Healthcare worker in the COVID-19 intensive care unit in San Salvatore Hospital in Pesaro, Italy in March.

The world’s 27 million nurses and midwives – who comprise 60% of the health workforce – are not only excluded from the health system’s corridors of power, but also have faced new levels of censure and reprisal during the COVID-19 pandemic when they protested dangerous or abusive working conditions, said expert panel members at the Geneva Health Forum on Monday.

Along with the widespread shortages of personal protective equipment (PPE) that put many nurses lives at risk and led to at least 20,000 deaths, the pandemic period has seen the suspension of labour laws in some countries, increased discrimination against healthcare workers, and employers’ restrictions or censorship of nurses who dared to speak about their working conditions. 

Speaking on the panel ‘The Year of the Nurse and Midwife 2020 – A Catalyst for Change’ on Monday, Soosmita Sinha, President of the Health Law Institute, said: “There were cases globally, and especially in the US, where … nurses could not talk to social media, nurses could not talk to government organizations. There were repercussions from employers.”

Soosmita Sinha, President of the Health Law Institute, at the Geneva Health Forum session on Monday.

In an interview with Bloomberg News in March, Ruth Schubert, a spokesperson for the Washington State Nurses Association, observed that “hospitals are muzzling nurses and other health-care workers in an attempt to preserve their image”, threatening to fire employees if they talked to the media without authorization or publicized their working conditions.  

Two states in the US, Colorado and Virginia, expanded whistleblower protections to apply to these circumstances and allow nurses to report issues to their employers, social media, and other organizations. Other states enacted laws enabling healthcare workers to bring their own PPE if the hospital had a shortage.

“We’ve heard reports of nurses having to work long hours, not being able to take vacations, working when they’re sick … how is it compromising patient safety? If nurses are not safe, can patients really be safe in that environment? Aren’t we actually making them vectors of COVID to pass on to the next person?” posed Sinha. 

Healthcare workers form between 2% and 3% of the population in most countries, yet data has shown that the healthcare worker COVID-19 infection rate is 10-14%. Of the 54 million total COVID-19 infections globally, some 5 million could be healthcare workers. 

Nurses Needed in Leadership Positions and Decision Making Bodies

The panelists reviewed WHO’s first-ever State of the World’s Nursing Report released in April, which highlighted the unrecognized contributions of nurses to health systems and called for new policy measures and investments to strengthen the nursing workforce.

“We need to hear and see and be advised by nursing leadership voices at all levels through our health systems,” said Howard Catton, CEO of the International Council of Nurses. “It would bring this nursing perspective into the heart of decision making about how service is delivered and also into political decision making as well.” 

Howard Catton, CEO of the International Council of Nurses, at the Geneva Health Forum session on the Year of the Nurse and Midwife.

The ability of nurses to influence policies is essential because “they understand the reality on the ground,” Sinha said. Nurses account for 60% of the health workforce and provide 90% of primary health care.

“It is absolutely necessary to have nurses in all the decision making bodies, to have nurses in the COVID management taskforce, to have a government chief nurse, to have the voices and the views of nurses everywhere and to have influence … and not just to be used for managing crises,” said Roswitha Koch Heepen, senior member of the Swiss Nurses Association. 

Nurses have played a vital role on the frontlines of combating the pandemic and they will be essential in global vaccination efforts for COVID-19. Globally, nurses administer and lead the majority of vaccination programs, and they are crucial to a safe and efficient rollout of a COVID-19 vaccine – alongside pharmacists and refrigerated truck drivers. They have largely been left out of vaccination discussions, however. 

“Where is the nursing voice in terms of the big policy decisions? Where is the nursing voice in terms of managing the mass vaccination response?” said Catton. 

The State of the World’s Nursing Report highlighted the need to create at least 6 million nursing jobs by 2030, primarily in low- and middle-income countries. Elisabeth Iro, WHO Chief Nursing Officer, highlighted that without this increase “the ability to adequately respond to the COVID-19 pandemic or similar crises in the future is compromised and would jeopardize our collective ability to achieve Universal Health Coverage targets”.

“If you don’t have a nurse in place or a pharmacist to give that vaccination, it doesn’t matter how much of the vaccination we have or how we got to that point,” said Sinha.

The Geneva Health Forum runs from 16-18 November. Follow Health Policy Watch’s coverage here and on Twitter.

Image Credits: Alberto Giuliani, Geneva Health Forum.

Panellists argued that the outcomes of digital technology implementation has highlighted key deficiencies and oversights in health systems.

A panel of experts have called for cautious, strategic and realistic approaches in rolling digital tools out to ensure that patients remain a priority.

Speaking at the Geneva Health Forum on Tuesday, panellists noted that while the expectations for digital health are high, stakeholders need to be aware that digital health tools alone will not solve the world’s global health crisis, and that collaboration is needed to maximise potential.

David Stewart, associate director of the International Council of Nurses (ICN), argued that the differences in the outcomes of digital health implementation in various countries and settings “shine light on major gaps and deficiencies within health systems and digital health strategies”.

David Stewart, associate director of the International Council of Nurses (ICN)

In the context of the COVID-19 pandemic, for instance, digital health applications can help track the disease better among patients and healthcare workers, but asked: “Do we have the mechanisms to resource these effectively, and the governance and regulations to support?”

