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.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus speaking at the virtual World Health Summit

The World Health Summit, one of global health’s premier policy conferences got underway today in the shadow of an escalating COVID-19 case surge across Europe. The surge saw WHS sessions shift to an all-virtual platform – after organizers were forced to shelve initial plans for limited in-person participation in Berlin, where the annual conference co-hosted by the German government, typically draws thousands of health policymakers, experts and researchers from government, academia and industry.   

“COVID-19 is shining a light on the decisions we and policy makers are making, not only today, but also in the past,” said WHO’s Director General Dr. Tedros Adhanom Ghebreyesus, at Sunday’s opening ceremony, in a session that included UN Secretary-General Antonio Guterres and European Commission President Ursula von der Leyen. 

“The virus thrives in the inequalities in our societies, and the gaps in our health systems. The pandemic has highlighted the neglect of basic health system functions underpinning emergency preparedness – to disastrous consequences,” Dr Tedros added. 

His comments echoed key themes in this year’s conference, which is focusing on pandemic preparedness and responses in multiple dimensions. Themes will touch on oft-polarized debates over vaccine nationalism and access to medicines  – as well as exploring more technical issues such as digital health and disease surveillance.  The conference will also touch on the broader context in which the pandemic has unfolded, including accelerating climate change and increasing non-communicable disease rates, which also make people more vulnerable to COVID-19. 

Repeating an oft-stated message, The WHO Director General underlined that robust health systems are the foundation of response now and preparedness tomorrow: “Of course, this pandemic is playing out differently in every country and in every community. But there are some constants,” said Dr Tedros. “Health systems, matter preparedness matters and doctors, nurses and health workers must have the training and equipment they need. This have been fundamental to how countries and communities are weathering this pandemic. ….Public Health is more than medicine and science. And it’s bigger than any individual, ultimately, it’s a matter of leadership at the question of political choice.”

“Vaccine Nationalism” Will Prolong Pandemic  

The WHO Director General also called upon countries to shun “vaccine nationalism” and support an equitable distribution of COVID-19 vaccines, once they become available, particularly in light of the unprecedented threat that COVID-19 poses worldwide. 

“Let me be clear, vaccine nationalism will prolong the pandemic, not shorten it,” said Dr Tedros. 

“It’s natural that countries want to protect their own citizens first. But if and when we have an effective vaccine, we must also use it effectively. And the best way to do that is to vaccinate some people in all countries rather than all people in some countries. 

“I will repeat. The best way to do that is vaccinate some people in all countries, rather than all people in some countries,” he said. 

UNAIDS – Vaccines Should Be ‘Public Goods’  

UNAIDS Executive Director Winnie Byanyima

Speaking at the opener, UNAIDS Executive Director Winnie Byanyima echoed the WHO call on equitable distribution of future COVID-19 vaccines and went further – saying that the therapies  must be a “peoples’ vaccine” in order to be and fairly distributed. “To do this, pharma companies must openly share their know-how and technology for producing the vaccines” as opposed to holding onto “patent monopolies.” 

The fight against COVID-19 must be one that “places human rights at the heart of the response to the crisis, she added, citing past pandemics like the HIV/AIDS crisis of two decades ago, as an example: 

“Through the AIDS/HIV crisis, there was a global HIV response that has allowed 25 million people to get on life saving HIV treatment to live full lives. 

“Only bold and radical policy action will get us out of crises like this. Nothing less than that can work,” stated Byanyima.

“We can beat COVID-19, we can beat inequality, we can finish the unfinished business of AIDS and also repair and restore the global economy, but only without people centered, public health, rights based approach.

“The most important drivers of change during the AIDS epidemic were not those in authority, but rather, those most affected, who can bring insight, practical innovations, as well as the truth needed to guide leaders and countries forward,” she added. “To do that, governments must acknowledge that COVID-19 vaccine tests and treatments are public goods.” 

Race Towards Vaccine is a Race Against the Virus, Not Pharma Companies, says Sanofi CEO

Sanofi CEO Paul Hudson

But global leaders calling for radical action also need to remember that the world is engaged in a “race against the virus,” and companies are part of the solution, not the problem, said Sanofi CEO Paul Hudson, which is developing a messengerRNA (mRNA) vaccine candidate together with GSK, currently in Phase 2 trials. 

