Schools could spawn COVID-19 outbreaks as children can also transmit the coronavirus.

In past decades, Europe has achieved one of the world’s highest water and sanitation coverages, but it is often forgotten that one in ten schools in the 53 countries of WHO’s European region still lack basic hand washing facilities, leaving some 5 million pupils without access to soap and clean water.

All in all, some 31 million Europeans lack access to basic sanitation, even in the form of a latrine, and 16 million lack access to basic drinking-water services that also enable hygiene – mostly in Eastern Europe, Central Asia and the Caucasus.

As students begin filling up schools in attempts to return to the ‘new normal’, these worrying gaps in Europe have potential to spur more Covid-19 outbreaks and to fuel existing inequalities, warned Marta Vargha from Hungary’s National Institute for Environmental Health, at a recent webinar hosted by Geneva Environment Dialogues.

Last Friday, Vargha’s warnings became even more relevant as a South Korean study of 65,000 people showed children between the ages of 10 and 19 can also spread the coronavirus, strengthening the case for improved water and sanitation coverage in all settings – including schools.

“[The] South Korea study means we can’t assume older kids won’t transmit”, said Director of Harvard’s Global Health Institute Ashish Jha, referring to the study by the South Korea’s Centers for Disease Control and Prevention. “Opening schools will need us to focus on suppressing virus transmission”.

As a result of inadequate water, sanitation, hygiene and health (WASH) services, 14 people die every day from diarrhoeal diseases in the WHO European Region.

And within European countries, services are unevenly distributed. In some cases, there is a four-fold difference between urban and rural settings in access to drinking-water and sanitation services, said a WHO spokesperson to Health Policy Watch.

But the burden of water-related disease is most significant outside of Europe, as about 90% of diarrhoeal deaths occur in south Asia and sub-Saharan Africa, acccording to the Global Burden of Disease 2016 Study.

Access to Safe Water – First Line of Defense Against COVID-19

Access to safe water is the first line of defense against the new coronavirus, and is the “primary tool” to prevent infection from any disease-causing organism, emphasized Vargha at a webinar hosted by Geneva Environment Dialogues last month:

“Under the current pandemic, to be really efficient in prevention, safe [water] should be accessible not only at home, but also wherever we go, including schools, healthcare facilities, in workplaces and public settings” like public transport facilities.

A Thirst For Data

The European region lacks basic data on water and hygiene services.

Europe’s nations cannot expand access to safe water to protect against the new coronavirus without reliable data.

Currently, basic data on water, sanitation, hygiene and health (WASH) services remains “limited” in some European countries, especially in healthcare settings and households, said Vargha.

Large regional disparities are also hidden behind national averages in “almost every country”, owing to the fact that basic WASH indicators have not been embedded into national monitoring.

The Protocol on Water and Health – A Unique International Legal Agreement In Europe 

While the problem of water, sanitation and hygiene in schools and other public buildings remains serious, Europe is still better placed than most regions of the world to address it, as 27 countries in the region are signatories to the 2005 Protocol on Water and Health.

Co-administered by the United Nations Economic Commission for Europe (UNECE) and the WHO Regional Office for Europe, the Protocol is the “only” international legal agreement of its kind that links oft-siloed sectors together – sustainable water management and prevention to control and reduction of water-related diseases, said Natalyia Nikiforova, Environmental Affairs Officer for the United Nations Economic Commission for Europe (UNECE), who also spoke at last month’s panel.

The Protocol helps countries set national targets on water sanitation, hygiene and health (WASH) based on their needs – and ensures “long-standing commitments” because they must report progress at national and international levels every three years.

In contrast to other legally binding agreements – like the WHO’s International Health Regulations (IHRs) or its Framework Convention on Tobacco Control (FCTC) –  the protocol’s compliance committee is a ‘very interesting’ alternative because it does not force Parties to comply, said Co-Secretary for the Protocol on Water and Health Oliver Schmoll. Instead, it achieves effective implementation through a “non-confrontational” and “facilitative” framework:

“The consultation mechanism is not a very hard instrument”, explained Nikiforova. “But it’s a very smart instrument to work with countries in order to facilitate implementation in a non-confrontational way through a consultative process, and thereby ensuring implementation.“

In total, twelve countries have already undertaken a self-assessment to address disparities in their populations, especially in rural settings, said Vargha.