“We are fully aware that we do not adequately capture the number of health professionals that are currently contracting COVID-19,” Stewart said, referring to the widespread assumption that the 20,000 health worker deaths from COVID that have been recorded is a huge under-estimate. “This is particularly relevant when you consider that hospitals and health services are meant to be safe places in which care can be delivered safely, so that people can enjoy quality outcomes.”

Kaspar Wyss, Deputy Director at the Swiss Tropical and Public Health Institute, took this sentiment further, saying that despite the growing number of digital health applications, real potential has often fallen short.

“We have seen a lot of interest, a lot of promises, a lot of new avenues related to digital health, in areas like asthma treatment, smoking cessation, or diagnostics of cancer,” he said. “But there are obviously downsides — ethical issues, legal issues. Sometimes promises were much higher than what was delivered in the end.”

The digital universe can also work against health workers, Stewart also said. Nurses, for instance, who comprise 60% of the overall health workforce have, new levels of censure and reprisal, when they complained on social media about abusive working conditions during the pandemic.

 

Health workers deaths due to COVID-19 in Africa, Asia and Europe by August, the first 6 months of the pandemic.
Digital Innovation is Key but Achieving UHC Requires More Work

Even so, the health sector is better positioned than ever to implement digital processes, said Maguette Thioro Ndong, Technical Advisor, Digital Health Solutions for the Digital Square of PATH, a Geneva-based global health non-profit that pioneers innovative health technologies.

“Ongoing digitalization and the introduction of new technology are already breaking down boundaries and creating patient-centered healthcare systems,” she said.

She cited telehealth and mobile health as services that allow healthcare professionals to communicate with, refer and potentially treat patients remotely – and more flexibly.

To achieve the ambitious goals for digital health, Ndong said it would require transformative thinkers to go beyond existing market structures to change the way digital health technologies and innovation are acquired and scaled.

“They will help us to better match the pace of digital health funding and implementation to the pace of technological evolution,” Ndong said.

But effectively innovating within the health sector would require more than just digital advancements and new technologies, argued Riccardo Lampariello, Terre des Hommes’ Head of Health Program.

Riccardo Lampariello, Terre des Hommes’ Head of Health Program.

He drew on experience from the deployment of the Integrated e-Diagnostic Approach (IeDA) in Burkina Faso, West Africa. The tool, which helps healthcare workers make a clinical diagnosis, has been deployed in 70% of primary health centers in Burkina Faso where it is being used for around 200,000 consultations every month.

The government of Burkina Faso is expected to take over the service by the end of 2020, and the system is now also being deployed in Niger and Mali.

“While digital health is necessary to reach universal health coverage (UHC), it is not sufficient to achieve UHC alone,” he said.

He emphasised several factors surrounding digital technologies which can limit – often severely – patient outcomes: namely sustainability and cost, along with health workers’ unwillingness or inability to use the technology applications.

These factors must play a part in designing implementation or response measures, he argued.

Keeping Patients at the Centre of Health Sector Innovation

Unlike in other global sectors, implementation of digital technology in health work must be more focused on patients than profit, argued Bernardo Mariano, Director of WHO’s Department of Digital Health and Innovation.

Bernardo Mariano, Director of WHO’s Department of Digital Health and Innovation.

Referencing the Global Strategy on Digital Health, approved by WHO Member States during the 73rd World Health Assembly in November, he said the ambitious WHO strategy aims to lay the foundation for the future of digital health and achieve transformation of the health sector similarly to how it has revolutionised the finance and banking sector.

“These sectors are quite advanced in their transformation. Government, social media and media in general are also quite advanced in their digital transformation. We want to see the digital transformation of the health care sector to be much better than all these other sectors,” Mariano said.

But unlike the finance and media sectors, where efforts have been geared primarily towards achieving profitability, Mariano stressed that it is essential that all stakeholders are working to ensure that digitalization of the health sector does not result in the loss of the people-centric element of healthcare.

“People centric elements in the ecosystem will deliver those health benefits we want to see delivered at every level,” Mariano said.

Image Credits: Geneva Health Forum, Amnesty International.

Dr. Sally Agallo Kwenda, survivor of cervical cancer

In the early 2000’s, when Kenyan doctor Sally Agallo Kwenda was diagnosed with cervical cancer, it was a big shock given she was not experiencing any pain or symptoms.

A bigger shock, however, was her husband’s decision to walk out on her. He claimed that he could not live with a woman who could not give him babies. 

Sally’s testimony is a sobering reminder of the devastation cervical cancer brings, even though it is almost entirely preventable and potentially curable, noted the World Health Organization’s Dr Tedros Adhanom Ghebreyesus on Monday.

She spoke along with nearly a dozen other cancer survivors from around the world at the historic launch of the WHO‘s Global Strategy to Accelerate the Elimination of Cervical Cancer.  It marked the first time ever that the world has committed to eliminating a cancerous disease – and an especially neglected one that kills a whopping 300,000 women every year. 

Coinciding with the launch, countries around the world, beginning with Japan and Australia, began lighting up landmark monuments in the color teal and blue, in a worldwide display of unity to eliminate cervical cancer once and for all. 

Princess Dina Mired of Jordan

Princess Dina Mired of Jordan, along with the first ladies of South Africa and Rwanda also appeared for the launch at a high level panel, alongside WHO’s Director General as well as officials of Unitaid, GAVI, the Vaccine Alliance, The Global Fund and others.