Hudson said that the company is committed to ensuring affordable and accessible distribution of any vaccines or health products that they produce – including “providing a significant proportion of our total worldwide available supply to COVAX,” he said, referring to the WHO global vaccine procurement facility to which over 180 countries have signed on .

“The race is not between companies; it’s against the virus,” said Hudson. 

He added that Sanofi also is collaborating with the European Union to build more resilience into the regional and global health products supply chain, in the wake of supply chain interruptions at the start of the pandemic, and consequent tensions between countries. The steps include co-creation of an  “European and global champion dedicated to the production of active pharmaceutical ingredients,” he said, “The crisis we face should not lead us to take further protectionist measures. What we need to ensure is building resilience and strategic health autonomy.” 

But he added that it’s also critical that governments around the world invest in stronger healthcare systems and infrastructure – otherwise medicines still will not reach those people who need them. 

“It is fundamental that governments around the world, despite all the headwinds, continue to invest in healthcare systems and infrastructure. We know that today almost half the world population still lacks access to essential health services.”

European Commission President Dr. Ursula von der Leyen

Added Nanette Cocero, President of Pfizer Vaccines, routine health services also need to be maintained, such as life-saving vaccinations  against existing preventable diseases. 

“Prioritizing vaccination against disease that is already preventable protects the most vulnerable among us, from newborns in maternity hospitals to older adults, for whom illnesses like seasonal flu and pneumococcal diseases pose a serious danger and disruption of immunization services” she said, adding that even “brief” interruptions can increase the likelihood of  outbreaks for highly contagious diseases like measles.” 

Added Von der leyen, the broader context of health also needs a closer look. Sounding notes on other themes such as climate change, which are also being featured at this year’s Summit, she said. “In today’s world, we need to look after our health by looking after our planet, our well being and our sustainable development. And we need to do it together through global health cooperation and not through global health competition.” 

 

Image Credits: R Santos/HP Watch.

A milestone study has found that women giving birth when they are infected with COVID-19, even if asymptomatic, may have more post-birth complications, including fever and hypoxia leading to hospital readmission, as compared to women who are not infected.

The study, conducted by Malavika Rabhu of Weill Cornell Medicine, observed 675 women admitted for delivery in New York. Of the women, 10.4% tested positive for SARS-CoV-2, although  78.6% of these women were asymptomatic. 

However, following birth, complications such as fever, hypoxia, readmission occurred in 12.9% of women with COVID-19 versus 4.5% of women without. 

There was also increased frequency of fetal vascular malperfusion among their newborn babies, which indicates thrombi in fetal vessels – occurring in 48.3% of women who had COVID-19 versus the 11.3% who didn’t. 

Malavika Prabhu, Weill Cornell Medicine

Cesarean rates also were higher in women infected by COVID-19, at rates of 46.7% in symptomatic COVID-19 cases, 45.5% in asymptomatic women, and 30.9% in women without COVID-19.  

These potential complications suggest impacts from COVID-19 for women and their newborn babies at the moment of delivery and beyond, Prabhu notes, speaking at a press briefing on Thursday. More research needs to be done she said, regarding the implications of COVID-19 on pregnancy. 

The risks identified are especially important for pregnant women to be aware of – if they are infected and due to give birth – particularly since some pregnant women have avoided accessing care at clinics in COVID hospitals, according to Prahbu. 

Obesity also represents a significant risk factor for enhanced disease for pregnant patients with COVID-19, added  Professor Kristina Adams Waldorf, speaking at The Union session. Waldorf who has studied the impacts of the infection on obese pregnant women in a study in Washington State.

Excess adipose tissue, which can impair immune response to viral infections, and the impact obesity has on pulmonary mechanics and breathing can make “pregnant patients that are obese prior to pregnancy more symptomatic,” Walfdorf states. 

There is evidence that suggests that there’s an increased risk for hospitalization and need for mechanical ventilation for pregnant infected patients. This is especially for pregnant patients with COVID-19, who have had their pregnancy compromised by the infection, which results in a preterm birth. Obesity would add another layer to these risks. 

“We have almost what we would consider kind of a perfect storm where there are multiple factors that are interacting at the same time that complicate the management of this pregnant patient, ultimately leading to the decision to deliver preterm.”

Image Credits: Flickr: Nuno Ibra Remane, R Santos/HP Watch.