In the Republic of Moldova, the self-assessment brought safe drinking water to some 67,000 villagers in rural areas through new infrastructure initiatives. Meanwhile, other countries like France, Portugal, Hungary, Ukraine and Armenia, have amended national legislation to fill gaps in WASH services, each in different ways.

Hungary has improved minimum standards for water safety, while Portugal and France have cheapened the cost of drinking water. And Armenia has incorporated a definition of marginalized groups in their Water Code, ensuring that legislation caters to the most vulnerable. 

Expanding The Protocol To Other Regions 

At the moment, protocol membership is exclusive to the 53 Member States in the pan-European region. However, it is Africa, Asia and slabs of Central and Latin America where WASH services are most needed.

Sanitation facilities are mostly needed outside Europe.

Around the world, some 2 billion people lack access to basic sanitation facilities, and one billion people in 149 countries suffer from neglected tropical diseases, which thrive in areas that lack basic sanitation. Most of these are outside Europe.

In light of unmet needs around the world, it “would make sense” for the Protocol to “open up” to other regions, said Nikiforova, although there is currently no road map for doing so.

Before the Protocol can expand, 26 additional European member states would need to ratify the Protocol first, and “considerable political will” is going to be necessary, added Nikiforova, as she referred to the fact that only 27 out of the 53 Member States in the Region have ratified the Protocol.

27 out of 53 Member States have officially ratified the Protocol on Water and Health

Image Credits: Source: Allison Shelley/The Verbatim Agency for American Education, Martha Vargha, Deep Knowledge Group.

Credit: Jernej Furman

In the largest and perhaps most robust peer-reviewed study to date, A COVID-19 vaccine candidate developed by pharma giant AstraZeneca and Oxford University has been shown to induce strong antibody and T cell responses in healthy volunteers, according to Phase 1/2 trial results published in The Lancet on Monday.

Most studies so far have focused on measuring the level of neutralizing antibodies, or antibodies that can bind to the virus in the blood to prevent it from attacking human cells. However, the Oxford/AstraZeneca vaccine was also able to to induce another type of immune response in a subset of 43 healthy volunteers within 14 days of vaccine – a T-cell response, which is another specialized immune response that can attack cells infected with the virus.

“The immune system has two ways of finding and attacking pathogens – antibody and T cell responses. This vaccine is intended to induce both, so it can attack the virus when it’s circulating in the body, as well as attacking infected cells,” said study lead author and Oxford professor Andrew Pollard in a press release. “We hope this means the immune system will remember the virus, so that our vaccine will protect people for an extended period.”

However, “there is still much work to be done before we can confirm if our vaccine will help manage the COVID-19 pandemic, but these early results hold promise,” added co-author on the study and Oxford professor, Sarah Gilbert.

WHO Health Emergencies Executive Director Mike Ryan shared the same sentiment.

“This is a positive result but again there’s a long way to go. These are Phase I studies; we now need to move into larger scale real world trials, but it is good to see more data,” Ryan told reporters on Monday.

The Oxford/AstraZeneca group tested their vaccine in 1,077 healthy volunteers, making the trial many times larger that of Moderna, which tested their vaccine candidates in only 45 healthy volunteers in Phase I trials. Moderna’s vaccine candidate, developed in collaboration with the US National Institute of Allergies and Infectious Diseases, was the first to have Phase I results released in a peer reviewed journal.

A third COVID-19 vaccine candidate, developed by Chinese biopharma company CanSino Biologics Inc. and the Chinese Academy of Military Sciences, was also able to induce an immune response in a Phase 2 trial that enrolled over 500 healthy volunteers, according to results published in The Lancet on Monday.

However, researchers have previously expressed concerns about the Ad5 vector, the technology used to carry the vaccine, in the CanSino candidate. HIV vaccine candidates using the Ad5 vector had inadvertently increased the risk of HIV infection in previous trials, and it is unknown whether the CanSino COVID-19 vaccine may have similar effects.

While early Phase clinical trail results have shown to be able to induce an immune response in healthy volunteers, it’s still too early to tell whether that immune response will protect against coronavirus infection or disease.

All three vaccine candidates are preparing to enter the final and largest phase of the vaccine testing process, Phase III clinical trials. These massive trials will enroll tens of thousands of volunteers in all age groups in order to test whether the vaccines can protect against infection by the virus and symptomatic COVID-19 disease.