“Today is the day we tell cervical cancer, loud and clear – your days are numbered,” said Princess Dina Mired of Jordan, a longtime advocate for cervical cancer elimination, and member of the director-general’s expert group on cervical cancer elimination. 

“We have let you run wild, causing much destruction and grief to hundreds of thousands of our women and their families for far too long. And the worst part is, you managed to do all of that, not because you were super smart, but simply because we let you infect women.”

“We made it easy for you, but not after today, because today we have a plan,” she added. “A solid plan to put you back where you belong – to the annals of history.”

The WHO’s three-pronged strategy, which was adopted by the World Health Assembly in a remote vote during August, offers a clear roadmap to expand Human Papilloma Virus (HPV) vaccination coverage, as well as cervical cancer screening and treatment by 2030: 

  • 90% HPV vaccination coverage of girls by age 15.
  • 70% screening coverage for women by age 35 and again by 45.
  • 90% access to treatment for cervical pre-cancer and cancer, including access to palliative care.

If successful, the WHO’s strategy could prevent over 40% of new cases of the disease, and 5 million related deaths by 2050, 90% of which are in low- and middle-income countries.

HIV & Cervical Cancer – The Double Whammy

Cervical cancer, like many other diseases, exploits those with weakened immune systems, especially in sub-Saharan Africa where HIV is still rampant, added panelists on Tuesday.

In fact, 85% of women that live with both HIV and cervical cancer are in sub-Saharan Africa, according to a meta-analysis of 24 studies from Monday, which was published in The Lancet.

Shockingly, women with HIV are six times as likely to contract cervical cancer, warned Shannon Hadder from UNAIDS, referring to the Lancet report. This explains why women in eastern and southern Africa are ten times more likely to die of cervical cancer, in comparison to women in Western Europe or Australia. 

She also warned that innovative technologies, such as artificial intelligence based screening tools, will not fulfill their potential unless we confront deep social inequities that impede access to preventative care and treatment. 

“This situation is not acceptable, and that’s why we don’t accept it,” added Marisol Touraine, chair of Unitaid and a former  French Minister of Social Affairs. “We cannot accept inequity because we have effective tools and solid policies [to prevent and treat cervical cancer].”

Even in countries that have the tools to offer high-quality care, gender inequities, as well as misinformation, are substantial roadblocks to improved cervical cancer management. In Swaziland, for example, 63% of men and 58% of women agreed that they had to seek permission from their male partner to visit a health care center, said Hadder, referring to a recent nationwide survey. 

Misinformation is another challenge that needs to be addressed quickly, she said, noting that in the same survey, 48% of respondents felt that only women with multiple partners were infected by cervical cancer. 

“There’s nothing shameful about our biology, and no woman needs permission from a man to access health care.”

High HIV rates in Sub-Saharan Africa exacerbate cervical cancer

Cervical Cancer – Treatable with Cost -Effective Strategies 

Eliminating cancer would have once seemed an impossible dream, but we now have cost-effective tools to make that dream a reality, said Dr. Tedros on Monday. 

Investing in cervical cancer can generate substantial societal and economic returns. For every dollar invested, the WHO estimates a US$ 3.20 return to the economy – and the figure rises to US$ 26.00 when the indirect benefits on families, communities and societies are considered.

Even though 93% of all cervical cancers are preventable, it is the fourth most common cancer in women worldwide. In 2018, an estimated 570 000 women were diagnosed with cervical cancer, and about 311 000 women died from the disease.

Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.

Image Credits: The Lancet .

TB screening activities in a rural village, Cambodia.

Médecins Sans Frontières. As the COVID-19 pandemic threatens to derail the global response to tuberculosis (TB), Médecins Sans Frontières/Doctors Without Borders (MSF) called on governments to accelerate testing, treatment, and prevention for TB, and called on donors to provide the financial support needed to ensure increased access to new medical tools for diagnosing and treating millions of people with this killer disease. A report released today by MSF and the Stop TB Partnership—Step Up for TB—surveys 37 high TB-burden countries and shows that critical medical innovations are reaching far fewer people who urgently need them, because many countries continue to lag behind in getting their national policies in line with new World Health Organization (WHO) guidelines.

“Instead of stepping up for TB, we are at risk of slipping back due to COVID-19,” said Sharonann Lynch, Senior TB Policy Advisor for MSF’s Access Campaign. “We cannot stress enough how urgent it is now for governments and donors to intensify their efforts so thatcritical medical innovations and tools reach people with TB. We finally have better drugs and tests to tackle and prevent this extremely infectious yet curable disease, so it’s both mind-boggling and unacceptable that they’re still not being used to save as many lives as possible.”

While reporting on the severe impact of the COVID-19 pandemic on TB services, WHO revealed a sharp drop in the number of people diagnosed. Besides needing to catch up to maintain continuity of existing TB services, it advised countries to adopt and roll out better testing policies and practices. 

Presently, countries continue to fall short on rolling out up-to-date testing policies that can assist in reaching nearly 3 million people still being missed.As highlighted in the report, a whopping 85% of countries surveyed still do not use the lifesaving point-of-care urinary TB LAM test for routine diagnosis of TB in people living with HIV, as recommended by WHO. 

