The 5th Special Session of the WHO Executive Board – hybrid virtual and face-to-face meeting

The United States appears to be walking back on threats to withdraw from the World Health Organization – just as US President Donald Trump is reported to be recovering from a bout with COVID-19 in Washington, DC. 

Speaking at the first formal meeting of WHO’s Executive Board governing body to be convened since May, US Assistant Secretary for Health, Brett Giroir, said that the US had developed a “roadmap for WHO reform” together with other members of the Group of 7 industrialized nations, suggesting that the US would be pushing for uptake of those  measures within the global health organization – rather than pulling out altogether.    

“The United States working closely with G7 partners, developed a roadmap for WHO  reform, which I shared with my fellow executive members in August,” said Giroir in his remarks today at the meeting of the 33- WHO member states that guide key policy directions.

“The roadmap outlines opportunities to strengthen the WHO by increasing its accountability, transparency and overall effectiveness, as well as promoting our shared accountability to one another to address new and emerging threats. Germany and France jointly provided a paper also along these lines, and we understand Chile, also has recommendations.” 

In his remarks, Giroir made one pointed, albeit indirect reference to alleged Chinese “failure” to report earlier on the virus spread – but in a departure from the heated anti-China rhetoric coming from the White House, he did not call out Beijing by name.

US Deputy Secretary of Health, Brett Giroir, speaking at a special session of the WHO Executive Board, 5 October 2020.

“Despite the many advances in technology, international cooperation and instantaneous communication, and the positive steps in response outlined this morning,… we cannot overcome the failure of any member state to provide accurate, complete and timely information on outbreaks and potential health emergencies,” Giroir said. 

The balance of his remarks stressed the common goals shared with other WHO member states going forward in beating back the pandemic.

“We also all share the same goal of reforming the WHO, fighting COVID-19 and defeating future outbreaks,” said Giroir. “The US welcomes all good faith efforts to strengthen public health protections, and we hope we can use this special session. To begin, converting these many good ideas, actions. 

“Consistent with our longstanding policy, the United States will be promoting reforms that strengthen transparency and accountability at every international organization, including the WHO.”  

Austria, Brazil and Others Echo Reform Calls  

An assortment of other high-income countries also joined into the US calls for reform – with a range of statements. 

Austria praised “the good and early reaction of WHO.. whoever says different is far from the facts, and believes in fake conspiracies.” But the Austrian representative, Clemens Martin-Auer, also complained that there had been “no global leadership when it comes to the many aspects of travel regimes and restrictions that is hurting commerce and the travel industry in many respects. We have no proper guidance of this valuable organization.”

And while he praised WHO Director General, Dr Tedros Adhanom Ghebreysus for doing an “extraordinary job when it comes to information” he pointedly added that “information is not a substitute for consultation,” saying that the organization’s “governing bodies” such as the Executive Board, could have been consulted more.  

In an obvious swipe at the United States, Martin-Auer added: “In addition to the health crisis, we are also facing a weakening of the organization. This political weakening is further reinforced by the potential withdrawal of a strong WHO Member State from the organization, which means a serious loss of organizational resources.”

Maria Nazareth Farani Azevêdo, Brazilian representative to the United Nations in Geneva

In their remarks, a number of other leading countries signaled their readiness to cooperate with the US ‘reform’ initiative. Brazil, for its part, said it was ready to “engage with other interested member states in a reform process of the WHO, on the basis of the roadmap circulated by the United States in collaboration with G-7 partners.”

And yet others, sidestepped criticism of WHO altogether, preferring to focus on the importance of maintaining a strong WHO leadeship role.  

“Our duty is to demonstrate that protecting the health of the people, makes good economic sense. We need a strong WHO to lead us forward,” said Dr Päivi Sillanaukee, Finland’s representative to the Executive Board. 

Meanwhile, India and Kenya called for a stronger WHO, with more transparent decision-making and better equity in access to vaccines and medicine. “It must be our collective endeavor to make the WHO accountable, stronger, and a more vibrant organization in the interest of our future generations,” said the Indian representative. “The WHO must also put in place a robust mechanism to ensure fair, affordable, equitable access to vaccines diagnostics, and therapeutics.”

The WHO Says Just Three Countries Hold More Than Half of All COVID-19 Cases
Dr Tedros Adhanom Ghebreyesus, Director General of the WHO.

In WHO’s opening remarks Monday morning before the EB governing body, WHO Director General Tedros pointedly noted that while “all countries have been affected by the virus, this is an uneven pandemic.”

“Just 10 countries account for 70% of all reported cases and deaths, and just three countries account for half,” Dr Tedros said. Although he didn’t call out the countries by name, the United States, India, and Brazil have together have had the largest cumulative totals, racking up nearly 19 million of the 35.3 million COVID-19 cases reported to date.

He outlined what he described as the four situations that countries are facing:

“First, some countries acted decisively and quickly and have avoided large outbreaks. Second, some countries have had large outbreaks but were able to bring them under control, and continue to suppress the virus. Third, while some countries brought the virus under control, as economies and societies have eased restrictions, there has been an increase in cases. And fourth, there are still some countries that are in the intense phase of transmission.”

But the virus is highly dynamic, he emphasized, meaning that “every situation can be turned around. And hard-won gains can be easily lost.”

World map representing COVID-19 deaths per 1 million population globally.
Shock Over Sexual Abuse Allegations in Democratic Republic of Congo

While most of the all-day session, which continues tomorrow, was devoted to reviews of the progress and challenges related to pandemic response, some countries, such as the United Kingdom, also expressed their dismay over the recent allegations of sexual exploitation among members of the WHO Ebola team that had been based in the Democratic Republic of Congo. 

“Like others we were shocked to hear the recent allegations of sexual exploitation and abuse against who and other organizations fighting Ebola in DRC. We welcome to DDS commitment to investigate these allegations and to ensure who safeguarding systems are for the offenses,” said the United Kingdom’s representative, Chris Whitty.  

-Raisa Santos and Madeleine Hoecklin contributed to this story.

Image Credits: WHO.

Albert Bourla, CEO of Pfizer, speaking at the World Economic Forum

The CEO of Pfizer, one of the frontrunners in the race to develop a COVID-19 vaccine, has lambasted US President Donald Trump’s politicization of the vaccine approval timeline, declaring in an open letter that the company is “moving at the speed of science” and will not “succumb to political pressure” to prematurely rush its product to market.

The letter by Albert Bourla to “US colleagues” was issued shortly after President Donald Trump declared Tuesday in a televised US presidential campaign that a COVID-19 vaccine could be ready “a lot sooner” than timelines laid out recently by US Centers for Disease Control Robert Redfield and other scientific experts.  

Responding to a debate question about Redfield’s projection that public release of a vaccine might not be feasible until next summer, Trump said: “I’ve spoken to Pfizer, I’ve spoken to all of the people that you have to speak to, Moderna, Johnson & Johnson, and others. I’ve spoken to the companies and we can have it a lot sooner.”

Bourla retorted that “the world will be safer if we stop talking about the vaccines’ delivery in political terms and focus instead on a rigorous independent scientific evaluation and a robust independent approval process.” 

Referring explicitly to Tuesday’s debate in his letter, Bourla said that “once more I was disappointed that the prevention for a deadly disease was discussed in political terms rather than scientific facts.”

He added that the political rhetoric swirling around the vaccine approval timeline undermines public confidence, which is crucial for the acceptance of a vaccine: “People, who are understandably confused, don’t know whom or what to believe. Global health has too much at stake, and the public trust and acceptance of a vaccine is so important to me, that I’m writing to explain the principles we are using at Pfizer today.”  

Among the three pharma front-runners in late-stage trials, Pfizer is the only company that has projected that it could have “an answer by the end of October,” before the 3 November US election. President Trump had, in turn, praised Pfizer for their speed and accelerated timeline. Experts have noted that the timeline  is largely driven by the shorter interval required between Pfizer’s two-dose vaccine and another candidate, being tested by Moderna, Inc.  Trials of a third vaccine candidate, by AstraZeneca, have stalled due to safety concerns.  

While Bourla’s letter did not upend the official Pfizer projections, the CEO said the pace of approvals should be determined separately from politics: 

“In March, I declared a bold ambition: that Pfizer would create a vaccine…I further announced, after consulting with our scientists, that we could have vaccine data ready to submit to the FDA by end of the third quarter, in October, and hopefully a hundred million doses delivered by the end of the year. I knew our goal was ambitious, but it would also be critical to protect against the second wave of cases that could accompany the return of colder weather in the Fall.

