly two hours while more than two dozen countries debated the recommendation of the “WTO Troika” that has been managing the DG selection process.

That “Troika” led by WTO Ambassador David Walker of New Zealand, along with Honduras’ Dacio Castillo and Harald Aspelund of Iceland.

Rockwell said that the Troika had made their recommendation after a wide-ranging series of  private consultations with member states. The Troika’s consultations found that Iweala had “by a wide margin, the most preference, that she had wide support across all regions and across levels of development, LDCs (least developed countries) developing countries and developed countries.

“They said she had had these since the very beginning of the process.”

However, no formal roll-count of WTO members has been taken, Rockwell added, noting that WTO elections aim to build a consensus of all 164 members.

“The process of consultation is confidential. It’s not a vote.  It’s very important to understand that this is a process of building a consensus around one candidate, so that the Director General will be the director general for all WTO members.”

“There will be a General Council meeting on the 9th of November, in which we hope to take a final decision on the matter.”

Navigating a Pandemic, Bickering Economies and National Protectionism

Ngozi Okonjo-Iweala at the Igniting Innovation in Financial Access panel, 2020.

On October 26, the European Union joined African and Caribbean states, among others, in endorsing Okonjo-Iweala. China has also reportedly expressed support for her appointment.

A former finance minister and World Bank managing director, Okonjo-Iweala is currently the African Union’s Special Envoy to Mobilise International Economic Support for the Continental Fight Against COVID-19. She has been named as one of Transparency International’s 8 Female Anti-Corruption Fighters Who Inspire (2019).

In a recent interview with Reuters she said: “I feel I can solve the problems. I’m a known reformer, not someone who talks about it. I’ve actually done it both at the World Bank and in my country.”

If her bid is successful, Okonjo-Iweala will need not only to navigate a pandemic, but also wider issues involving bickering economies as national protectionism has risen during the pandemic. She will need to overhaul the WTO’s top appeals body which has had judge appointments repeatedly blocked by US President Donald Trump’s administration.

Gavi Board Chair Ngozi Okonjo-Iweala.

Even if Trump is defeated next week by Democratic contender Joe Biden, Trump will remain a “lame duck” president until the inauguration of his successor in January 2021.

Potentially, if Trump digs in his heels, that could prolong any WTO debate over the final choice of a director-general for a couple of months, leaving the organization with no one at the helm — even as the expected announcement of COVID-19 drug and vaccine breakthroughs will make the scramble for health products and the urgency of resolving emerging disputes over patent rights even more immediate.

Commitment to Health and Global Immunization Goals

Okonjo-Iweala first moved to the United States in the 1970s to study Economics at Harvard University, graduating magna cum laude. She later received an International Fellowship from the American Association of University Women (AAUW) to support her doctoral studies at the Massachusetts Institute of Technology (MIT).

She later served as Nigeria’s longest-running finance minister from 2003-2006 and 2011-2015, during which time she negotiated a $US 30 billion reduction in the country’s external debt.

In 2015, Okonjo-Iweala was appointed Chair-elect of the Gavi Board, and four years later received the Lasker-Bloomberg Public Service Award for her role in supporting work to provide sustained access to childhood vaccines for more than 760 million children.

It was that same year she became a dual US citizen, having spent several decades already working and studying in the country.

Image Credits: DGTresor , WTO, World Bank Photo Collection, Ngozi Okonjo-Iweala.

More than 200m people in sub-Saharan are infected by playing in contaminated water.

It starts with a child bathing in a stream to escape scorching temperatures. Silently, beneath the water, larvae that have emerged from a tiny snail burrow into their leg before entering the bloodstream. Over the next few weeks, the larvae turn into adult worms which mate and produce hundreds of eggs every day. This is schistosomiasis, also known as bilharzia – a neglected tropical disease (NTD) affecting more than 200 million people in sub-Saharan Africa, many of whom are children who have acquired infection just by playing or washing in contaminated water.

People across the world have become attuned to the fight for public health on a global scale in 2020. Never before has there been this amount of discussion about vaccines, treatments and prevention of disease. This year’s World Health Summit – held virtually from Berlin and which I had the honour to address earlier this week – had a strong focus on preparedness and resilience in the age of COVID-19, and the importance of global cooperation. Yet while the world rightly fights coronavirus, we must not forget about another widely prevalent and devastating subset of infections: the neglected tropical diseases (NTDs).

What are Neglected Tropical Diseases (NTDs)?

NTDs are a diverse group of 20 infectious diseases that are prevalent in tropical and subtropical conditions of some 149 countries worldwide. They affect more than 1.5 billion people, and cause an estimated 500,000 annual deaths globally.

Despite these shocking figures, they are termed ‘neglected’ because they continue to receive little attention.

Dr Mwelecele Ntuli Malecela, World Health Organization

During the World Health Summit, I spoke of the need to change how we think about NTDs. They not only compromise people’s health, keep children out of school and cause disfigurement and mental distress that disproportionately affects and stigmatises women. NTDs do not just affect health – they also hamper the economic growth and productivity and impede education. The good news is that most NTDs are easy to treat and can be prevented. The moral responsibility now lies with us to invest in their treatment and prevention and help the poor and marginalized communities who are mostly affected.