“As clinicians working on the frontlines of the raging TB epidemic, it is distressing to see the sluggish uptake of TB LAM in national treatment programmes, despite its proven role in saving the lives of people living with HIV,” said Dr Patrick Mangochi, Deputy Medical Coordinator for MSF in Malawi. “Countries must step up the use of TB LAM as a core component of testing services, otherwise delays in diagnosing people with TB and getting them started on treatment will continue to fail people with HIV who get TB.”

TB remains the world’s top infectious disease killer, with more than 10 million people falling ill and 1.4 million people dying due to this disease in 2019. Implementing WHO guidelines is urgently needed to minimise the unnecessary risk of COVID-19 by reducing visits to health facilities, without disrupting treatment. Countries must take immediate action to implement people-centred TB policies, including treatment initiation and follow-up at primary healthcare facilities. Also, national treatment programmes must prioritise the use of all-oral treatment regimens for people with drug-resistant TB (DR-TB) that no longer include older, toxic drugs that have to be injected and cause serious side effects. The report finds that only 22% of countries surveyed allow TB treatment to be started and followed up at a primary healthcare facility, instead of travelling to a hospital, for instance, and for medicines to be taken at home. Additionally, 39% do not use a modified all-oral shorter treatment regimen and 28% of countries surveyed still are using injectable medicines when treating children with DR-TB.

“I have been through an agonising journey of being treated with medicines with excruciating side effects, and lost one of my lungs,” said Meera Yadav, a survivor of extensively drug-resistant TB (XDR-TB) in Mumbai, India.“Finally, in 2016, I was able to access newer TB drugs as part of the regimen that saved my life. I don’t want anyone else to have to go through this ordeal. With newer medicines, it is now possible to give people all-oral treatment that works to cure them. People with TB can’t be excluded from accessing these innovations anymore, especially when they are afraid to visit treatment centers due to COVID-19.”

Image Credits: Yoshi Shimizu/WHO.

Women health workers in LMICs are often the targets for research but are rarely part of the decision-making process, Dhatt says.

Women must be exposed to digital technology as both users and innovators – in order to fashion and expand AI designs that meet the needs of hard-to-reach populations, said experts at a Geneva Health Forum.

Speaking at the session ‘How Can The World Advance Towards AI Maturity In Health?’ on Monday, Roopa Dhatt, executive director of the Women in Global Health network, noted that only 12% of people in AI research are women.

And while women health workers in low- and middle-income countries (LMICs) are the majority of front-line care givers and thus the target of many AI research solutions, they are “rarely part of the design or decisions”.

Roopa Dhatt, executive director of the Women in Global Health.

“We hear about human-centred design, but how often are we making sure the creators are people of diverse backgrounds?” Dhatt asked, whose network aims to advance gender equity in the health sector. She added: “We need to hardwire diversity and equity in all of our aspects of innovation.

“So the first thing is making sure that we have people from diverse backgrounds.”

The concern, she said, is that if “100% of the talent pool in health isn’t engaging, you are not going to get the best results”.

There is a similar disconnect between AI research goals and the prevailing levels of digital literacy among women. Globally, some 1 billion women do not currently have access to digital mobile technology, with a large majority of these women living in LMICs.

“That’s a pretty large number,” she added. “To say that you’re going to work on achieving universal coverage and health equity when a billion of the world’s population does not even have access to digital technology.”

Half of women’s contributions to global health remains unpaid.

The gender gap in health sector leadership is another link in the broken chain of digital transformation, she added, noting that around 70% of the global health workforce are women, but less than 25% of leadership roles are occupied by women. In addition, half of women’s contribution to global health remains unpaid.

Country Context Also Critical To Appropriate Research

“When it comes to digital specifically, it’s really important to understand what the context is,” said Kanishka Katara, Head of Digital Health (India) at PATH: a French-based non-profit that helps countries develop and scale digital technologies in health systems.

Kanishka Katara, Head of Digital Health (India) at PATH

Katara flagged, as an example, that countries have diverse responses based on the context of their national local health systems and health burden – which varies enormously, country to country.

“Issues from one place to another, even though they might appear to be the same, are very different,” he said. “We need more contextual, localised solutions for that.”

The Geneva Health Forum runs from 16-18 November. Follow Health Policy Watch’s coverage here and on Twitter.

 

 

 

Image Credits: WHO/UNITAID, Flickr – UN Women Asia and the Pacific, Geneva Health Forum.

Geneva Health Forum session. Pictured on screen, clockwise: Neda Milevska Kostova, Bisi Bright, Karen Alparce-Villanueva, Angela Grezet, & moderator Arianne Alcorta.

The COVID-19 pandemic, while devastating, has also created an opportunity for “patients to stand up, educate themselves well and build their expertise,” says Karen Alparce-Villanueva, a board member of the Philippine Alliance of Patient Organizations (PAPO).

She was speaking at a session of the Geneva Health Forum that focused on “Patients as Co-creators and disseminators of innovation.”

She added: “Patients need to realize that we are not merely passive recipients of care but we need to be co-creators and disseminators of information. The more that we know that we are able to participate in policy making.”

But to be achieved during the pandemic, patients must be involved at every stage of a health intervention, from design to evaluation, research to implementation, and from health policy to service delivery, said the speakers panel, which included representatives from three other organizations involved with patient and provider engagement.

The speakers noted that modern patient advocates need motivation, knowledge, skills, attitudes, and the ability to engage in all steps in order to be effective co-designers, co-producers, and co-deliverers of patient centric health systems.