“Now, we are approaching our goal and despite not having any political considerations with our pre-announced date, we find ourselves in the crucible of the U.S. Presidential election. In this hyper-partisan year, there are some who would like us to move more quickly and others who argue for delay. Neither of those options are acceptable to me. Against this backdrop, people need to know three things:

“First, we are moving at the speed of science. With a virus this ferocious, time is our enemy. This week, we will hit the grim marker of 1 million deaths globally and the number continues to climb. This danger supersedes any other timing considerations.

“Second, we would never succumb to political pressure. The only pressure we feel—and it weighs heavy—are the billions of people, millions of businesses and hundreds of government officials that are depending on us. We’ve engaged with many elected leaders around the globe through this health crisis, but Pfizer took no investment money from any government. Our independence is a precious asset.  

“Third, our priority is the development of a safe and effective vaccine to end this pandemic…The amplified political rhetoric around vaccine development, timing and political credit is undercutting public confidence. I can’t predict exactly when, or even if our vaccine will be approved by the FDA for distribution to the public. But I do know that the world will be safer if we stop talking about the vaccines’ delivery in political terms and focus instead on a rigorous independent scientific evaluation and a robust independent approval process.”   

Newly Established Global Lab Network Will Compare COVID-19 Vaccines 
The manufacturing process of Pfizer’s COVID-19 mRNA vaccine

Presuming that several vaccines, at the least, will eventually make it to marketing approval, scientists are also grappling for ways to assess what are the most effective vaccine(s) for different population groups and settings. 

As part of that effort, a new global laboratory network is being set up to examine data from major COVID-19 vaccine trials and assist with their selection, said Melanie Saville, director of vaccine R&D at CEPI, the Oslo-based Coalition for Epidemic Preparedness Innovations. Ultimately, the information would help inform the choice of vaccines for mass manufacture and procurement by the WHO co-sponsored COVAX initiative, which has brought 168 countries together in a vaccine purchasing pool. 

The non-profit coalition involving Norway as well other donor countries and health research foundations, has co-funded nine of the leading  COVID-19 vaccines in advanced Phase 3 clinical trials, including candidates from Moderna, AstraZeneca, Novavax and CureVac.

In an interview with Reuters, Saville said the aim is to establish a centralized network of labs across Europe, Asia, and North America. Six labs will analyze samples from trials of COVID-19 candidates, of which there are currently over 320 underway at different stages. The labs will try to improve comparisons by creating a centralized system to analyze them “as though [the] vaccines are all being tested under one roof,” said Saville, removing the inter-laboratory variability. 

Due to the variety of vaccine technologies used in potential COVID-19 vaccines, from viral vectors to messenger RNA, there is a high degree of complexity in the evaluation process. The network will begin by assessing early-stage human trials, later moving to Phase 3 trial data, she said. 

Gilead’s Remdesivir is Under Investigation by the European Medicines Agency 

Meanwhile, in what appeared to be a bad turn for the prospects of one key COVID-19 treatment, the European Medicines Agency announced on Friday that its safety committee was reviewing reports of acute kidney injuries in COVID-19 patients taking Gilead Sciences Inc.’s Remdesivir. 

Remdesivir was one of the first treatments found to shorten recovery time in COVID-19 patients and was approved for emergency use by the US Food and Drug Administration as well as by the European regulatory authority, where it has been given a conditional marketing authorisation as a treatment for COVID-19 for severely ill adults and adolescents.

Emer Cooke, WHO

At the time of the authorization, Remdesivir was flagged for the potential risk of renal toxicity. Subsequent reports of acute kidney injury in patients who were treated with the medication triggered action by an EMA safety committee, which has now enhanced monitoring of the drug. 

The EMA said in a press release that kidney injuries can also be caused by other factors, including diabetes and COVID-19 itself, so as of yet, there is no causal relationship between remdesivir and kidney injury. In response to the reports, WHO’s Emer Cooke, said that it would be examining the reports, but that the EMA investigation was still in the “early stage of development.”

 

Image Credits: Pfizer, World Economic Forum.

Donald Trump at a recent White House meeting – close contact among staff may have fueled COVID-19 infection spread

WHO Director General Dr Tedros Adhanom Ghebreyesus joined the chorus of world leaders wishing United States President Donald Trump and his wife a speedy recovery from COVID-19 – while the US presidential campaign entered uncharted waters, with the cancellation of campaign rallies and fears that other White House Staff and political allies who had accompanied Trump recently on the campaign trail, and to a raucous election debate with Democratic candidate Joe Biden, might also have been exposed to the virus.     

Trump revealed on his Twitter account early Friday morning that he, along with first lady Melania Trump, had tested positive for the SARS-CoV-2 virus. He said they will quarantine in the White House for an indeterminate period. 

“Tonight @FLOTUS and I tested positive for COVID-19,” tweeted President Trump at 1 a.m. EST. “We will begin our quarantine and recovery process immediately. We will get through this TOGETHER!”

“The President and First Lady are both well at this time, and they plan to remain at home within the White House during their convalescence,” said Dr. Sean P. Conley, the White House physician, in a statement.

Speaking at a WHO press briefing later the same day, Dr Tedros and other senior WHO officials avoided any reference to the hailstorm of criticism that Trump had directed for months at WHO’s performance in the pandemic. Instead, they struck a conciliatory note, stressing the leadership role the US President could still play in the battle against the pandemic.

“Overnight we heard that the president of the United States of America Donald Trump, and first Lady Melania Trump tested positive for COVID-19; I want to start today by wishing them both a full and swift recovery. Our prayers are with them,” said Dr Tedros in his opening remarks at the briefing. 

Asked whether Trump had failed to show adequate leadership in controlling infection spread  in the United States, where new infections are averaging some 40,000 cases a day, Mike Ryan, Executive Director of Health Emergencies, refrained from explicit comment.  

But Ryan suggested that the US President, who is 74 and overweight, might draw new insights into the disease from experiencing it himself, adding it was still not too late for the United States to “turn the corner” on it’s own chronically high infection rates.  

“We wish the president well. Like we would wish anyone facing this disease well. This is a nasty virus and this virus can cause severe disease. Particularly in older individuals with underlying conditions,” said Ryan. 

“We’ve all been through things in our life, health events that transform our lives whether we want them to or not. And other things that allow us to learn and absorb lessons in our lives. 

“We want all public leaders, particularly leaders of great countries to lead us and to give us hope, to give us certainty, to give us truth and to give us a chance to fight and win against this disease. So it is never, ever too late for that to be true.” 

Election Campaign In Uncharted Waters Alongside Reports Biden may have been infected   
Crowds flock to recent Trump campaign rally in Virginia

The news of Trump’s infection poses a clear challenge to the pace and tone of his re-election campaign against former Vice President Joseph Biden, the Democratic nominee. The President has already cancelled his campaign rallies scheduled over the weekend and early next week, while uncertainty surrounds plans for the next presidential debate, scheduled for October 15 in Miami. 

Disease experts also suggested that a much wider outbreak among White House staff and political allies may be underway. In the week leading up to Trump’s positive test, he interacted with staff members, donors, and supporters at a variety of events. 

It is presumed that the president and first lady tested positive for the virus following close contact with a senior advisor, Hope Hicks, whose positive test results were reported late on Thursday evening. However, according to White House officials, Hicks began exhibiting symptoms on Wednesday, when she traveled with Trump to a campaign rally in Minnesota. The White House wanted to keep the news of Hicks’ positive test result from leaking, said White House aides. 

Advisors to the president were reported as saying that they expected additional cases among those who are in close and regular contact with Trump. Ronna McDaniel, Chairwoman of the Republic National Committee, already had tested positive for the coronavirus on Wednesday, after having contact with Trump last Friday. However, Vice President Mike Pence and Secretary of State Mike Pompeo, tested negative for the virus on Friday as did Biden who had faced off against Trump on Tuesday in a raucous, nationally televised election debate that lasted more than two hours and included ample shouting from the podium.  

Asked about the potential for a wider COVID outbreak among White House staff, Biden and others, WHO’s Ryan added: “Two cases that are linked to space and time can be considered to be an epidemic or a cluster, and there is clearly a cluster of cases occurring in that scenario. And that needs to be properly investigated. And those individuals who may be at risk need to be advised, the necessary quarantines need to be put in place. This is epidemiology 101. 