In fact, investing in treatment and prevention of NTDs not only helps alleviate suffering against these diseases, but also prevents other diseases that share the same origins: namely, poor sanitation and inadequate access to clean water. This investment would lead to better sanitation and access to clean, safe water that will help prevent NTDs and minimise other serious threats across the African continent, including COVID-19.

Eliminating NTDs while meeting COVID-19 Challenges

As a community, we are continuing our mission to eliminate NTDs, while ensuring that the challenges of COVID-19 are met. Investing in NTDs is one of the most cost-effective buys in public health, with treatment for the top 5 NTDs costing less than $0.50 per person, yet it is instrumental to improving development and equality, and lifting up communities.

The lessons that we have learned from NTDs can also be applied to other public health threats, like COVID-19 which is now pervasive across the world. This is also the case in Africa, with almost 1.5 million cases and over 35,000 deaths reported by the African Centre for Disease Control and Prevention. Many of those affected by NTDs also live in poverty without adequate access to water, hand sanitizer and masks, all of which are non-pharmaceutical public health interventions recommended to reduce their risk of contracting COVID-19. With so much at stake, it is now more important than ever to focus on investing in NTDs to prevent more deaths from COVID-19. To look at it from another angle, an investment in public health measures to combat COVID-19 is also an investment in the fight against NTDs.

The World Health Organization is set to launch its 2021-2030 Global NTD Roadmap, setting out important milestones and targets in our ongoing endeavour to eliminate and eradicate these diseases. These milestones will be even more important and will also benefit the work the global health community is undertaking against COVID-19.

The new NTD roadmap will provide the direction needed to ensure that the global health community does not take its foot off the pedal when it comes to the fight against NTDs. A lot remains to be done to ensure that those who require interventions against NTDs receive them. I urge countries, donors, political leaders and citizens to not lose sight of these low-cost, high-impact interventions.

We must ensure that NTDs and those who suffer from them do not find themselves neglected even furhter while the fight against COVID-19 rages on. The livelihood of 600 million African people depends on us all.

Dr Mwelecele Ntuli Malecela is the Director of the Department of Control of Neglected Tropical Diseases, WHO.

After weeks of inaction, Prime Minister Narendra Modi’s government has signalled that it will create a comprehensive law to halt rice stubble burning in rural areas of northern India, where drifting smoke from thousands of fires is a major contributor to Delhi’s annual autumn air pollution emergencies.

But experts remain skeptical, stating that there are already enough laws on the books and yet another one could just cause more confusion; what is really missing, they say, is strong central government action.

India’s solicitor general announced the plans for the law on stubble burning in a hearing on Monday before the Supreme Court, as the Court again reviewed the state of  government planning and options for judicial intervention.

“The Centre has taken a holistic view of the matter and now a comprehensive law is being planned with a permanent body with the participation of neighbouring states,” said Tushar Mehta, the solicitor general for the government at the hearing, referring to the federal government led by Prime Minister Narendra Modi.

Recent view of air pollution haze over Delhi

The Government announcement on Monday came after weeks in which Delhi Chief Minister Arvind Kerjiwal, pledged to declare “war” on air pollution caused by the crop stubble burning, but so far has failed to advance his attack from a high-tech “war room” in the city itself.

India’s Supreme Court also has championed solutions – none of which have really been implemented.  Meanwhile air pollution levels have already mounted dangerously in the city and throughout the northern India region, as a result of the unabated crop burning.

This is happening even as India also struggles to manage one of the world’s highest rates of COVID-19, a respiratory infection whose hallmark is breathing difficulties even in the best of air quality.

Critics skeptical 

Against those setbacks and a budding crisis, critics remained doubtful about whether government action could even be effective at this late date.  Historically, the prime minister has been largely indifferent to the chronic air pollution hazard of India’s northern region and Delhi itself.

“The problem lies in the fact that political will is missing when it comes to implementation,” Polash Mukherjee, environment health and air pollution management researcher, told The Tribune newspaper. “Having said that, it will be welcome if there is a specific provision to deal with crop residue burning at a national level, and not leave it contained as a problem in Punjab and Haryana only. Satellite images from central and southern India show the extent of crop residue burning in these parts as well, which have an impact on local climate resilience.”

“Let’s see what they come up with,” said Vimlendu Jha, founder and executive director of environmental non-profit Swechha, adding, “anything will be better than the one-member judicial committee.”

“Hazardous” air quality in Anand Vihar, Delhi: 9pm CET 27 October 2020. (AQICN.org)

He was referring to the October 16 move by the Supreme Court to appoint a single judge to monitor and manage crop stubble burning with a team of volunteers from the National Cadet Corps and Bharat Scouts and Guides. On Monday, the court suspended the order after Modi finally said he would act. The Court said the October 16 order would be “kept in abeyance”.