Creating a Patient-Centric Approach – COVID and Beyond

Alparce-Villaneuva and others discussed how the solution to dealing with today’s public health challenges and changing landscape was not to change strategic direction, but to increase patient engagement through a “patient-centric” approach to health.

Neda Milevska Kostova, Board Vice Chair at the International Alliance of Patients’ Organizations (IAPO), said that patients should rather be referred to as “partners”, in order to broaden the scope and the experiences of others.

“It is not only about the health system, because we know that health comes from 20% of the system, and the remaining 80% is related to the way we live,” she said. “Therefore, it’s the patients alone who can bring this extra component that the health system alone cannot encompass.”

A continuous engagement of patients in policy-making would allow true patient participation, added Angela Grezet, of the Association Savoir Patient, who cited best engagement experience in her home country of Venezuela, where she describes her personal experience with doctors “who went the extra mile” to not only diagnose but also explain to her the background of any condition that she might present. 

“I really noticed that [doctors] really tried to understand my situation, and then spent extra time to really explain to me from A to Z, the treatment that they were going to be providing,” said Grezet, who has lived and worked in Europe as well as Latin America.  “We can’t really continue to treat very big health issues without the whole population [being involved].” 

Creating a patient-centric approach is needed to provide better healthcare, speakers argued.
Stigma Over Patient Involvement Persists In Many Health Systems

Despite the apparent benefits, a lot of stigma still exists around patient involvement. This is often an issue in low and middle-income countries where communication is ‘one-way’ between the practitioner and the patient – and it may be less culturally acceptable for patients to challenge the traditional authority of health practitioners, said Bisi Bright, CEO and Founder of the LiveWell Initiative (LWI).

“Empowering [patients] allows them feel safe and not ashamed to be a patient,” noted Bisi Bright, CEO and Founder of the LiveWell Initiative (LWI), describing examples of empowering and training women through crises such as HIV and AIDS. This gives them the confidence to come out and talk about their conditions as expert patients. 

Beyond the current pandemic, fostering a health systems culture of expert patients who are actively involved in their healthcare and health management paves the way towards achievement of universal health coverage, the panelists said.   

Concluded Kostova, “It’s not only about patients but also patient carers, patient advocates… , and this pandemic has shown that it is not only patients but it is everyone, everywhere who can help in improving our lives.”

The Geneva Health Forum runs from 16-18 November. Follow Health Policy Watch’s coverage here and on Twitter.

Image Credits: Geneva Health Forum , Flickr – US Navy.

Developing & rolling out COVID-19 diagnostics has been a key challenge.

Many Geneva-based health agencies have worked together for years to improve global access to diagnostics and treatment, but the COVID-19 pandemic has necessitated much closer collaboration and speedier decision-making.

This is according to experts from the WHO co-sponsored  “ACT Accelerator” medicine access partnership – including UNITAID, the Foundation for Innovative New Diagnostics (FIND), and the Global Fund to Fight AIDS, Tuberculosis and Malaria who appeared today at a session of the Geneva Health Forum.

They appeared together at a session of the Geneva Health Forum with other colleagues from the Swiss Data Science Center of the Swiss Federal Technical Insitute-Lausanne (EPFL) and the European Organization for Nuclear Research (CERN) to talk about what it means to have “Geneva at the Forefront of Epidemic Response.”

Wealthy countries lack the tools to properly diagnose patients.

“Geneva is the epicentre of global health and also innovation,” said Philippe Duneton, Executive Director of Unitaid- a multi-country partnership with the UN system – which is a key channeler of new product innovations into national health systems. He described how his organization’s pre-existing partnerships around HIV and TB had provided a solid platform for collaboration on COVID-19.

“We have been coming together very easily because of the work that we were doing for a long time, ” said Duneton. “But the level of speed, procedure and mastery now is unprecedented.”

Unitaid works primarily through partnerships to channel funds to countries and actors that can help ensure equitable access to innovative health products for the world’s leading infectious disease killers.

Diagnostic Testing: a “Burning Issue”

Ensuring that there are accurate diagnostic tests for COVID-19 has been one of the key challenges for such Geneva-based organisations – and one of the first that was tackled by the formal and informal networks of global health actors.

Diagnostic testing became a “burning issue” during COVID-19 as the deadly disease spread, often silently, and even wealthier countries realized that they lacked the tools to properly diagnose patients, according to FIND’s Emma Hannay. FIND is a non-profit that seeks innovation and delivery of diagnostics to address major diseases.

“Many low, and middle-income countries have access to only the basic tests that you need to be able to care for patients. And even where there is more advanced infrastructure in high-income countries, we have seen countries struggle to be able to respond to the peaks and demands of the pandemic,” said Hannay.

Hannay said she and Duneton had almost daily conversations to address this and other issues since the pandemic began.

“Diagnostics is much less regulated than for other global health commodities. There have been some pretty expensive mistakes made by countries, early on in the procurement of substandard tests,” said Hannay.

“We’ve also seen the emergence of “diagnostics nationalism”, when there have been supply-chain wars over access to diagnostic testing where low-income countries have typically missed out. By the time a diagnostic comes to market, the entire stock might have been reserved by some government.”

To address such issues, the WHO co-sponsored Access to Global COVID-19 Tools, ACT Accelerator, was launched last spring, including Unitaid, FIND and the Global Fund among the key players.