“We absolutely trust the US public health authorities to make the appropriate decision and advise those individuals whether there may be a risk,” he said, adding, “There is no reason why the United States of America cannot control this disease, turn the corner. But that requires work. Corners don’t turn by themselves, they need to be turned in the case of biologic processes.  You’ve got to fight the virus, push the virus down. That costs, that costs in effort, in commitment in transparency. It costs in honesty and it costs a sustained support to get that job done. 

New Report Charges Trump With Fueling “Infodemic” On COVID-19

Trump’s positive COVID-19 test results emerge after months in which he consistently downplayed the severity of the pandemic and the threat of the virus, saying at times that it was no worse than the flu. While the pandemic advanced, killing 207,816 people in the US so far, Trump continued his appearances before large crowds of people, both indoors and outside. Those appearances had picked up in pace as he hit the campaign trail even harder, in preparation for the November 3 Presidential election, holding big rallies with little social distancing, and limited mask wearing – often in defiance of state public health guidelines and regulations. 

The news also followed the recent publication of a critical report, charging that Trump is one of the leading contributors to the current ‘infodemic’ of misinformation around COVID-19, including disinformation and conspiracy theories about a virus that he has consistently blamed China for releasing, even malevolently. 

He has also been accused of lighting false hopes of an easy resolution to the pandemic from a vaccine – which experts have said would likely only be about 50% effective, and still take a number of more months to develop and release safely. On Thursday night at a political dinner, several hours before Trump’s diagnosis, the US President remained optimistic, saying, “we are on track to develop and distribute a vaccine before the end of the year, and maybe substantially before… the end of the pandemic is in sight.” 

And at the same time, Trump’s eagerness to accelerate the vaccine clinical trial processes  – even overriding standard scientific safety protocols – has also fueled growing distrust among members of the US public that a vaccine, whenever one is released, will be safe and reliable. 

“We don’t comment on the behaviour of any specific individual,” said WHO’s Ryan, when asked about Trump’s overall attitude towards the pandemic as well as the preventive measures that the President may or may not have observed personally.

“We don’t know what risk management measures were put into place, especially around the president. What we do know is that each and every individual and each and every citizen should be guided by the national guidance in their country, and that there are a combination of different measures that reduce risk … washing your hands, staying at a safe distance, avoiding crowded spaces, wearing a mask, both to protect others and yourselves. We are a community and we need to get through this together.” 

Even so, WHO Health Emergencies technical lead, Maria Van Kerkhove, herself a US citizen, acknowledged that Trump, 74, is in an age category considered most vulnerable to the coronavirus. 

“If you have underlying conditions or are above 60, 70, 80 you have a higher risk of death,” Van Kerkhove said at the WHO briefing. She added that the infection fatality rate “increases by age.. estimates overall are around 0.6 %, … and the more infections we have, the more opportunity there is for those infections to reach people of an older age, who are at a higher risk of dying.” 

According to the US Centers for Disease Control, eight out of 10 COVID-19-related deaths in the US have been among adults aged 65 and older. Trump reportedly also has a Body Mass Index over 30, which places him in a higher risk group of overweight people.

Trump’s age has thus raised concerns about the potential incapacitation of the US president, which would have global repercussions. In the case of medical incapacitation, presidential power could temporarily be transferred to Vice President Mike Pence, according to the 25th Amendment in the US Constitution. 

Such scenarios are not far-fetched, particularly in light of the hospitalization of leaders such as Britain’s Prime Minister, Boris Johnson, 56, after contracting a serious case of COVID-19 in April. 

On the other hand, a range of other world leaders have contracted COVID-19 and recovered relatively quickly,  including Jair Bolsanaro, president of Brazil, Juan Orlando Hernandez, president of Honduras, Alexander Lukashenko, president of Belarus, Alejandro Giammattei, president of Guatemala, and Jeanine Anez, the interim president of Bolivia.  So it remains to be seen if Trump will emerge more defiant than ever from a mild bout of the virus –  or visibly humbled by a more serious case. 

 

Image Credits: WHO, White House, Twitter – Donald Trump.

Every year, tobacco consumption claims 8 million lives and costs economies $1.4 trillion

For the second year in a row, Geneva’s International Chamber of Commerce has hosted a dialogue bringing local tobacco industry leaders together with a major Geneva-based UN Agency – in this case to discuss the ‘role of multinationals in economic recovery following the coronavirus’. 

The ICC’s 6th Business Dialogue, involving Teresa Moreira, Head Competition and Consumer Policies Branch of UNCTAD, the UN’s main body for trade, investment and development issues, and Vice President External Affairs of Philip Morris International Gabriela WURCEL, took place on Wednesday evening at the Four Seasons Hotel in Geneva. 

Face-to-face meetings in such fora are supposed to be taboo in the UN system, according to the model policy for agencies of the United Nations system on preventing tobacco industry interference, which was developed out of the WHO Framework Convention on Tobacco Control (FCTC), a WHO official told Health Policy Watch.

“The policy runs across all UN, ‘to ensure that efforts to protect tobacco control from commercial and other vested interests of the tobacco industry are comprehensive, effective and consistent,’” said the official who asked not to be named. 

Thomas Pletscher, the ICC’s Secretary General, said UNCTAD did not express any reservations about participating in the event with PMI, in the same format as it did last year, to Health Policy Watch.

UNCTAD’s Teresa Moreira did not respond to queries from Health Policy Watch regarding her appearance. The UNCTAD media team also declined to respond. 

UNCTAD headquarters in Geneva

Event is Example of Way Tobacco Industry Exerts Political Influence 

The participation of big tobacco in a dialogue focusing on coronavirus recovery was all the more ironic, in light of the fact that tobacco use increases vulnerability to serious cases of COVID-19:

A WHO review of studies by public health experts published in April found that smokers are more likely to develop severe disease with COVID-19, compared to non-smokers.  

And only last week, WHO, released a major brief detailing how most countries in the world are still failing to enact robust policies to increase tobacco taxation, limit advertising and expand smoke-free public spaces — and that is often due to the industry’s outsize political influence. 

Asked about the meeting, happening in WHO’s own Geneva backyard, a WHO spokesperson declined to comment publicly. 

Anti-tobacco campaigners have  frequently called out the ways in which industry exerts its political influence, interferring in the development of stronger national control measures.   

“Interference by the tobacco industry remains one of the greatest obstacles to implementing the WHO FCTC,” one expert source told Health Policy Watch.

“Tobacco industry interference takes many forms…. exaggerating the economic importance of the industry while ignoring the social, environmental and health costs caused by tobacco and tobacco products; manipulating public opinion to gain the appearance of respectability, this is part of efforts to look “socially responsible”. The corporate social responsibility of the tobacco industry is an inherent contradiction since the tobacco industry’s core functions are in conflict with the goals of public health. “

In Switzerland alone, where the tobacco industry still thrives, tobacco products account for 15% of total deaths every year – or four times as many as the coronavirus. The current coronavirus death toll has almost reached 2100 deaths, compared to some 9,500 yearly deaths from tobacco, reports the Federal Office of Public Health.

ICC Calls PMI’s Invitation “Mere Coincidence”

Thomas Pletscher, ICC Secretary General

When asked why the ICC chose to invite PMI, for the second year in a row to its annual dialogue event, Pletscher told Health Policy Watch the choice was “mere coincidence”.

Asked why the ICC didn’t invite one of the many other Swiss-based multinationals, such as Nestlé or Procter & Gamble, Pletscher acknowledged that locally, the ICC’s contacts with P&G were not as close as those with PMI.

“We choose panelists according to familiarity with the topic, mixture of the panel and notably availability,” Pletscher said. “Nestlé was not available for speaking and we do have less close contacts to P&G in Switzerland. There is no priority for PMI, it is mere coincidence.”

Asked why the ICC could justify an invitation to the world’s largest tobacco company for meeting on economic recovery from COVID, Pletscher argued that PMI’s “challenges and opportunities” are “similar” to other multinationals that may be in the same boat as PMI.

PMI headquarters in Lausanne, Switzerland

“In fact, PMI employs more than 70,000 people at 38 production facilities worldwide and is a typical global manufacturer including close links to primary sector, logistics and distribution,” said Pletscher. “We expect contributions on the panel [to] how PMI reacts to such and other challenges [including] organisation of work, protection of workers, working from home and ensuring the supply chain.”

The ICC, headquartered in Paris with 45 million members in 100 countries worldwide, is a well-known vehicle for big tobacco’s interests for over two decades, civil society critics say.

Even so, the policy of the Geneva ICC branch is particularly regrettable, given the plethora of other multinationals headquartered in Switzerland- some of which can “genuinely” contribute to economic recovery, said Mary Assunta, of the Bangkok-based Global Center for Good Governance in Tobacco Control (GGTC). 