Jha said that that any plan devised by the central government would have funding as well as legally binding provisions. “And I hope it’s not just the stubble burning issue, but an overall airshed approach,” he added.

“I hope that this is not just a reactionary step that creates a hastily conceived new agency,”  said Dr Santosh Harish, Fellow at the Centre for Policy Research who specialises in energy and environment policy and air quality governance in India. “The present crisis could provide us an opportunity to make much needed institutional changes for more effective coordination and implementation at the NCR level. While various powers can be provided to a new agency on paper, several other factors determine how those powers get used– funds and staffing being two critical inputs,” he added.

Experts remain doubtful that any sort of  “comprehensive law”, even if enacted immediately, would be able to dampen down the farm fires, midway through the stubble burning season.

Sunil Dahiya, an analyst at Centre for Research on Energy and Clean Air, said: “Coming up with new legislation alone is not going to help clean the air. Actual action on pollution sources is needed.”

Smoke Envelopes Delhi and Northern India

NASA satellite data began showing fires and small spikes in fine particulate matter (known as PM2.5) in early October.

Now, thousands of crop stubble fires are already burning across the states of Punjab, Haryana and Uttar Pradesh in the north Indian plains, and smoke blowing into Delhi is driving up air pollution levels to emergency levels.

Delhi’s Air Quality Index (AQI) levels on Sunday were 303 – considered to be ‘very poor’ according to the government’s SAFAR app India Air Quality service – but had improved slightly to 256, with some wind movement later in the week.

Crop burning contributes about 5-8% of Delhi’s pollution over the course of the year. But in  the late autumn peak period, crop fires can contribute to as much as 40% of Delhi’s daily air pollution load – due to a combination of unfavorable geography, wind direction, and the lack of rainfall.  Earlier this week, Indian Express reported that according to SAFAR, the Ministry of Earth Sciences’ air quality monitor, “farm fires accounted for 22% of the air pollution in the national capital on Saturday, and 17% on Sunday.” It seems that any measures to deal with crop stubble, if successful, would be significant.

“Managing for winter burning of crop residue has to be a year-long effort and cannot be started in September each year,” said Karthik Ganesan, Research Fellow at the Council on Energy, Environment and Water. “No matter what the size of the committee, unless we clearly have a consultation process that captures inputs from relevant stakeholders – and most importantly the farmers – and put up final recommendations for public review, these are unlikely to achieve any more success than past efforts,” he added.

The “Wild Card of Meteorology” Likely To Decide  

Delhi’s AQI levels have already breached 300 several times in October. Before the fires began, the AQI dipped to 41 on Sept 1, 2020, a record low since 2015 when AQI monitoring began at national level. By the time agricultural fires have peaked, these index usually cross levels well beyond 500.

And with October this year showing many more early fires, some experts fear pollution could be worse.

An analysis by the Council on Energy, Environment and Water (CEEW), for instance, stated that 9,000+ fires had been observed by satellite data covering the period between September 1 and October 20. Last autumn, in comparison, farm fires peaked to around 4,000 per day by October 31. The day after crop residue burning in the States of Punjab and Haryana accounted for 44% of total air pollution, Central Pollution Control Board Member Secretary Prashant Gargava stated.

On the other hand, since the fires began a little bit earlier this year, prevailing winds may yet blow some of the smoke away from the city, other observers say. In addition, more mechanical machinery has been introduced to grind, rather than burn the stubble quickly, so that farmers can plant their next crop right away.

In addition, there has been a 10% reduction in plantations of the kinds of industrial rice stalks, that are the hardest to manage: more local basmati rice varieties are being grown, less of which is burnt. “We believe that this year should see lower levels of burning and more spread out burning” depending on the wild card of meteorology, said Karthik Ganesan & Tanushree Ganguly, researchers at the Council on Energy, Environment and Water.

No National Plan For Integrated Air Pollution Solution 

Indeed, with no accountability and no political party at the state or central government levels right up to the Prime Minister, a population larger than that of the entire continent of north America now depends on meteorology to save it from disease, disability and death triggered by toxic air.

New Delhi, India – Toxic smog blocks out the sun.

“On one hand we have courts which have good intentions, but not the expertise, on the other, the government and its large cohort of expert institutions, which have the expertise but not the intention to solve this issue,” said Dr Amrita Bahl, another CFA board member.

Said Vimlendu Jha: “Each year the Supreme Court passes strong worded observations, reprimanding every stakeholder, and this year has gone a step ahead and appointed a retired Justice.

“Rather than creating new mechanisms and institutions, it is important to strengthen existing ones, collectively, collaboratively and responsibly. We need to fix accountability of our government servants and departments. Stubble burning in particular and air pollution in general cannot and will not be fixed unless we relook at our agricultural practices including crop choices, construction and demolition regime, production and management of waste in our cities and its disposal, enhancing public transport.”

Delhi’s ‘GreenWar Room’ Fails To Advance To Battlefield

Just two weeks ago, Delhi’s chief minister Arvind Kerjriwal had said that he was setting up a ‘war-room’ to fight pollution and said he would be promoting a miracle composting agent amongst his rural neighboring states, which could rapidly degrade the rigid rice stalks that are the lion’s share of the crop stubble problem.