Madhukar Pai, Director of McGill Global Health Programs and Director of the McGill International TB Center.

In combatting COVID-19, many countries around the world are currently facing “house on fire moments,” as described by Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. However, the syndemic of COVID-19 and TB poses an even more deadly threat. 

TB and COVID-19 respiratory diseases affect mostly the same vulnerable populations. Disproportionately, marginalized communities, those living in poverty, those with underlying conditions, those who don’t have access to clean drinking water or sanitation, and those who can’t afford masks or are unable to socially distance have been hit hardest medically and socioeconomically by both COVID-19 and TB. 

According to Madhukar Pai, associate director of the McGill International TB Center, 25 years of progress in malaria, TB, HIV detection and treatment, as well as widespread vaccinations of vaccine preventable diseases and care for non-communicable diseases, has been rolled back in 25 weeks. He and Osterholm were both speaking at a session at the 51st Union World Conference on Lung Health on Thursday. 

COVID-19 has severely disrupted health systems and services globally. 1.4 million people died from TB-related illnesses in 2019. With a 25 percent disruption in TB detention and treatment, 13 percent more TB deaths could potentially occur this year, found the recent WHO Global Tuberculosis Report. In addition, a decade’s worth of progress in reducing deaths from TB, the world’s oldest known and still the most deadly infectious disease, has been pushed back over the 10 months of the pandemic. 

The infrastructure laid down by TB systems and programmes was in fact essential to mounting the early response to COVID-19, particularly in low- and middle-income countries. 

“When this virus hit us, many countries were able to leverage existing capacities, be it the influenza surveillance systems or the molecular diagnostic testing capacities of TB programs, to respond more effectively to COVID-19,” said Maria Van Kerkhove, WHO COVID-19 Technical Lead. 

In order to rebuild the disrupted health systems, Pai called for the leveraging and repurposing of innovative COVID-19 systems and technologies to fight TB. 

“The amount of investments that have gone into COVID-19 vaccines in six to eight months exceeds all the investments ever made on TB vaccines in the history of humanity. How is this acceptable, given the death toll that TB has cost in the last several years. We must ensure that these R&D investments are not wasted,” said Pai. 

Community-based testing for COVID-19 in April in Madagascar.

The same infrastructures that have been created to respond to and manage the COVID-19 pandemic could revolutionize TB detection, treatment, and care, if they were applied to the latter. These include: 

  • Mobile apps designed for COVID-19 self-assessment, public education, screening, and contact tracing, all of which are necessary for TB. 
  • Innovative diagnostics, such as digital chest x-rays using artificial intelligence based software, could be used to screen for both COVID-19 and TB. 
  • Decentralized, community based testing could be scaled up for TB.
  • Remote service provision systems and technologies, including tele-health and at-home delivery of medicines, could be repurposed for both COVID-19 and TB. 
  • Behavioral changes in healthcare facilities, with wearing PPE, and among the public, with distancing and wearing face masks, can interrupt transmission for TB and COVID-19. 
  • Global partnerships, such as COVAX – a multilateral collaboration of over 171 countries, established to pool funding for COVID-19 vaccine development and distribution – are critical to increase access to research, technology, and treatment for TB. 

“If we don’t use this crisis and invest in universal health coverage [UHC] as a long standing solution for better pandemic preparedness…then TB will suffer because TB desperately needs the protection of UHC,” said Pai. “And therefore my biggest dream would be for UHC to get front and center on the political agenda and for our countries’ leaders to have learned this hard lesson that health is wealth and wealth is health.”

 

Image Credits: Flickr – World Bank, International Union Against Tuberculosis and Lung Disease.

Jilian Sacks presents results of FIND evaluation of COVID-19 rapid diagnostics – only two by SD biosensor make the grade

Rapid diagnostic tests (RDTs) could play a critical role in decentralising testing and reaching remote communities as WHO launches an Africa roll-out, but a recent study has found that only two of the six RDTs making it to the final round of testing met WHO accuracy standards.

RDTs test for proteins produced by the SARS-CoV-2 virus, collected using nasopharyngeal or oropharyngeal swabs. Typically, they are more reliable in symptomatic patients, with a high viral load, especially in their upper respiratory tract, and their ease-of-use makes them preferable to other means of testing in critical situations.