“The tobacco industry cannot be involved in economic recovery,” said Assunta, “Its traditional products kill 8 million people a year and cause poverty and human suffering. Its new products [smokeless tobacco and electronic nicotine delivery systems] result in youth addiction and cause health harms.” 

Tobacco Industry Put Workers at Risk In COVID-19 Pandemic  

Louis Laurence, Researcher for University of Bath’s Tobacco Control Research Group

In its rush to maintain supply chains and sales, PMI also put factory workers at risk during the pandemic – especially in Indonesia, Argentina and Pakistan, charged Louis Laurence, Investigative Researcher for the Tobacco Control Research Group at the University of Bath.

“It is sickening that ICC thinks a tobacco company can contribute to economic recovery post COVID-19,” Anna Gilmore, Professor of Public Health at the University of Bath, and a partner of tobacco industry watchog STOP, told Health Policy Watch. 

Along with violating UN policy, UNCTAD’s repeated exchange with PMI at the ICC means that it is also contributing, at least indirectly, to tobacco interference within international fora, Gilmore added. 

Loss Of “Credibility” For Geneva ICC   

Overtures to PMI also reflect a “loss of credibility” for the ICC as an international face of the business community in Geneva, Gilmore said.  While it is member states, and not businesses, that are signatories to the WHO FCTC, the ICC should set the example by aligning to UN norms.

“Since ICC is ostensibly partnering with UN agencies, it should abide by the UN Norms and values that are reflected in the WHO FCTC [these include] WHO FENSA, UN Model Policy on Tobacco Industry Interference for the UN System, and UN human rights principles,” she said.

Anna Gilmore, Professor of Public Health at the University of Bath

Every year, tobacco consumption claims 8 million lives and costs the economy $1.4 trillion, she pointed out. “Even without the additional burden from COVID, most countries around the world already struggle to cope with the massive health care burden caused by smoking.

“Not only is there is clear evidence that smokers have worse outcomes from COVID-19, but tobacco companies have actively sought to undermine efforts to control the pandemic,” warned Gilmore, noting that recent tobacco advertising has also aimed to cast doubts about proven links between smoking and serious COVID-19 disease.

–Updated 2 October 2020

 

Image Credits: SimonDes, WHO FCTC, Mourad Ben Abdallah, ICC, Louis Laurence, Anna Gilmore.

Moderna’s mRNA research and innovation centre

Moderna intends to seek US Food and Drug Administration emergency authorization for its COVID-19 vaccine candidate for frontline medical workers by November 25th at the earliest, and only in late January for use in the general population. 

That means that the vaccine, if approved on schedule, would only be available for widespread distribution to the general population in spring, 2021, said Stéphane Bancel, CEO of Moderna Therapeutics. 

Speaking at a Financial Times’ sponsored US Pharma and Biotech Conference on Wednesday, Bancel said “I think a late [first quarter], early [second quarter] approval, is a reasonable timeline, based on what we know from our vaccine.” This matches with what public health experts have predicted.

Bancel’s announcement of the timeline appeared to remove the Moderna vaccine, if not other vaccine candidates, from the political turmoil around the November 3rd US presidential elections.  US President Donald Trump had recently expressed hopes that a vaccine would be approved before he stands for re-election. While FDA officials have set guidelines requiring further safety checks after evidence of the vaccine’s efficacy is demonstrated, Trump had even suggested he might override that.

Stéphane Bancel, CEO of Moderna

In fact, sufficient data on the effectiveness of the Moderna vaccine should be available by November, according to a Bancel interview with CNBC. However, in order to comply with the FDA guidelines requiring at least half of the trial participants to have undergone at least two months of screening after their second injection, the timeline for seeking FDA approval for the vaccine, even on an emergency basis, was set back, he said. 

Among the two other vaccine candidates already in late-stage, Phase 3 testing, including AstraZeneca and Pfizer, Pfizer’s candidate is the one most likely to have enough data of its vaccine by late October. Due to the shorter period of time required between Pfizer’s two shots, the company’s trial has operated on a faster timeline than that of Moderna’s Bancel explained.  

FDA Widens Probe into AstraZeneca COVID Vaccine

AstraZeneca’s timeline has been stalled by reports of severe side effects among at least two trial participants.  And in a related development, the US FDA said it would widen its probe into those events, following its decision in early September to halt the late-stage US trials. Trials were also paused in the United Kingdom, Brazil and South Africa after a participant in the UK became ill, reportedly with a spinal inflammation called transverse myelitis – but they have since resumed. 

According to a recent report, the FDA will examine data from earlier trials of similar viral vector vaccines designed by the Oxford University researchers who are AstraZeneca’s COVID-19 vaccine partner, in order to determine if similar side effects were present in other vaccine trials as well, indicating a common thread. 

Chills, Fever and Body Aches Reported By Moderna, Pfizer Trial Participants 

While most clinical trials are cloaked in privacy and secreacy, some of the participants in the Phase 3 Moderna and Pfizer trials have spoken freely to media about their experiences. In a series of interviews with CNBC, participants reported symptoms of high fever, body aches, headaches and exhaustion after receiving the candidate vaccines.   

The side effects were experienced most intensely and sometimes severely after the second dose, lasting up to a day, described by one participant as “full on COVID-like symptoms.” But they said that they felt that the side effects from the vaccine would be well worth it to protect themselves against the SARS-CoV-2 virus that causes COVID-19.  

Both Moderna and Pfizer have recognized the potential for their vaccines to induce such “mild” side effects similar to mild COVID-19 symptoms. In Pfizer’s Phase 1 study, the majority of recipients of the vaccine were reported to have experienced “short-lived fever, mostly mild to moderate in severity.” This, however, does not impact the safety of the vaccine, according to spokespeople of the companies.

In light of the concern over the safety and efficacy of a potential vaccine, some vaccine researchers fear that a lack of communication of the potential side effects of the vaccine to the public could cause widespread backlash and decisions to not get the COVID-19 vaccine.

Study Finds that Young Adults are Biggest Superspreaders in Coronavirus Pandemic

Meanwhile, in other coronavirus science developments, the largest ever contact tracing study in the world published Wednesday in the journal SCIENCE found that the primary source of COVID-19 spread is young adults. It found that infection probabilities ranged from 4.7-10.7 percent. Approximately 8 percent of patients accounted for 60 percent of new infections.

“The young to middle adult age group is the one that is coming into contact with people…They are the ones taking the disease from one place to the other,” said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy. 

The findings also contradicted the belief that children are less likely to catch the coronavirus. The researchers identified a high prevalence of infection among same-age contacts. These results may influence decisions to re-open schools. 

The study emphasized surveillance and contact tracing as critical to effective public health responses to COVID-19. 

Image Credits: Moderna, Moderna.

Prime Minister Justin Trudeau announces US$440 million for the COVAX vaccine pool at today’s highl-level UN General Assembly event.

The World Bank will make available up to $12 billion in “fast-track financing” that low- and middle-income countries can access to procure vaccines against Covid-19 – as soon as one is approved, said the Bank’s president David Malpass, on Wednesday.

The announcement at a United Nations high-level panel on the pandemic that also included commitments from the big pharma firm Johnson&Johnson, Bill Gates and numerous heads of states – marks the first serious flow of finance into an ambitious global vaccine pool.  The “Covax” vaccine pool is part of a World Health Organization co-sponsored Act Accelerator initiative to raise some $35 billion to finance 2 billlion vaccine doses, as well as diagnostic tests and treatments, for low- and middle-income countries across the globe.

A handful of rich countries, including Canada, the United Kingdom, Germany and Sweden, also announced nearly $670 milllion in new pledges to the “Covax” pool, which is co-sponsored by the WHO and Gavi, the Vaccine Alliance. Some 168 rich and poor countries have joined the pool, in an unprecedented show of solidarity. But until today, the vaccine facility had only secured $3 billion in donations, far short of the billions that WHO and its partners have said they would need to roll out vaccines in 92 low- and middle-income countries that can’t afford to pay.

In another precedent for the fund-raising effort, Alex Gorsky, CEO of the pharma giant Johnson&Johnson also pledged to “allocate up to 500 million doses” of its Covid-19 vaccine to lower-income countries – should its candidate now under development pass Phase 3 trials with results showing it is safe and effective. Trials were launched just last week for company’s vaccine candidate, which is the only one that would require just one dose. Other vaccines in advanced R&D stages, by AstraZeneca, Pfizer and Moderna, would require two doses.