These cheap, easy and accessible Pusa decomposer pills that the Delhi chief minister has been promoting convert the stalks into valuable fertilizer as well – something that should be an incentive to stop farmers burning.

Delhi sky on a clean air day earlier this summer, when the COVID-19 lockdown brought many factories, transport and construction – which are other major sources of the city’s air pollution.

But although his Green War Room is up and running with technical experts who meet every day in an office equipped with large screens displaying NASA-ISRO images to monitor real-time data and hotspot conditions, actually moving out into the smoke-filled rural regions with the Pusa decomposer pellets or other solutions, isn’t being given much importance, said one insider, speaking on the condition of anonymity.

And it remains unclear how readily Delhi’s political leaders could really influence policies among their rural neighboring states. It is equally unclear if Kerjiwal will be getting much backing from Prime Minister Narendra Modi – a political rival.

Modi has remained largely indifferent to the criticism heaped upon him nationally and globally over his failure to take action on practical matters like stubble burning – as well as the bigger picture of expanded dirty coal power production. Modi’s ruling Bharatiya Janata Party is already grappling with farmers agitating against the passage of three agriculture bills in Parliament last month.

1.67 million Indians Died from Air Pollution in 2019

The latest air pollution crisis comes as the The State of Global Air 2020 was released, showing that 1.67 million Indians died from air pollution in 2019. That represents an increase of 61% over deaths in India attributable to air pollution nearly a decade ago in 2010. It’s also roughly one-quarter of the total deaths attributable to air pollution worldwide.

In addition, India has been steadily recording average annual increases in PM2.5 pollution since 2010, contrary to the federal government’s claims that annual air pollution levels are falling. This is despite marked regional reductions in pollution levels in east Asia driven primarily by declines in China.

Last October, the University of Chicago’s Air Quality Life (AQLI) tool showed the average citizen living in the Indo-Gangetic plain region – comprising the states of Bihar, Delhi, and West Bengal, among others – can expect to lose about seven years of life expectancy because air quality fails to meet the WHO guideline for fine particulate pollution. Particulate pollution rose 72 per cent from 1998 to 2016 in an area that is home to around 40% of India’s population.

Solutions Abound – Incentives For Alternative & More Nutritious Grains    

Even if the Pusa decomposer doesn’t gain rapid, widespread acceptance, there are plenty of other solutions that would likely trigger rapid change. Most of them revolve around money.

In 2019, stepping in once more to the national vacuum in air quality decision-making, the Supreme Court ordered governments in the three states with the highest level of fires to actually pay farmers a set sum, per paddy crop, as an incentive for not burning their crop stubble. The initiative was opposed even by environmentalists – and later set aside.

“There should be deterrence but not a perverse incentive. That works against the polluter pays principle,” Sunita Narain, Director General of Centre for Science and Environment told The Indian Express.

However, environmentalists say that positive incentives for farmers to cease growing water-hungry rice – and shift fields to other types of nutritious grains would be a welcome corrective to distortions in existing policies.

Punja, India – Crop burning reduces soil fertility and worsens air pollution

The hybrid rice varieties that have come to predominate in the region, are heavily subsidized by the government.  But the rice also depletes the water tables of the water-scarce Punjab region – while much of the production actually creates a huge surplus that goes for export.

Rather than subsidizing the wrong crop in the wrong place, they say, the government should incentivize farmers to shift their fields back into more of the indigenous grains that used to predominate on India’s northern plains, use far less of precious water reserves.

Minimum support prices are an easy way to guide farmers on what they should grow. The Ministry of Food and Agriculture could trigger a shift in growing patterns simply by offering higher subsidies via minimum support prices, said agricultural economist  Ashok Gulati, in one recent blog.

Growing patterns of the traditional crops, and the stubble they produce, both would give farmers a longer window of time to clear their fields so they don’t have to burn their fields in a rush to prepare a field for the next planting season.

These crops also are healthier. They include nutrition dense grains like pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize (makki) – all of which are native to the area. Punjab was once known for its makki ki roti, a flat bread made from cornmeal.

Gulati referred to the potential to incentivize corn as a “crop for clean air.” But the same solution could be used for traditional grains that have a high iron content and are perfect for a country that harbors one quarter of the world’s cases of anaemia.

“Stubble burning needs a well-understood multi-pronged strategy: easy access to happy seeders and other in-situ methods, markets for collected stubble, and a shift away from paddy cultivation in the long term. And yet, the execution by the state governments remains poor. The ban on burning was always going to have a limited impact, and we should not expect new committees to monitor the situation to yield very much,”  said Harish.

Zero Till  – Another Immediate Option. 

Tere is yet another solution, which if implemented sincerely and rapidly can still firefight and help north India from suffocating this winter – even at this late date. It has been around since 2016, with the International Maize and Wheat Improvement Centre (CIMMYT) advising and propounding this simple, zero-till practice. 2016 was the year NASA reported the higher number of crop residue fires.