Partners of the WHO co-sponsored Act Accelerator.

Francoise Vanni, Head of External Relations at the Global Fund, said that her organisation’s success is based on “collaborating and joining forces with others”.

“Over the past 20 years, together with our partners we’ve saved, 38 million lives so we know that this approach works,” said Vanni.

Before the pandemic, many of the Geneva-based partners shared a “global health campus”, said Vanni. But the pandemic had forced many of the partners to work at home and to collaborate online.

“What I have had to learn from working online is to listen proactively,” said Vanni.

The Geneva Health Forum runs from 16-18 November. Follow Health Policy Watch’s coverage here and on Twitter.

Image Credits: WHO, University of Washington Northwest Hospital & Medical Center.

Ignazio Cassis, Head of the Swiss Federal Department of Foreign Affairs, at the opening of the Geneva Health Forum.

A mix of strong national measures and international cooperation is needed to solve the COVID-19 pandemic – and the Geneva Health Forum (GHF), which opened on Monday, is showcasing examples of both, said Switzerland’s Foreign Affairs head Ignazio Cassis and Harsh Vardhan, Indian Minister of Health, speaking at the opening session of the three-day event (16-19 November). 

“A coherent approach at the bilateral and multilateral level is needed,” said Cassis. “The GHF has a key role to play. A global crisis needs a global answer. By facing the crisis, we should think globally, act locally and help each other in the spirit of solidarity.” 

Harsh Vardhan, Indian Minister of Health & Family Welfare, at the opening session of the Geneva Health Forum.

“It is imperative to have a multifaceted approach towards collaborations at both the national as well as the international levels,” said Vardhan, Minister of Health and Family Welfare for India, which is co-hosting this year’s GHF event. “I believe that collaborative partnerships could play a pivotal role with inputs from various nations with respect to innovative solutions, supply chain systems, technology transfers, human resources, and more.”

With more than 54 million cumulative cases globally, COVID-19 has upended livelihoods, health systems and societies. But on the brighter side, it has also driven extensive, beneficial and potentially long-lasting changes to health care delivery systems, moving “high quality health care from hospitals into homes and communities,” said Vardhan.

He noted that India’s COVID strategy has emphasised decentralised solutions allowing innovation among individual states, while the shift of health care provision towards digital technologies, helping to strengthen response in the country that has been hard hit by the virus. India’s burden of 8.8 million reported COVID-19 cases is second only to the United States’ 11.1 million infections, so far. However, per capita India’s infection rate is in fact only about one-quarter as high insofar as India has a population of 1.3 billion people – as compared to 328 million for the USA. And India has had only about half as many deaths as the United States.

Map of incidence rate of COVID-19 globally, at 8pm CET, 16 November 2020.

Said Vardhan, “Our decentralized but unified mechanism to provide universal, accessible, equitable and affordable health care to one and all was the driving force behind our response strategy to COVID-19. In the interest of global knowledge sharing, India is willing to share its strategy and know-how.”

Universal health coverage, neglected tropical diseases, sustainable development goals, cancer, the impact of climate change are all to be discussed as major themes at the Forum. However COVID-19 – the reason behind the event’s move this year to a digital platform – will likely dominate conversation.

“COVID-19 has put the spotlight on the important and interdependent nature of public health. In fact, one third of the sustainable development goals (SDG) are health related, and SDG 3 – focusing on good health and wellbeing – is universal and underpins everything we do,” said Tatiana Valovaya, Director-General of UN Office at Geneva, another keynote speaker. “I believe that the participation of 1,600 stakeholders in this forum, connecting from 80 countries is a sure example of the type of inclusive and interconnected multilateralism that we need.”

Tatiana Valovaya, Director-General of the United Nations Office at Geneva.

The goal of the GHF, co-organized by the Geneva University Hospitals (HUG) and the University of Geneva, is to create links between stakeholders, enable the sharing of collective intelligence, and discuss innovative solutions.

Other panelists at the opening session included: Nicole Rosset, Co-President of the Geneva Health Forum, Alexandra Calmy, Vice-Dean of the Faculty of Medicine at the University of Geneva, Shripad Yesso Naik, Indian Minister of State for Ayurveda, Yoga and Naturopathy, and Piyush Singh, Counsellor of the Embassy of India.

The Geneva Health Forum runs from 16-18 November. Follow Health Policy Watch’s coverage here and on Twitter.

Image Credits: Geneva Health Forum, Johns Hopkins.

Dr Tedros warned that the vaccine updates will not solve immediate problems.

The World Health Organization is encouraged by early results of the efficacy of the Moderna COVID-19 vaccine but its most immediate concern is the impact of the surge in cases in Europe and the Americas, threatening both health workers and health systems.

“While we continue to receive encouraging news about COVID-19 vaccines and remain cautiously optimistic about the potential for new tools to start to arrive in the coming months, right now, we’re extremely concerned by the surge in cases we’re seeing in some countries, particularly in Europe and the Americas,” said WHO Director-General Tedros Adhanom Ghebreyesus at the press briefing on 16 November.

“Health workers on the frontlines have been stretched for months. They’re exhausted,” warned Tedros. “We must do all we can to protect them, especially during this period when the virus is spiking and patients are filling hospital beds. At this moment, when some governments have put all of society’s restrictions in place, there is one set game, a narrow window of time, to strengthen key systems.”