Gorsky did not elaborate on whether his offer meant that the company would donate the vaccines outright or offer them at a reduced price.  However he underlined that,  “having access to life saving COVID diagnostics therapeutics or vaccines… shouldn’t depend on where you live, whether you’re rich or poor, and whether you live in an industrialized country or in an emerging economy. The COVID-19 virus does not care about any of those things, and neither do we.

“Decisive collaborative action itnow will help us beat this pandemic and better prepare us for the future virus outbreaks.”

Also at the event, Bill Gates announed that his  Bill & Melinda Gates Foundation had signed an agreement with a coalition of 16 pharmaceutical companies and the to cooperate on vaccine manufacturing and to scale up production.

Funds Mark Step Towards Goals, But More Funding Still Needed
Bill Gates, chair of the Bill and Melinda Gates Foundation, at the UN General Assembly event

Altogether, WHO and Gavi have said that some $15 billion is needed immediately to began making the manufacturing orders and planning distribution networks that would allow for the massive rollout of a vaccine in 2021. The US$ 12 billion in World Bank finance goes a long way towards that, most immediate goal.

Among the individual countries making fresh pledges to the COVAX global pool, Canada made the largest outright commitment of $440 million, including $220 million as a donation to low-income countries. But the United Kingdom upped the ante, with Foreign Secretary Dominic Raab, pledging to donate up to £250 million ($322 million) more to match new pledges from other countries. That benchmark was met and then exceeded as Germany and Sweden also threw new cash into the pool, for €100 million and $10 milliion respectively.

Said World Bank President David Malpass: “I’ve proposed to our board to make available up to $12 billion of fast track financing to countries for the purchase and deployment of COVID-19 vaccines. Once the vaccines have been approved by several highly respected stringent regulatory agencies. This additional financing will be to low and middle income developing countries that don’t have adequate access and will help them alter the course of the pandemic for their people. “Our vaccine financing is additional to the COVID fast track health financing we announced in March, and it’s an important part of bank group’s intention to make available $160 billion in grants and financial support over a 15 month period to help developing countries respond to the health, social and economic impacts of COVID-19.”

The World Bank’s pledge, together with a total of nearly $US 3 billion in commitments secured from national and philanthropic donors, means that most of the funds required to get 92 low-income countries access to the vaccine pool have now been secured. High-income countries, on the other hand, will pay for their vaccines, with flexible pre-purchase agreements that will allow them to get the best vaccine options for their nation as well as to trade in their vaccine “shares”, in some cases, according to national needs. ,

However, according to the WHO’s investment case, another $22 billion more in funding would still be needed for the other two pillars of the so-called ACT Accelerator initiative, including hundreds of millions of units of COVID treatments and protective gear and 500 million rapid COVID tests – 120 milliion of which WHO is already planning to roll out in low- and middle-income countries that lack the equipment for expensive PCR laboratory tests.

The new funding for COVAX, largely closes the finance needs for vaccines. However, billions of dollars still need to be raised for tests and treatments.

Still, that is remarkable progrss for the ACT Initiative, which was launched by the WHO together with the European Commission, France and the Gates Foundation five months ago.

Said Gates, “One thing I’ve learned studying the history of pandemics is that they create a surprising dynamic when it comes to self-interest and altruism. Pandemics are rare cases where a country’s instinct to help itself is tightly aligned with its instinct to help others. The self-interested thing and the altruistic thing–making sure poor nations have access to vaccines–are one and the same.

“A number of countries, most recently the United Kingdom and Canada, are good models for what other wealthy nations should do. They have donated enough money for COVAX, the vaccine pillar of the ACT-Accelerator, to procure, probably, hundreds of millions of vaccine doses for poor countries. But more will be needed and I hope wealthy nations will continue to be generous.”

Image Credits: NIAID, UNGA, WHO .

Over fifty women in the Democratic Republic of Congo have accused aid workers from the World Health Organization and leading international NGOs of sexual abuse and exploitation, concluded a year-long investigation led by the New Humanitarian and the Thomson Reuter Foundation on Tuesday.

The report highlights how “common” sexual exploitation and abuse are in humanitarian settings like the DRC, where Ebola has killed over 11,000 people in its 10th and deadliest outbreak.

The investigation found “at least” 30 separate incidents of sexual abuse or exploitation from men that claimed they worked for the WHO, as well as UNICEF, Oxfam, Médecins Sans Frontières, World Vision, ALIMA, and the International Organization for Migration. The perpetrators were from Belgium, Burkina Faso, Canada, Côte d’Ivoire, France, and Guinea, among other countries, said the women.

Okapi Palace in Beni in the DRC was “favorite spot” for sexual misconduct

The report was based on more than fifty interviews with women in Beni, one of the epicentres of the DRC’s Ebola outbreak. The findings were corroborated by over a dozen aid agency drivers and NGO workers.

Many women were approached near supermarkets or job recruitment centres, and taken to hotels using official drivers hired by the aid agencies, said four chauffeurs, who wished to stay anonymous. Among the “favorite spots” for abuse included the Okapi Palace hotel and Hotel Beni, where aid groups frequently booked rooms and had offices.

One of the women interviewed said the man that abused her drove in a car bearing a World Health Organization logo, noted the report.

Sexual Exploitation “As Regular” As Buying Food In A Supermarket

Sexual exploitation in the region is a “consistent finding”, Nidhi Kapur, a consultant for aid group CARE International, said to The New Humanitarian.

“It [sexual exploitation] was so common,” added one driver. “It wasn’t just me; I’d say that the majority of us chauffeurs drove men or their victims to and from hotels for sexual arrangements like this. It was so regular, it was like buying food at the supermarket.”

But in the past two years, “most” of the three dozen international organisations and local NGOs in the area have received “no complaints” of sexual abuse or exploitation. They also emphasized that policies are in place to prevent and report sexual misconduct, through staff training, complaint boxes or reporting hotlines. 

However, most women interviewed said they did not know how to report sexual abuse or exploitation. Others never spoke up for fear of losing their jobs, acknowledging that sexual favors have become a “passport to employment”, especially given the lack of job opportunities for women in the region.

“In this response, they hired you with their eyeballs,” said one of the women that was interviewed. “They’d look you up and down before they’d make an offer [for a job].”

WHO, World Vision and Alima have pledged to investigate the allegations. WHO encouraged the survivors to reach out to the Organization. 

Dr Tedros Adhanon Ghebreyesus, the Organization’s Director-General, has begun a “thorough review” of the investigation’s allegations and into sexual abuse and exploitation more broadly in emergency response settings.

“The actions allegedly perpetrated by individuals identifying themselves as working for WHO are unacceptable and will be robustly investigated”, the WHO said on Tuesday in a press release. “Anyone identified as being involved will be held to account and face serious consequences, including immediate dismissal.”

–  See WHO’s press release on Tuesday.

Tobacco products kill half of its users and claim 2 million lives a year through heart disease.

As fresh data reveals that tobacco products kill over 2 million people a year through coronary heart disease, tobacco control advocates are more determined than ever to protect the world against a product that kills half its users, not only from heart attacks but stroke, lung cancer and other diseases as well.

Comprehensive, but simple tobacco control policies, such as tobacco taxation, combined with blanket bans on smoking in indoor public places, could prevent up to 25% of strokes and heart attacks in some cases, reported a meta-analysis by the World Health Organization, World Heart Federation and Australia’s University of Newcastle just a week ahead of World Heart Day, observed this Tuesday. 

And now more than ever, quitting tobacco use in the midst of the pandemic can help protect the population against severe coronavirus disease, said WHO’s Medical Officer for the Tobacco Free Initiative Kerstin Schotte, in an interview with Health Policy Watch. It could also free up space in hospitals, especially as the flu season begins. 

Heart disease is, in fact, the leading cause of death worldwide, and in some cases, the main reason for admissions to hospitals and nursing homes – and in the past two decades, CHD deaths from tobacco have increased by 10,000 every year, warned the WHO last week.

Second-hand smoke is three times as toxic as mainstream smoke

Policies that create smoke-free public spaces also curb hospital admissions for non-smokers, as they limit exposure to second-hand smoke – which is three times as toxic as the smoke that smokers inhale themselves, and has double the nicotine content. Smoke-free public spaces also prevent young people from taking up the habit, noted Schotte.

In one meta-analysis of over 30 studies, comprehensive smoke-free legislation in all public places reduced hospitalization for acute coronary events by 14%, or almost twice as much as partial smoking bans on their own – which only reduced acute coronary events by 8%.