If adopted, this would bring emissions down by almost 80%. It can also increase productivity and maximize profits for farmers, according to a 2019 study published in Science.

No-till practices that leave straw on top of the soil as mulch can preserve soil moisture and improve soil quality and crop yields in the long-run, said Principal Scientist of the International Maize and Wheat Improvement Center M.L Jat, who co-authored the study.

All these are solutions that have existed for years, but the lack of both the state and central government’s intentions have continued to allow north India’s residents to suffer the severe pollution levels that we breathe each winter. Last winter, the Supreme Court had pulled up the chief secretaries of all the surrounding states, berating them for allowing stubble burning.

Now in place of the might of the entire government which should have been working to solve this problem stands a vague proposal for yet another new law.  Meanwhile, the population of northern India holds its breath.

Jyoti Pande Lavakare is a New Delhi-based journalist and the author of “Breathing Here is Injurious to Your Health: The Human Cost of Air Pollution” to be published by Hachette next month.

Image Credits: @pawanpgupta, Jepoirrier, AQICN.org, Sumitmpsd , Neil Palmer.

World Health Summit closing session- top global health leaders including Peter Sands (The Global Fund), Henrietta Fore (UNICEF), Jeremy Farrar, (The Wellcome Trust), Muhammad Pate (World Bank), Detlev Ganten, World Health Summit, and Mohammad Pate (World Bank); Marison Touraine (UNITAID) and Tedros Adhanom Ghebreyesus (WHO) share views on a post-COVID future with Ilona Kickbusch, former head of Geneva Graduate Institute’s Global Health Centre.

New modes of interagency collaboration triggered by the COVID-19 pandemic should be used as a model to advance more progress, post-pandemic, on important Sustainable Development Goals (SDGs) related to health, said a group of top international agency leaders in Tuesday’s closing session of the World Health Summit.

The three-day summit, which featured 310 speakers at 53 sessions, drew more than 6,000 participants from more than 100 countries – despite being shifted from its usual Berlin venue to a virtual platform as a result of the COVID-19 pandemic.

While sessions naturally saw a huge focus on the pandemic, other panels also reflected on a wide variety of topics ranging from climate and health to neglected tropical diseases and women in the health workforce.

At this, the concluding panel, leaders at the World Health Organization, UNICEF, The World Bank, The Global Fund and Unitaid, which had signed on last year to an ambitious Global Action Plan for Healthy Lives and Well-being (GAP) to accelerate progress on health- related SDGs, talked about how plans had both been upended and advanced by the pandemic.

The Global Action Plan, including 12 multilateral health and humanitarian agencies in total, aims to accelerate progress on the SDGs by improving inter-agency coordination, streamlining international support offered to countries. and thereby reducing inefficiencies in the delivery of health services and programmes on the ground.

Panellists underlined that some of the active cooperations between agencies that have been launchd around the pandemic, like the WHO-coordinated  Access to COVID-19 Tools Acclerator – should help advance the GAP’s overall aims – although they were scarce on the details of immediate plans.  The so-called ACT Accelerator has brought together leading health agencies around three core initiatives to develop, procure and distribute COVID-19 tests, treatments and vaccines, when they become available.

“We need to seize the opportunity to feedback what we’ve learnt through the ACT Accelerator,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. The ACT Accelerator is a collaborative programme established by WHO to provide equitable access to COVID-19 tests and vaccines globally.

Sands added that countries must work together to ”ensure that these changes aren’t a flash in the pan” and to “turn the fight against COVID-19 into a moment for rethinking the role of health in society and the economy.”

Jeremy Farrar, director of the Wellcome Trust, said that post-pandemic, the Global Action Plan can pick up where the ACT Accelerator leaves off, to sustain the new forms of global health collaboration that have been forged by crisis.

But he added that  countries also have an “absolute responsibility” to invest in health systems, adding that, “the neglect and undermining of institutions has been part of the build up to the COVID-19 pandemic, including in very rich ones.”

The panellists also touched on the overwhelming amount of attention the pandemic has demanded, highlighting a disparity in the support provided for countries with high rates of other infectious diseases.

“We need to use the way we have responded to COVID-19 as a catalyst,” said Sands.  He pointed out that while COVID-19 deaths rates are rising higher and higher, it remains unclear if the pandemic will really outpace the burden of TB, traditionally the world’s most deadly infectious disease, or not.  And at the same time, TB surveillance is so much weaker than what has already been put in place for the pandemic, that the final answer won’t be apparent for some time to come.

“[Either] TB or COVID-19 will be the biggest infectious disease killer in the world,” said Sands. “We will know within 99-99.5% accuracy, on January 1st how many people died of COVID-19 in 2020. To get that number for TB, we will probably wait until October 2021.”

Summit Declaration by Leading Health Research Institutes Calls For Patent Waivers and Debt Relief in Pandemic Wake

M8 Alliance that supports the World Health Summit annual event.