AstraZeneca/Oxford Vaccine Candidate Set to Move Into Multi-Country Phase III Trials

Colorized electron microscope image of SARS-CoV-2, the virus that causes COVID-19

While the Phase 1/2 trial is ongoing, the AstraZeneca/Oxford vaccine, ChAdOx1, will move into further Phase 2 and Phase 3 trials. AstraZeneca has already ordered 100 million doses to be produced by the Serum Institute of India, a major developing world biopharma company and generics producer, for Phase 3 trials.

Volunteers are currently being enrolled in the UK, Brazil, and South Africa, making this the first vaccine candidate to be tested on the African continent.

The authors further noted that the Phase III trial will focus on observing the vaccine in a wider demographic, including those at higher risk of COVID-19 infection or death such as older people, ethnic minorities or marginalized people, people with preexisting health conditions, and healthcare workers. Participants in the earlier Phase 1/2 trial were mostly likely to be young and Caucasian – some 91% of study subjects were white and the average age of participants was 35 years.

None of the participants reported serious adverse reactions to the vaccine. Around 70% of the participants who received ChAdOx1 reported mild adverse side effects such as fatigue and headache, compared to 48% in those who received the placebo meningitis vaccine.

Participants who took paracetamol, a pain common pain medication, at the time of injection had a reduced likelihood of experiencing adverse side effects. Paracetamol had no effect on the immune response generated by the vaccine.

WHO Experts Urge Countries To Step Up Contact Tracing Rather Than Waiting For Vaccine

WHO Assistant Director-General of Emergency Response, Ibrahima Socé Fall

Still, WHO experts on Monday warned against waiting for an effective vaccine to stem the tide of the pandemic, urging countries to step up contact tracing efforts.

“We do not have to wait for a vaccine. We have to save lives now,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Contact tracing has long been the bedrock of outbreak response from smallpox to polio to Ebola, and now COVID-19.”

“If we look at viruses that are much more fatal than COVID-19, we were able manage and master these epidemics by regularly following [contacts] with high level efficiency,” said WHO Assistant Director-General of Emergency Response, Ibrahima Socé Fall. The 2014-2016 Ebola outbreak in West Africa for example, was largely managed and quashed through contact tracing, before a vaccine was available.

Investing in contact tracing now is even more important, considering “many countries were not very well prepared for contact tracing” at the beginning of the pandemic, according to Fall.

“Developed countries have surveillance systems centered on hospitals, but by the time the patients arrive it’s too late. They’ve already contaminated others in the community,” said Fall.

“Nothing replaces boots on the ground,”  said Dr Tedros. “[Countries must] train workers to go door to door to find cases and contacts, and break the chains of transmission.”

Image Credits: Flickr: Jernej Furman, National Institute of Allergy and Infectious Diseases, NIH.

WTO Headquarters in Geneva

The race for the leadership of the World Trade Organization (WTO) gained traction this week as eight competing nominees presented their pitches to fill Azevêdo’s role to the WTO General Council, and later to the press and public.

The nominees include: Ngozi Okonjo-Iweala, the chair of Gavi, the Vaccine Alliance, and former finance minister of Nigeria; Abdel-Hamid Mamdouh, former director of WTO’s trade in services and investment division; WTO’s founding deputy director-general Jesús Seade Kuri; as well as Kenyan diplomat and cabinet official, Amina C. Mohamed; the United Kingdom’s former trade secretary, Liam Fox; Moldova’s Tudor Ulianovschi; Republic of Korea’s Yoo Myung-hee; and Saudi Arabia’s Mohammad Maziad Al-Tuwaijri.

COVID-19 has triggered the largest ever slump in global trade. Source: WTO
Why The WTO’s Race to the Top is Important

As the COVID-19 pandemic prompts many countries to ban the export of medical supplies, hoard essential healthcare products and conduct backroom negotiations with vaccine developers, it’s becoming clear that WTO’s role as an arbitrator of both intellectual property as well as global trade rules will have immediate repercussions on global health as well as COVID-19 economic recovery.

The Organization also faces deeper challenges to ensure multilateralism can survive in global trade agreements, as well as to ensure trade rules don’t undermine climate and sustainability – as per swelling debates over subsidies for fisheries that are accelerating the depletion of ocean fish stocks.