“Smoke-free public spaces make sense not only to protect people from the dangers of secondhand smoke,” said Schotte. “They can also prevent young people from starting to smoke, because if kids go out at night to bars and nightclubs, and they can’t smoke, they’re really less likely to start.”

Most of the world still lacks comprehensive tobacco control policies.

Most Countries Have ‘Long Way To Go’ On Tobacco Control

Despite a wealth of encouraging evidence about the health benefits of tobacco control policies, most of the world’s countries have a long way to go to adopt the “full package” of tobacco control policies, warned Schotte. 

Currently, four fifths of the world’s population live in countries where smoking is still permitted in some indoor public spaces – and three quarters of the world’s population live in countries where tobacco taxation is lower than the WHO’s recommended levels, according to the Organization’s latest report on the global tobacco epidemic.

Eduardo Bianco, Chair of the World Heart Federation Tobacco Expert Group

Eduardo Bianco, Chair of the World Heart Federation Tobacco Expert Group, also noted that stand-alone tobacco control policies are insufficient. A comprehensive approach is needed, including mass media campaigns, tobacco cessation programmes, as well as taxes on tobacco and smoke-free zones, among other measures, he said in an interview with Health Policy Watch. 

“You cannot fight this huge and complicated problem with a single tobacco control measure,” warns Bianco. “You need the total combo to have a strong impact as they are not enough on their own.”

But comprehensive policy approaches on tobacco require high-level political commitment, which is often challenging to generate, he added.

Ministries Of Finance Need To Get On Board With Tobacco Control  

Adoption of comprehensive tobacco control policies often meets with resistance from the Ministries of Finance, which may be beholden to big tobacco interests. And it is Ministries of Finance, not Health, which usually approve tobacco taxation policy – as well as approving finance for anti-tobacco initiatives in the Ministry of Health or Ministry of Education.  

“It is often difficult to implement all tobacco control policies in one go because ministries don’t always work well with each other,” said Bianco. “Ministries of health cannot tackle the tobacco epidemic on its own, as they must convince ministries of finance for tobacco taxation, or other ministries to approve mass media campaigns.”

Kerstin Schotte, WHO Medical Officer for the Tobacco Free Initiative

And there is still “incredible interference” by the tobacco industry, with many tobacco giants like Japan Tobacco International (JTI) headquartered just a few kilometers from the WHO in Geneva, said Schotte.

“Big tobacco interferes with policymaking,” Schotte noted. “They scare governments, they overestimate the economic impact of business from tobacco, they make threats of illicit tobacco trade if taxes are increased, and continue to intimidate governments with litigation for implementing tobacco control measures.”

“From the rooftop of the WHO building, we can see the JTI building, one of our biggest enemies,” she added. “In our department [Tobacco Free Initiative], it’s a little bit different than in other departments. We don’t fight germs or viruses, but we fight a very powerful and resourceful tobacco industry.”

In fact, tobacco taxation makes economic sense because of the revenues taxes bring to governments. However, there is a lot of resistance, added Bianco, mainly due to unfounded claims by the tobacco industry that tobacco taxation could increase illicit trade. He also noted that, in the early 2000s, when Canada bowed to political pressure to reduce taxes on tobacco, it was a “terrible failure”. Not only did illicit trade remain unsolved, tobacco consumption also increased.

Countries Should Implement FCTC & MPOWER  

Countries around the world should take advantage of the historic WHO Framework Convention on Tobacco Control (WHO FCTC) to slash tobacco consumption and save lives, emphasized Schotte. The FCTC has been ratified by over 180 Member States since it was adopted almost two decades ago, and is hailed as one of the biggest successes of the WHO ever.

WHO’s MPOWER tool lays out six key tobacco control measures to implement the WHO FCTC as fast as possible.

However, the FCTC is complex, and sometimes difficult to translate into policy action, especially for low- and middle-income countries with limited legal and regulatory capacity, said experts familiar with the FCTC.

They recommended the MPOWER policy package is a “good place to start” to implement the WHO’s FCTC on the ground, referring to six highly effective measures to reduce tobacco use as fast as possible. 

On the bright side, over five billion people are covered by at least one MPOWER measure, according to last year’s report  – more than four times as many compared to 2007. And in 2019, two-thirds of countries had robust monitoring systems to track tobacco usage and the impact of tobacco control interventions, compared to only one third of countries in 2017. 

Many Healthcare Professionals Still Ignorant or Indifferent to Deadly Link Between Tobacco & CHD

Another barrier is the attitude of healthcare professionals themselves, including cardiologists that remain unaware or indifferent to tobacco as a driver in heart disease – and cardiology associations have largely avoided the tobacco issue.

“Except for the World Health Federation and the Interamerican Heart Foundation, most cardiologists have not stepped up to encourage their patients to stop using tobacco products,” he noted. “This is malpractice, and equivalent to a pulmonologist failing to encourage his patients to quit smoking.”

“Cardiologists are a highly influential group, and they should lead and support tobacco control coalitions and policies,” he said.

In addition, CHD is perceived less seriously among members of the public than other diseases like cancer, added Schotte. Many people imagine that CHD is a  “painless” and “ideal way” to die – even though people with heart disease face repeated hospital stays, many years of disability and a poor quality of life.

But only one year of abstinence can halve the risk of heart disease for a smoker, although up to 15 years are required to further reduce the risk of CHD to that of a non-smoker. 

Based on such evidence, “All healthcare professionals should encourage their patients to quit smoking tobacco and avoid exposure to second-hand smoke,” she said. “Because there’s the amazing fact that if you quit smoking, one year later, your risk of heart disease is only half that of a smoker. So that is really something encouraging for people.”

Generating Political Commitment – The Story of Uruguay 

A whole-of-society approach is the “only way” to generate the necessary level of political commitment to tackle the tobacco epidemic, especially against the backdrop of tobacco industry interference, noted Bianco.

Tobacco control advocates can generate political commitment by setting up formal structures that support their efforts, he explained. 

“Tobacco control advocates can set up formal structures to foster and sustain their efforts, such as advisory committees within ministries of health, special funds to help pay off costly litigations, or research centers to demonstrate the beneficial impact of policies,” said Bianco. “In the past two decades, all of those have helped Uruguay fight tobacco, even to this day.”

In the early 2000’s, Uruguay’s highly respected National Medical Association created the National Tobacco Control Alliance, with representatives from various medical groups, civil society, smoking rights associations, as well as officials at Uruguay’s Ministry of Health.

A few years later, the National Tobacco Control Alliance put in place a special advisory commission on tobacco control within the ministry of health, with representatives from academia and civil society.

Tabaré Ramón Vázquez, former President of Uruguay, slowly gained the trust of tobacco control advocates.

The Alliance contacted the leading presidential candidate at the time, Tabaré Ramón Vázquez, who is an oncologist by training, to gain his support on the WHO FCTC that was being debated at the time. When Vázquez entered office in 2004, the advisory commission presented him with concrete policy advice on tobacco control. 

A few years later in 2007, the national Epidemic Research Center was set up to generate evidence that Uruguay’s tobacco control policies were cost-effective and that they could save lives.

As the years passed, Vázquez developed trust with the advisory commission’s policy advice, which helped tighten tobacco control in Uruguay, added Bianco. 

But in 2010, Philip Morris International (PMI) interfered through an international lawsuit, claiming the country’s tobacco policies violated the Bilateral Investment Treaty (BIT) between Uruguay and Switzerland.

Although Uruguay eventually won, without the support of Bloomberg Philanthropies with an initial $ 500,000 USD to kickstart the law case, Uruguay would have been unable to defend itself against PMI in court. The litigation cost $ 7 million in total, which PMI eventually paid back to Uruguay.

“These lawsuits cost millions and sometimes tens of millions of dollars, and we need to make sure that middle- and low-income countries can financially stand up against them through special funds, like the current Anti-Tobacco Trade Litigation Fund led by Bloomberg and Mill and Melinda Gates Foundation,” said Bianco. 

30-day tobacco consumption in Uruguay in teenagers aged 13-17

Presidents As Scientists – Helpful But Insufficient 

Although Uruguay’s former president Vázquez was “definitely” more receptive to tobacco control policies because of his training as an oncologist, having scientists at the helm of countries is insufficient to bring about health-related political change, emphasized Bianco. 

He referred to Chile’s tobacco control policy, which stagnated under the leadership of Michelle Bachelet in 2006-2010 and 2014-2018, even though she is a medical doctor by training. 

“Chile lacked the formal structures that Uruguay had to help generate evidence, trust, and high-level political commitment on tobacco control.”