Also on closing day, the M8 Alliance of public health education and research institutions, issued a Summit Declaration calling upon global policymakers to take more radical action to level the playing ground on access to needed COVID-19 health products – through measures such as patent “waivers” for the duration of the emergency – a proposal recently debated at the World Trade Organization’s TRIPS Council  (Trade-Related Aspects of Intellectual Property Rights).

The call by the Alliance of prominent public health institutions from around the world, also called upon the G7 and the G20 groups of industrialized countries to enact measures that would bring significant debt relief to poor countries hard hit by the “economic COVID”:

“The corona pandemic is not a single-issue pandemic – it is a syndemic, impacting on societies in a multitude of ways, uncovering deep inequalities and structural disadvantages,” stated the manifesto.

“To stem the pandemic not only “at home” but everywhere the global community must use every tool at its disposal throughout the multilateral system to leave no-one behind,” it stated, adding,

“There can be no health security without social security and access to health services and medicines. This includes TRIPS waivers through the World Trade Organisation for COVID-19 therapeutics, diagnostics and vaccines as requested by a group of countries. The World Health Summit stands by its commitment to equity in global health.

“The required COVID19 responses range far beyond the global health organisations – they require determined decisions by political bodies such as the G7 and the G20, financial institutions such as the IMF and the World Bank and many other development banks. Financing global health action has already reached new dimensions – it requires billions not millions.

“Equitable distribution of a COVID19 vaccine through the COVAX mechanism is estimated at $US 35 billion. But other short-term financing measures are also required, such as debt cancellation for the poorest countries. The world is paying the price for the lack of investment in preparedness and sustainable financing models.”

The M8 alliance includes the Baltimore-baed Johns Hopkins-Bloomberg School of Public Health, the London School of Hygiene and Tropical Medicine, Geneva University Hospitals and the Geneva Graduate Institute, along with other institutional counterparts in the USA, Japan, Uganda, Iran, Singapore, Australia and elsewhere.

Left to right: Miriam K. Were; Amandeep Singh Gill; Alicia Ely Yamin; Dame Sally Davies; Soumya Swaminathan; and Aishath Samiya at the World Health Summit Achieving Health for all through Digital Collaboration session.

At a time when the COVID-19 pandemic has exposed the fragility of health systems – digital health technologies are playing a fast-expanding role – showing their revolutionary potential to address old and new needs and gaps, said participants on a Digital Health panel at the World Health Summit on Monday. 

“COVID-19 is the first pandemic of the digital age. We’re seeing first-hand how these new tools can support our efforts. Digital health technologies are helping to screen populations, track infection rates, and monitor resources,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO. “They’re also helping us monitor the social and environmental determinants of health, which are fundamental elements in the fight against COVID-19.” 

Data sharing with biological specimens and whole genome sequences have enabled an unprecedented level of vaccine development within 10 months of the discovery of the novel virus, WHO Chief Scientist Soumya Swaminathan, another panel participant pointed out. 

Digital solutions also are making health care services more accessible and allowing people to better monitor and manage their own health – and their potential in that respect has only begun to be tapped, said Stella Kyriakides, Commissioner for Health and Food Safety in the European Commission.  

Stella Kyriakides at the World Health Summit Achieving Health for all through Digital Collaboration session.

“COVID-19 has accelerated the use of digital tools in health and helped make telemedicine more effective and accessible. However, it is also a stark reminder that we must ensure the growth in mutual support, inclusive resilience, and sustainable economies and societies. Every person must be able to benefit,” said Kyriakides. 

She and others called for more global collaboration on prioritizing and investing in digital health technologies, while ensuring high ethical standards to protect patient privacy and confidentiality. 

But despite the opportunities digital technologies offer, 47 percent of the world’s population is not connected to broadband internet and many low-income countries don’t have the capacity to invest in digital health. 

In this context, three values are critical to reaping the benefits of digital health technologies: inclusivity, collaboration, and innovation, said Dame Sally Davies, Special Envoy on Antimicrobial Resistance in the UK Government.

Digital Technologies Need to Spread Globally 

“These are global issues, so any digital technology cannot be confined – if it’s successful – to a national space. We need to collaborate to govern these technologies, but we also need to collaborate to maximize the use for addressing concrete challenges,” said Amandeep Singh Gill. Gill is Project Director of the International Digital Health and AI Research Collaborative (I-DAIR), which aims to do just that. It was recently launched by the Geneva Graduate Institute and Fondation Botnar and Geneva Science & Diplomacy Anticipator Foundation. 

“The promise of the SDGs, leaving no one behind, will not be met if we don’t change the rules of the game that continue to drive income to be redistributed upwards from poor to rich within countries…Part of unlocking the resources that are necessary to fully use digital technologies needs to include some assessment of those rules,” including rules around technology and intellectual property, warned Alicia Ely Yamin, Senior Advisor on Human Rights at Partners in Health. 

A draft WHO global strategy on digital health will be brought before the World Health Assembly for approval when it reconvenes in November. Member states will review a WHO roadmap to promote expanded, worldwide use of digital technologies over the next five years. 

The end goals for digital technologies are improved health outcomes, a people-centered approach, empowered community health workers and the public, and trust, said Swaminathan. 