WHO has 150 emergency teams in the field assisting countries to plan and implement their responses to the pandemic, added Dr Tedros.

“This is a dangerous virus, which can attack every system in the body. Those countries that are letting the virus run unchecked are playing with fire,” he warned.

Tedros also said that he hoped that the G20 meeting this coming weekend will commit more funds to fighting the pandemic.

While $US 5.1 billion had been committed so far, another $US 4.2 billion is needed urgently and $US 23.9 billion will be required in 2021, said Dr Tedros.

Moderna vaccine results

“There are many many questions still remaining about the duration of action, the impact of severe disease on different subpopulations especially the elderly, as well as the adverse events, beyond a certain period of time,” said WHO Chief Scientist Dr Soumya Swaminathan.

People who are at the highest risk in all countries, particularly health workers who are being disproportionately affected, should have access to a vaccine first, she added. For a more detailed report of the Moderna results, see Health Policy Watch’s story here.

Dr Soumya Swaminathan talks about the Moderna vaccine
WHO Chief Scientist Dr Soumya Swaminathan said there are still many questions remaining.
COVID-19 at WHO HQ

WHO also dismissed reports of a COVID-19 outbreak at its Geneva headquarters (HQ), saying that 5 recent cases have been diagnosed among workers there, but it’s not clear if they were infected in the building or outside.

“There is no outbreak at WHO HQ,” says Dr Maria van Kerkhove, the organization’s COVID-19 technical lead. “Since the beginning of the pandemic, there have been 65 cases at HQ, and 36 cases of staff on the premises.”

Confirming that five HQ staff had been infected in the past week “that are linked together”, Van Kerkhove added that WHO didn’t yet know “if they’re an actual cluster”.

“There are possible ways in which they were infected outside of the premises. So we’re still doing the epidemiologic investigation with these individuals, but they are all doing well,” she added.

Map of cumulative COVID-19 cases globally, at 8pm CET, 16 November 2020.

Dr Michael Ryan, Executive Director of WHO’s Health Emergency Program, added that some of the Geneva staff lived in areas that “have some of the most intense transmission in the world right now”.

“To my knowledge, the cluster being investigated is the first evidence of potential transmission on the site of WHO, but we can’t completely protect ourselves. We are human beings and we live within a society and we’re not entirely within a cocoon here.”

Image Credits: WHO, Johns Hopkins University & Medicine.

Moderna’s mRNA research and innovation centre

Moderna’s mRNA vaccine candidate has had a vaccine efficacy of 94.5%, the company announced today. unveiling the stunning, initial analysis of Phase 3 clinical trial results by an independent Data Safety Monitoring Board, appointed by the US National Institutes of Health. 

And news that the vaccine can be stored at 2° to 8°C (36° to 46°F) for up to 30 days, make the results even more significant for low- and middle-income countries that lack ultra-cold storage facilities required for storage of the other candidate mRNA vaccine, which is being developed by Pfizer, and showed almost as good – 90% results last week – in interim analysis of its Phase 3 trial. .  

The Moderna vaccine only requires a long-term storage temperature of around -20 C° (-4 F°) , in comparison to Pfizer’s requirement of  ultracold storage temperatures of -70 C° or below.  Overall, the data makes the Moderna candidate a prime candidate for vaccine rollout in low- and middle income countries, and even in rural regions of high-income countries that lack ultra-cold storage facilities. 

Last month, Moderna also pledged to “not to enforce our patents” on the COVID-19 vaccine for the duration of the pandemic – meaning that generic vaccine manufacturers could also step in very soon after the vaccine is approved by regulatory authoriities to support massive production. 

According to the company’s press release of the results, of the first 95 adults who developed COVID-19, 90 were in the placebo group of the trial, while only 5 were in the control group of participants who actually received the vaccine.  Among the severe cases, all 11 occurred among people who did not receive the vaccine at all. Moreover, Moderna’s results were obtained from a diverse group of participants, as evidenced by the fact that among the 95 reported COVID-19 cases, there were 15 older adults (ages 65+) and 20 participants identifying as being from diverse ethnic communities, including 12 Hispanic or LatinX, 3 Black or African Americans, 3 Asian Americans and 1 multiracial participant.  There were no significant safety events, and most adverse events were short-lived fatique or mild or moderate headache or muscle pain.

“This is a pivotal moment in the development of our COVID-19 vaccine candidate. Since early January, we have chased this virus with the intent to protect as many people around the world as possible. All along, we have known that each day matters. This positive interim analysis from our Phase 3 study has given us the first clinical validation that our vaccine can prevent COVID-19 disease, including severe disease,” said Stéphane Bancel, Chief Executive Officer of Moderna.

Stéphane Bancel, CEO of Moderna
Vaccine Stability & Potential Protection Against More Severe Disease Hailed   

Reaction in the health community was swift, albeit cautious.  At a WHO press conference on Monday, Chief Scientist Soumya Swaminathan said that while the results were encouraging: “Of course, we need to wait and see what the final efficacy and the safety profile of this vaccine will be when the whole data is analysed after they reach their primary endpoint.”