“Having a scientist as president does not guarantee political will. What’s needed is a supportive environment and sustained action by civil society, academics, national medical associations, with the support of the international community and international treaties like the WHO’s FCTC.

Image Credits: WHO , Dennis Skley, WHO, Eduardo Bianco, Kerstin Schotte, Bloomberg Philanthropies, World Heart Federation / WHO, Presidencia de la República Mexicana, The World Bank.

Closing plenary at the European Health Forum Gastein,  2019. This year’s forum will meet in virtual format.

Billions of dollars in vaccine investments are needed to beat back Covid-19. But on the bright side, Europe is playing a more active global health leadership role. Geneva’s ‘dean’ of global health speaks to Geneva Solutions ahead of Wednesday’s opening of the European Health Forum (Gastein), which brings together key policymakers and experts from across the region.  

Health Policy Watch: The World Health Organization (WHO) says the world needs $35bn to fund the manufacture and equitable, worldwide distribution of two billion Covid-19 vaccines, as well as tests and treatments. But so far, only $3bn has been raised. Can we raise that kind of funding – and how?

Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Programme in Geneva

llona Kickbusch: Stepping back, I think it shows us that the whole system of funding for these initiatives is totally insufficient. We are moving in global health from a situation where we were looking for millions to looking for billions and in some cases even trillions. And that means we need other sources. That is why there has been so much talk about linking up with various development banks and finding other types of funding from governments.

Very clearly, $35bn is actually peanuts, if you look at the trillions being discussed by the finance ministers of the G20. Many of the rich countries, if they got their act together, plus some of the middle-income countries could actually contribute, together with the development banks, and maybe even some of the philanthropists. If you look at the amount of money Mark Zuckerberg made during the Covid-19 pandemic, some of these sums pale in comparison. It shows that our whole system of financing is wrong- and bankrupt.

HPW: Ursula von der Leyen, European Commission President, also proposed that there should be a  European version of BARDA, the US agency in the Department of Health and Human Services, that has invested billions in vaccine research and development. Do you agree?

IK: Absolutely. That would be another mechanism.  It is clear the European Union has defined itself as a geopolitical actor in the global health conversation. And that has two dimensions – stronger cooperation between the European countries so they act as one, and then acting jointly in terms of global responsibility. That is reflected in the EU joining Covax [the WHO-led Covid-19 vaccine pool], supporting the World Health Organization, and making European institutions more fit for purpose for a global role.  And the EU moves have also been made towards other regions, like the African Union, which I think is important.

HPW: Why?

IK: Because you could say the global north is telling everyone else what to do. And this is not what the European Union wants to do. It wants to move away from an old-fashioned “leadership” model in global health to a “partnership-and-responsibility” model.

HPW: So can these regional initiatives help fill the gap that’s been left by the US withdrawal from the global health arena?

IK: The old model of multilateralism is one that always had this notion of countries like the United States or the United Kingdom showing leadership. The new notion of multilateralism is particularly important for smaller countries. That is why Germany and France created this alliance for multilateralism. And there are regional organisations, the African Union being a really important one. But there are also Asian groupings, all kinds of different constellations. And we are finding that regional organisations are going to be even more important in global health. And that also means stronger WHO regional offices.

HPW: So you see some hopeful signs in terms of regional actors stepping in to fill the gap – or reshape the paradigm?

IK: It has to change. The US has to change in its approach and the rest of WHO member states need to change. This is an organization of 194 countries, and that cannot be driven by three or four major donor countries. So I don’t want to even talk about a gap, I want to say we need a different kind of partnership based on common goods, based on multilateralism and not one or two countries thinking they should call the shots and tell everyone else what to do.

HPW: And WHO?  We’ve seen countries reaffirming WHO’s leadership role in the recent UN General Assembly resolution on the pandemic. But we also know that WHO is a big bureaucracy with lots of warts.  So what can WHO do to reform from the inside?

IK: I am a political scientist and I just do not understand why being a bureaucracy, per se, is considered a negative element. Bureaucracy is a form of organization, and if you have 196 member states…you need rules. And those rules are described as a bureaucracy. Obviously, I think digitalization will contribute to greater democratisation of WHO.  Tedros has also been working on a transformation. He has tried to streamline processes and be much more in direct touch with his staff, to have better cooperation between regions and headquarters, and have better staff in the country offices.  So I think there is a lot happening.

HPW: But if you are supposed to make use of digitalization, do you have the resources? And can you ensure continuity of work if you do not have the resources to hire staff for years, but only for months. So, as per the German and French initiative, you have to increase the assessed contributions of the WHO.  You have to address the budget to make it a well-functioning organisation.

Ilona Kickbusch (bottom right) in a webinar 11 September with other health policy experts from industry and the public sector, leading up to the 30 September event.

HPW: You have put up a strong defence of WHO, but at key moments in the pandemic, it moved very slowly. Why was WHO often behind rather than out front?

IK: What we need now is to strengthen the science part of the emergency response. There needs to be a good interface between the Health Emergencies programme and all of the science. Remember, many years ago, WHO had all kinds of research committees and they were closed down. Expanding that work, working together with key science organizations around the world is one of the things that needs to be a lesson from this pandemic. But it needs resources. I hope the WHO independent review panel would provide recommendations, just like we did after the Ebola.

HPW: Returning to the European Health Forum, Gastein, where you will be a keynote speaker next week, what role can this forum play now in regional health diplomacy?

IK: I think Gastein has an enormous opportunity this year to shape the agenda for the European Union. And through that for global health. The fact that the President of the European Commission has said very clearly we need a European health union – this is an issue that has been raised in Gastein very frequently. There are always high-level policymakers meeting linked to Gastein, and we have had discussions about how we would like to focus that meeting on what, beyond the slogan, is a European Health Union, and what is it in very concrete terms?

What are additional health competencies that the Commission should have? How can one strengthen the European Centre for Disease Prevention and Control? What should the European Medicines Agency look like?   What about social protection throughout the union? There are also many issues that relate to the social determinants of health – such as trade agreements that the European Union enters, European agriculture policy, and are they health proof? And now there is an opportunity for these to come together in a clear agenda. There is a closing panel which I am going to moderate, which will say ‘okay if we are to go to Ursula von der Leyen and the European Parliament and the Council, what should a European health union look like?’ So I think that is an extraordinary opportunity which must be used.

HPW: You have talked about a new sense of European solidarity but you also see the UK leaving the EU, and eastern European countries not as enthusiastic about multilateralism as France or Germany?

IK: Well, call it health diplomacy but if you have 26-27 countries, you have to reach agreements along the way.  And I think it’s been quite intriguing how with very hard negotiations, around the budget and everything else, in the end, there is a consensus. That is what the European Union is about. I would also urge us not to think you know there is one eastern Bloc and they are not interested. It is diverse and complex. And then there are the questions about positions the UK is going to take on global health and what alliances it will enter, as well as other non-EU countries like Switzerland and Norway.  Even here [in Switzerland], there are many common global health agendas and, sometimes agendas that you know the global south would be critical of, like around [access to] medicines.

HPW; As for Switzerland, where you have lived and worked for many years, what would be your single piece of advice to the Swiss Government about how it could position itself?

IK; Switzerland is the host country of a whole range of international health organisations. I would like to see Switzerland very active in ensuring the financial base of all these organisations, particularly the World Health Organization.

‘Leadership’ from a host country that is both a middle-sized power and a country committed to multilateralism should be important for Switzerland. It’s also important in terms of all the related economic issues and being the centre for multilateralism in Geneva. And we know that quite regularly there are issues around whether all of these organisations should really stay in Geneva. There are all kinds of support; I’m not trying to minimize that. But I think coming out very strongly politically for multilateralism is something that can be strengthened. I think that this is at the forefront for me. Because as a host country, while these are not necessarily your adopted children, you also have a kind of caretaker function for the organizations.

HPW: You have served in many high-level roles, but are still perhaps best known as the founder of the Geneva Graduate Institute’s Global Health Centre. What was your single biggest accomplishment there, and what is your biggest priority now that you have left the director’s post?

IK:  We created a centre that brings political science and international relations dimension to the global health governance debate. We gave that the term ‘global health diplomacy’. After ten years, I am delighted that I have been able to hand it over to such committed new co-chairs who are strengthening that political dimension, as well as focusing also on new issues, like access to medicines.