The innovations from digital technologies that emerged during the COVID-19 pandemic could also help address other existential threats, such as climate change and antimicrobial resistance (AMR) – all of which were key themes at this year’s World Health Summit. 

In other sessions of the Summit, participants have debated how to improve pandemic preparedness going forward in the age of COVID-19 as well as examining risks and solutions to drug-resistant bacteria, viruses and other pathogens – which could in the future trigger another major outbreak of diseases for which few treatments exist. Here are snapshots of key messages conveyed: 

Antimicrobial Resistance  – The Importance of Innovation
Scientists test a variety of bacteria for antimicrobial resistance.

If not addressed, the evolution of new strains of drug resistant bacteria and viruses could eventually pose an even bigger health emergency than the COVID-19 pandemic, potentially causing 10 million deaths annually by 2050, according to one recent UN report. At a session on Perspectives from the Covid19 Pandemic, the Importance of Innovation, Panelists at another World Health Summit session zeroed in on the future threat posed by antimicrobial resistance (AMR), the process by which some bacteria, viruses and other common pathogens become resistant to commonly used drugs, threatening effective prevention and treatment of a wide range of infectious diseases.

“The main threat of AMR is that it undermines modern medicine as we have it today. Antimicrobials are fundamental tools and how modern medicine is practiced. As resistance emerges against the tools that we have refined, the ability to deliver other types of medical interventions becomes more difficult and the threat of infectious diseases more generally, becomes a much bigger problem,” said Tim Jinks, Head of the Drug Resistant Infections Priority Program at Wellcome Trust.

It is perhaps no accident that in July 2020, at the height of the COVID-19 pandemic, the AMR Action Fund, was launched. The fund, developed in a partnership between the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), WHO, Wellcome Trust, the Biopharmaceutical CEO Roundtable, and the European Investment Bank, aims to address the current dearth of funding in R&D for new antimicrobial agents, and bring 2-4 new antibiotics to market this decade.  Some two dozen leading pharma companies, including Pfizer, Roche, Johnson & Johnson, Merck and others, have invested in the fund.  

Panelists noted that other innovative R&D frameworks created in response to the COVID-19 pandemic could be used in the future to develop better treatments to address AMR. One example is  the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to speed up the development, manufacture, and distribution of tests, vaccines, and treatments for COVID-19. 

Along with innovation, much more needs to be done to strengthen global collaboration on AMR surveillance and regulation, to ensure that existing antibiotics and other antimicrobial drugs are better rationalized in human and animal populations to prolong their usefulness, while ensuring access to legitimate, full-formulas in developing country markets where weakened or counterfeit formulations may also contribute to growing drug resistance.

“Through data-driven practices, we can ensure that our antimicrobials, particularly the last line of drugs are there for patients who really depend on them, sharing data and collaborating to deliver…health care,” and encouraging investment in the antibiotic pipeline, said Davies.

Pandemic Preparedness in the Age of COVID-19
Tom Frieden at the World Health Summit’s Pandemic Preparedness in the Age of COVID-19 session.

The global experience with COVID-19 has cast a spotlight on the emergency preparedness of health systems, revealing that “the world remains woefully underprepared for epidemics,” warned Tom Frieden, President of Resolve to Save Lives, at the Pandemic Preparedness in the Age of COVID-19 session of the World Health Summit. 

“We have to recognize that COVID it is a long term threat to public health and the pandemic is nowhere near over...It’s very clear that this is the most destructive infectious disease threat the world has faced in a century,” said Frieden. “The disruption that COVID causes could kill many millions. The risk of explosive spread is not going to end when we have a vaccine.”

The lessons learned from combatting SARS, MERS, Ebola, and SARS-CoV2, thus far, are essential to better prepare for the continued threat of COVID-19 and future pandemics that will follow, he said. 

On a brighter note, the unprecedented speed of progress made in developing tests, treatments and vaccines since the beginning of the pandemic has created models for new modes of global collaboration, and strengthened public-private partnerships. 

“The industry, the IFPMA manufacturers, have committed to sharing their know-how, their experience, to work together, to collaborate with each other, but also with society at large… And one of the reasons [this happened] is that there was this deep sense of responsibility that the industry has the unique skill set to help us,” said Thomas Cueni, Director-General of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). “As a result, eight months later we have almost 1000 clinical trials [looking at], more than 300 treatments. We have 200 vaccine candidates, 12 of them in late stage clinical development.”

Thomas Cueni speaking at the World Health Summit session on Pandemic Preparedness in the Age of COVID-19.

Industry mobilization, as well as some of the technologies being developed, both can help improve future pandemic preparedness. he cited examples such as: “ever-warm” vaccine technologies, which could be stored at a higher range of temperatures than existing vaccines, and drug treatments using monoclonal antibodies, which require a complex manufacturing process, but could provide a basis for treating other pathogens that could emerge as future pandemic threats. 

Image Credits: World Health Summit, World Health Summit , Flickr – UK Department for International Development.