The study, led by the Foundation for Innovative New Diagnostics (FIND), evaluated the performance and ease-of-use of six commercially available RDTs in people presumed to have COVID-19, in testing centres across Brazil, Germany and the UK. The 2,400 adult participants enrolled in the study were identified as at risk for infection according to their local department of public health. Patients were excluded if they had previously been diagnosed with SARS-CoV-2.

The results, which were released at The Union World Conference on Lung Health and also pre-published on medRxiv.org, were then compared to the accuracy requirements approved by WHO. According to this profile, RDTs must have a minimum sensitivity of 70% and at least 97% specificity, but only two tests met the proposed minimal requirement for both categories.

The Standard Q, an RDT made by SD Biosensor Inc, performed best overall, with 76% sensitivity and 99% specificity in Germany, and with 88% and 97% in Brazil. It also scored 86 out of 100 for ease-of-use.

“These tests are likely to be useful in settings where the COVID-19 positivity rates are higher to minimize the number of false positive tests that are detected,” said Jilian Sacks, an author on the study. Because data suggests RDTs have improved accuracy in people with higher viral loads, this would be a good way, she added, “to be sure you’re diagnosing someone with COVID-19, and then take appropriate health measures.”

Tests For Antibodies Post-infection Seem More Sensitive 

On a more positive note, Sacks said, the blood tests being rolled out now to test antibody levels in the general population seem more reliable. The FIND study evaluating those tests, found that  of the 15 enzyme-linked immunosorbent assays (ELISA), 11 met performance targets. ELISAs detect antibodies 14 days or more after symptoms appear, with a performance time of up to two hours. 

This makes such tests an excellent way to track infection and immunity in large groups of people, but the sophisticated equipment required makes them inefficient for use in the rapid diagnosis of people who are actually ill and infectious. 

Effective control of the virus is largely dependent on the quick identification of infected individuals, followed by a period of isolation and clinical support, if needed. The current gold standard of testing – polymerase chain reaction (PCR) tests – can only be conducted in a laboratory as they detect nucleic acid from SARS-CoV-2. This can leave people waiting anywhere from 48 hours to more than 10 days for results, impeding rapid identification and isolation efforts.

It is believed that RDTs, with their turnaround time of up to half an hour, play a critical role in cutting this delay and limiting the transmission of COVID-19. The cheap cost and ease-of-use mean they are being considered as an effective method of testing alongside current PCR tests.

Rapid testing could turn the tide in Africa

Standard Q, the best performing RDT tested by FIND, is one of two rapid tests being rolled out across Africa by WHO, in the hope of increasing testing capacity.

Globally, 120 million RDTs are being made available to low- and middle-income countries through the ACT-Accelerator, a coalition also including UNITAID, the Global Fund, and FIND. The coalition, together with the Africa Centres for Disease Control will distribute the tests in 20 African countries. WHO is also supporting countries to procure the tests through the supply portal set up by the United Nations.

Many African countries have struggled to test in numbers sufficient to control the transmission of coronavirus. In the last month, only 12 countries reached the key threshold of 10 tests per 10,000 people per week. Many are also falling short when compared to countries of a similar size in different regions. Nigeria is testing 11 times less than Brazil, with Senegal testing less than 14 times that of the Netherlands.

“Most African countries are focused on testing travellers, patients or contacts, and we estimate that a significant number of cases are still missed,” said Dr Matshidiso Moeti, WHO Regional Director for Africa at a press conference on Thursday. “With rapid testing, authorities can stay a step ahead of COVID-19 by scaling up active case finding in challenging environments, such as crowded urban neighbourhoods and communities in the hinterlands.”

WHO recommends RDTs for use in outbreaks in hard-to-reach areas with no access to the city-constricted PCR testing sites, and in areas with widespread community transmission.

120 million RDTs are being made available to low- and middle-income countries under the umbrella coalition ACT-Accelerator. Institutions and organisations, including FIND, will distribute these tests in 10 African countries.

The Standard Q RDT will roll-out alongside the Panbio COVID-19 Antigen Rapid Test Device, manufactured by Abbott. It is important to note that the Panbio RDT was not commercially available when FIND conducted their study,  Sacks said. She said an independent study of that RDT is now underway.

“It’s important to conduct limited performance evaluations in order to support affordable access to testing, particularly in low and middle income countries,” Sacks said.

  • James Hacker contributed to the reporter and writing of this article