While storage temperatures for the vaccine open up the possibility of worldwide distribution in low- and middle income countries, WHO’s Vaccine Depatment head Katherine O’Brien cautioned that the logistics remain formidable: “This is a two-dose vaccine, and certainly any vaccine that can achieve a one-dose vaccine is certainly easier to deliver than a two-dose vaccine,” she pointed out. In addition, most existing vaccine programmes are geared towards children – while this vaccine will first need to be rolled out for adults.

“It is incredibly promising that the vaccines we urgently need are now on the horizon,” said  Charlie Weller, Head of Vaccines at The Wellcome Trust, which has supported COVID vaccine R&D through the Oslo-based Coalition for Pandemic Preparedness (CEPI) funding of vaccine R&D

“To have multiple vaccine candidates with interim results that surpass our expectations is phenomenal, and testament to the incredible global research effort this year….  it is promising to hear Moderna report that doses can be stored at clinics at more regular refrigeration temperatures for up to a month once delivered to healthcare facilities.”

On a more cautionary note, Weller added that while “The results from Phase III of Moderna’s Covid-19 vaccine trial are highly encouraging, however as with other results, we must remember they are interim and we are yet to see the full data. Urgent questions remain to be answered, including how long these vaccines will be effective for, and whether these vaccines work across different populations, in all age groups, ethnicities, and those with prior health conditions.  Only upon trial completion will we be able to assess the full efficacy and safety of any vaccine candidate.

CEPI’s CEO Richard Hatchett also noted that information released by Moderna “suggests that the vaccine may protect against more severe disease  (although they don’t address the statistical significance of this finding), and the reported side effects appear to be manageable. The fact that the vaccine shows stability when stored in a normal refrigerator for up to 30 days is also terrific news and will allow the vaccine to be distributed broadly.

Fair Distribution & Logistics Hurdles: The Next Big Challenges

Once vaccine efficacy is proven, the world will face huge challenges in getting the first doses to the most vulnerable groups around the world – particularly health care workers. 

Adding to that anxiety is the fact that in the case of the first, and apparently high-performing vaccine candidates, like Moderna’s  – rich countries have already  queued up already in line with big pre-orders. 

Moderna has said that through its a collaboration with the Swiss-based company Lonza, it will be able to launch production of up to 1 billion vaccine doses in 2021 at the company’s USA and Swiss sites. By next month, Lonza’s Swiss-based plant in Visp will already be poised to start producing some 300 million doses said Lonza site manager, Torsten Schmidt in an interview last month: “Everything will be ready for the production of the first doses in December.” 

Moderna has also been negotiating with the WHO co-sponsored COVAX facility about distribution through the WHO co-sponsored global procurement network of some 186 countries. The facility promises to secure and distribute sufficient doses to immunize  health workers and at-risk populations first of all. 

But in the press conference today, WHO officials refrained from saying if Moderna had in fact signed an agreement with COVAX – although Wellcome Trust’s Weller indicated that it has saying in his statement: “Moderna’s vaccine is part of the COVAX Facility, which will be instrumental to ensuring any effective vaccines are prioritised for those most in need globally…. ,” but adding, ““It is critical that we urgently and decisively work on the wider issues of Covid-19 vaccine allocation and delivery. Overcoming the logistical hurdles ahead will take unparalleled levels of global collaboration.”

More significant, perhaps, is Moderna’s it’s pledge to not enforce its patents for the duration of the pandemic. That opens up the way for other generic manufacturers to produce Moderna’s COVID-19 vaccine for the COVAX pool.

Tal Zaks, chief medical officer at Moderna

 

Countries Representing Just 12% of World’s Population Hold Options on 78% of Moderna’s 2021 Vaccine Supply

Indeed, production of the Moderna vaccine by generics may become the only way out for the rest of the world since high-income countries, including the United States, the European Union, Canada, Switzerland and Japan, have already made vaccine pre-orders to Moderna for some 300.5 million doses, and have options to purchase another 480 million more – for a total of 780.5 milion out of the 1 billion doses to be produced in 2021.

That would mean that up to 78% of Moderna’s own available vaccine supply next year could be gobbled up by countries representing only 12% of the world’s population, pointed out a coalition of medicines access campaigners in a press release today.

The groups, including the UK-based STOPAIDs, also noted that Moderna has so far received some US$ 2.48 billion in United States government public subsidies, and yet its reported price tag for the two-dose vaccine at $US 50-60 per course is the “highest cited for a potential vaccine so far.”

The coalition called on Moderna to “openly share their vaccine technology so doses can be produced at needed scale, at the lowest possible price.”

In any case, most experts still agree that ultimately, a large pool of effective, but diverse, vaccines will be the best assurance that everyone can get a fair share. Said Weller, “We cannot become complacent. If we are to have enough doses for the entire world and vaccines that work across different groups and settings, we must continue developing and investing in a wide range of [vaccine] candidates.”

However, the innovative mRNA technology being used by Moderna as well as Pfizer still has certain inherent advantages, insofar as it takes less time to develop and also is less bulky in terms of the vaccine volumes. That is becaue the vaccine consists merely of an RNA protein that  “instructs” the body’s own cells to produce the main antigen of the virus. In comparison traditional vaccines typically rely upon an inactivated portion of the virus itself to provoke an immune response.  For more details on the vaccine’s mechanism of action, see our exclusive interview with Moderna Chief Medical Officer, Tal Zaks.

  • Updated 18 November, 2020

 

Image Credits: Moderna, Moderna, Moderna TX.