Spain announced a state of emergency on Sunday and ordered a nationwide curfew just days after becoming the first Western European country to surpass one million confirmed cases.

The curfew and restrictions on gatherings of more than six people has made Spain the latest country in Europe to toughen its guidelines, after France placed 46 million citizens under a 9pm to 6am curfew last Friday, and following Italy’s implementation of a strict 6pm closing time for bars and restaurants on Sunday.

“The reality is that Europe and Spain are immersed in a second wave of the pandemic,” said Pedro Sánchez, the Spanish prime minister, after a meeting of cabinet officials on Sunday.

The concern was shared by Dr Michael Ryan, Executive Director of the WHO Health Emergencies Programme, stating that there was “no question that the European region is an epicentre for disease right now.” Speaking at a press conference on Monday 26 October, Ryan added: “We are well behind this virus in Europe. Getting ahead of it is going to take some serious acceleration.”

Active cases of COVID-19 in Europe as of 9:00PM CET 26 October 2020. (Johns Hopkins University & Medicine)

France now ranks as the country with the fifth highest level of infections globally, with more than 1.1 million total COVID-19 cases, ranking behind only the US, India, Brazil and Russia. Poland also announced new restrictions following a 30% upswing in cases last week.

The trend is mirrored outside of Europe. In China, a new COVID-19 outbreak of more than 130 asymptomatic cases was detected in Kashgar, Xinjiang – the first local outbreak to occur in China since the second week of October. More than 4 million residents will be tested over the next few days.

Cumulative Deaths In United States Could Exceed 500,000 by February – Projects Nature Study

Over the weekend, the US reported a record 85,000 new cases in a single day. The number of cumulative deaths in the US could pass 500,000 by February 2021, according to a study projecting near-term US trends, published in Nature.

Using case and mortality data from February to September 2020 the COVID-19 Forecasting Team of the Seattle-based International Health Metrics and Evaluation arrived at this projection based on current non-pharmaceutical state intervention strategies. They note than universal mask use could reduce that number by nearly 130,000. The publication of IHME’s forecast follows a 40% rise in COVID-19 hospitalisations in the past month.

Health systems are also seeing a rise in non-hospital admissions related to COVID-19. A Guardian investigation reported a 71% increase in young people being admitted to eating disorder services in England in September. Sleeping pill prescriptions for those under 18 years old also increased by 30% between March and June, in comparison to data from two years prior.

“These alarming findings suggest that the Covid-19 crisis has had a profound impact on the mental health of many young people,” said Emma Thomas to the Guardian, chief executive at Young Minds, a UK charity advocating for children and young people’s mental health. “This may be related to fears about the virus, social isolation, the loss of routine and structure, and in some cases bereavement or other traumatic experiences.”

Suspended COVID clinical trials resume in the US  – as 184 countries join universal roll-out initiative

Two late-stage clinical trials for COVID-19 vaccines, developed by AstraZeneca and Johnson & Johnson, resumed in the US on Friday.

The AstraZeneca trial was paused for six weeks after reports of neurological symptoms in two trial participants. The US Food and Drug Administration (FDA) reviewed safety trials globally and determined that the trial could continue.

“The restart of clinical trials across the world is great news,” said Pascal Soriot, CEO of AstraZeneca in a statement released on Friday. “It allows us to continue our efforts to develop this vaccine to help defeat this terrible pandemic.

He added: “We should be reassured by the care taken by independent regulators to protect the public and ensure the vaccine is safe before it is approved for use.”

The Johnson & Johnson trial was paused for 11 days due to an unexplained illness in a participant, now believed to be unrelated to the vaccine, following an independent investigation.

In a statement released on Friday, Johnson & Johnson said:  “Clinical trials are designed to evaluate safety and efficacy based on a complete view of all participants and their experiences. Unexpected adverse events, including illnesses, can occur in study participants during any clinical study.”

Over 40 vaccine candidates are now in various stages of R&D, including 9 candidates in Phase 3 trials. The Israel Institute for Biological Research (IIBR) announced on Sunday that it would begin human trials for a vaccine candidate on November 1. The first phase will include 80 participants, expanding to 960 in Phase 2 and 30,000 in Phase 3. This is expected to take place in spring April or May 2021.

“I believe in the abilities of our scientists and I am confident that we can produce a safe and effective vaccine,” said Shmuel Shapira, director of the IIBR. “Our final goal is 15 million rations for the residents of the State of Israel and for our close neighbors.”  The vaccine would be easier to administer than many other late-stage candidates currently under trials, he said, because it would only require one dose, as compared to two. Many other leading candidates, with the exception of Johnson&Johnson require two shots to provide immunity.

In a press conference on Monday, Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, noted that some 184 countries have by now joined the COVAX Facility vaccine initiative, calling it a “positive development” against trends of vaccine nationalism.

“Having a vaccine and using it as a global public good means sharing it,” he said, noting that this is not easy. “Every political leader would be worried about their own constituency. It will need a very strong leadership convincing their constituency that when we share we can have better value.”

Image Credits: S. Lustig Vijay/HP-Watch.