Now I’m involved in trying to shape the global health agenda in the European Union. I also work with the German presidency. I am involved with the World Health Summit in Berlin; that has become you know a major forum for debate. I have been part of the Swiss national health report. What I always try and do is to work at three levels, national, regional, and global and then see how those levels interface.

HPW: The UN Global Preparedness Monitoring Board, of which you are also a member, projected last year that the world could soon face a pandemic? What can you say now?

IK: Tedros has repeatedly said “health is a political choice,” we’ve seen very clearly in this year’s GPMB report, that political choices were either made too late, or the wrong political choices were made. There is a sort of negative extreme politicization – what is happening right now between the US and China. But one mustn’t fool oneself that global health is not political. Global health and global health diplomacy are always political. I hope that the [WHO] independent review panel with Helen Clark and Ellen Johnson Sirleaf will be able to take up the political decisions that were not taken, or were wrong, as well as show us those decisions that helped us move ahead –and keep the people secure.

Professor Ilona Kickbusch is the Founding Director of the Global Health Programme at the Graduate Institute of International and Development Studies in Geneva. She is a member of the Global Preparedness Monitoring Board and the WHO High-Level Independent Commission on NCDs and co-chair of Universal Health Coverage 2030. She has been involved in German G7 and G20 health-related activities, and the development of the German global health strategy.

This article was first published by Geneva Solutions, a new Geneva-based platform for news about health, climate, peace & humanitarian affairs, technology and sustainable business& finance, with which Health Policy Watch is partnering.

Image Credits: European Health Forum Gastein.

Speakers at the WHO Press Briefing 27 September

Some 120 million COVID-19 rapid diagnostic tests will be made available to low and middle-income countries through the World Health Organization-hosted ACT Accelerator, an initiative to scale up COVID-19 drugs, diagnostics, and vaccines.

The WHO Director-General Dr Tedros Adhanom Ghebreyesus made the announcement just before the world crossed the 1 million mark for deaths from the novel coronavirus, saying in a statement Tuesday, “It is never too late to turn things around.”.

The rollout of the rapid tests follows on WHO’s first listing of a rapid COVID-19 diagnostic antigen test last week for emergency use by global health procurement agencies. The test can offer reliable results in approximately 15 to 17 minutes, as compared to the hours or days required to process a traditional PCR test for COVID-19.

And the tool will help rapidly scale up testing in low-resource or rural settings, which often do not have access to labs that are required to process traditional COVID-19 tests. The new rapid test is produced by the Republic of Korean company SD Biosensor, and allows the diagnosis of COVID-19 on the spot, without the need to wait for a laboratory analysis.  A second test, by the United States-based firm, Abbott Laboratories, is due to be added to the list, said a WHO press release that accompanied the announcement.

“This will enable the expansion of testing, particularly in hard to reach areas that do not have lab facilities or enough trained health workers to carry out [traditional COVID-19] PCR tests. This is a vital addition to their testing capacity and especially important in areas of high transmission,”  Dr Tedros said at a WHO press briefing Monday.

High-income countries are conducting 292 tests per day per 100,000 people, according to Peter Sands, CEO of the Global Fund, a partner of the ACT Accelerator’s diagnostics pillar. However, testing is lagging in middle- and low-income countries, which are testing at less than half the rate, if that.  In low-income countries, the average testing rate is merely 14 tests per day per 100,000 people.

“Testing is a critical cornerstone of the COVID-19 response, enabling countries to trace and contain the virus now, and to prepare for the roll-out of vaccines once available,” said the WHO press release. “Effective testing strategies rely on a portfolio of test types that can be used in different settings and situations. While molecular tests started to be rolled out within a month of the virus being sequenced, these tests are mainly laboratory based, relying on infrastructure and trained personnel to conduct them. Rapid tests to detect the presence of the virus at the point of care, which are faster and cheaper, are a vital addition to the testing arsenal needed to contain and fight COVID-19.”

World crosses 1 million mark for COVID-19 deaths

The ACT Accelerator has agreed to purchase 220 million tests from manufacturers whose tests have been listed by WHO as reliable, for distribution in low and middle income countries. The Bill and Melinda Gates Foundation has agreed to help finance the procurement of 120 million tests, but more money is required to fund the procurement of the remaining 100 million. The tests are currently priced at US $5, which is already significantly lower than the price of a traditional PCR test.  The Global Fund to Fight Tuberculosis, HIV/AIDS and Malaria announced it would be contributing US$ 50 million to kickstart test procurement already this week.

However, US $1.7 billion in funding is still required to before the end of the year to ensure that all tests can be distributed to countries in need, according to Catharina Boehme, CEO of the Geneva-based Foundation for Innovative New Diagnostics (FIND), a non-profit agency that is a co-convener of the ACT Accelerator’s diagnostics pillar. Some US $650 million of the required funds will be used help finance the roll-out and distribution of tests in countries.

The first tests will be ordered as early as this week, and will be rolled out in up to 20 African countries by the Africa Centres for Disease Control (CDC) and its partners in October, WHO said.

World Crosses Somber Milestone of 1 million COVID-19 Deaths 

Commenting Tuesday on the milestone 1 million deaths from the SARS-CoV-2 virus that have now occurred, the WHO Director General cast a hopeful gaze across  those countries that have outperformed in terms of containment, setting examples for others.

Countries that applied an “all-of-government and all-of-society approach”  have succeeded to contain virus outbreaks before they got out of hand, he added, citing Thailand, Uruguay, Pakistan, New Zealand and others as among the success stories – along with countries such as Italy that were hit hard in the first wave, but eventually fought the virus back.

“Learning from the Wuhan experience, Italy put strong measures in place and was able to reduce transmission and save many thousands of lives,” he said. “National unity and solidarity, combined with the dedication and sacrifice of health workers, and the engagement of the Italian people helped bring the outbreak under control.

“Uruguay has reported the lowest number of cases and deaths in Latin America, both in total and on a per capita basis. This is not an accident. Uruguay has one of the most robust and resilient health systems in Latin America, with sustainable investment based on political consensus on the importance of investing in public health.

“Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children against polio have been redeployed and utilized for surveillance, contact tracing and care. This has both suppressed the virus and, as the country stabilizes, the economy is also now picking up once again. Reinforcing the lesson that the choice is not between controlling the virus or saving the economy; the two go hand-in-hand.

“Informed by the best available scientific advice, and a trained and committed community health workforce, Thai authorities acted decisively to suppress the virus, to build trust and to increase public confidence.

“There are many other examples including Cambodia, Mongolia, Japan, New Zealand, the Republic of Korea, Rwanda, Senegal, Spain, Vietnam and more. Many of these countries learnt lessons from previous disease outbreaks of SARS, MERS, measles, polio, Ebola and flu to hone their health system and respond to this new pathogen,” he said. “No matter where there is an outbreak it is never too late to turn things around.”

He underlined that the four essential steps to containing the virus, include:

  • Preventing amplifying events;
  • Reducing deaths by protecting vulnerable groups, such as older people, those with underlying conditions and health workers;
  • Public compliance with mask etiquette, hand hygiene and social distancing, while avoidance of the “three Cs” – closed spaces, crowded places and close-contact settings.
  • Government actions to find, isolate, test and care for cases, as well as tracing and quarantining contacts.
Scientifc Collaboration ‘Unprecedented’; But Money Needed Along with ‘Words Of Solidarity’, Says Wellcome Trust

Dr Tedros also lauded the unprecedented scientific “Just nine months on from the virus first being identified, some of the best scientists in the world have collectively developed tests to diagnose cases, identified treatments like corticosteroids to reduce mortality in the most severe cases of COVID-19, and produced vaccine candidates that are now in final phase three trials,” Dr Tedros said.

At the same time, Wellcome Trust Director Jeremy Farrar cast a more sober note, saying that the world remains far short of the US$ 35 billion needed to finance desperately needed tests, treatments and vaccines.

“Today, the world has passed a devastating milestone: 1 million recorded deaths from covid-19. In reality, the unrecorded total is much higher,” said Farrar in a statement.  “We must not forget that this pandemic is still accelerating and shows no signs of slowing down.

“The ACT-Accelerator urgently needs $35 billion to develop and provide tests, treatments and vaccines for the world and to have the health systems to deliver them. In the last week, the UK & Canadian Governments have stepped up and committed significant amounts. We urge global leaders to delay no longer and join them. Every day matters.

“This needs more than warm words of solidarity. This needs a moment of visionary, historic, political and financial leadership. Only when we have tools to detect, treat and prevent it everywhere, will we be able to stop this pandemic and therefore save lives, give children the education they deserve and restart all our economies.”

–Updated 29.09.2020