“The critical importance of trade is now beyond debate, whether for growth, development, job creation, poverty reduction or World Peace,”  said Mamdouh. “And, remember, trade is no more about merchandise crossing borders. It’s also about services and intellectual property.”

Despite the looming challenges, the WTO can be reinvigorated, asserted nominees in their speeches. Here’s a thumbnail of a few comments some of the candidates made:

Global Health and Intellectual Property Rules

In mid-May, about 90 countries had introduced export prohibitions or restrictions on health products, according to the United Nations Economic Commission for Africa. Okonjo-Iweala, a Harvard trained development economist, has stood out as one of the most vocal candidates on that issue, pledging to ensure developing countries aren’t left standing in the queue for COVID-19 health technologies – whilst also respecting intellectual property rights:

“The world should be able to come to the point where mechanisms are put in place to make vaccines available. The world trading system should be a facilitator of that and not an impediment,” said Okonjo-Iweala.

Ngozi Okonjo-Iweala, Nigeria’s former finance minister

“It’s critical that everyone has access to live-saving vaccines. If I became WTO’s DG, I would have a very strong collaboration with the [WHO’s ACT] Accelerator…to make sure there are no barriers, no restrictions on the availability of these vaccines whilst respecting the intellectual property rights of those who have manufactured the vaccines,” she added.

In contrast, Mamdouh took an even sharper stance on intellectual property rights, acknowledging there are ‘still issues’ impeding wider uptake of WTO’s Doha Declaration on the TRIPS Agreement and Public Health – which affirmed that member states can temporarily circumvent patent monopolies, to produce or import generic versions of critical health technologies under ‘emergency circumstances’ like a pandemic.

“The reform agenda will no doubt identify additional items for negotiations. The backlog, including Doha issues, is still there”, said Mamdouh, who was involved in the landmark ‘Doha Round’ of 2001 that made the Declaration on public health.

“You will recall, in Nairobi [in 2015], Ministers disagreed on the Doha framework as a basis for negotiations [over intellectual property rights], but all agreed on the need to address Doha Issues. “

Abdel-Hamid Mamdouh, former director of WTO’s trade in services and investment division

In late July, WTO will hold a special session of the TRIPS council to discuss these unresolved issues, although there have been attempts to delay the meeting by the United States and Switzerland, ostensibly to postpone this very debate, some critics say.

Restore Viability of WTO’s Dispute Settlement Function

WTO’s troubled dispute settlement mechanism has also ‘failed’ to produce significant results since 1995, said Mamdouh. As just one example, WTO negotiations to end harmful fishing subsidies that support the plundering of ocean fish stocks have dragged on for five years – despite a 2015 pledge by countries to prohibit subsidies that contribute to overfishing by 2020.

“Political issues remain to be resolved,” said Keith Rockwell, a WTO official who spoke at a panel on the fishing issue last month as well as moderating this week’s candidate’s press conferences.

There’s also a ‘chronic imbalance’ between the WTO’s dispute settlement function and its negotiating function, or the ‘legislative’ and ‘judicial’ functions of the Organization. This ‘unsustainable’ imbalance needs to be urgently restored to avoid repeating mistakes from the past, said Mamdouh.

“In any legal system, there needs to be a balance between the “legislative” and the “judicial” functions. For the WTO, these are the negotiating and the dispute settlement functions,” Mamdouh said. “What we have seen over the past 25 years was that the dispute settlement function gained strength…while the other functions [like the negotiating function] have subsided completely, and particularly the negotiating function break-down is causing huge difficulties for the organization.”

Rebuild Trust in the Multilateral Trading System

In recent years, trade tensions among WTO members have flared up evermore sharply, “threatening the fundamental architecture” of a multilateral trading system (MTS) that brings shared prosperity and development for everyone. Warns Okonjo-Iweala:

“In recent years, the multilateral trading system (MTS) has been going through difficult and challenging times. But, in my view, the world now needs, more than ever, a reinvigorated WTO [and the MTS].“

“The rules-based MTS is a public good that underpins peace, security, stability and a chance for prosperity in the world. Every effort should therefore be made to safeguard, improve and renew it to enable it effectively address the challenges of the 21st century.”

The Role of Women in Trade

It is “fundamentally wrong” that trade departments around the world are still male-dominated, said British candidate Liam Fox, a medical doctor by training who later became trade and defense secretary of the UK. His plan to upend the status quo:

“I commit to you today that if you give me the honour of becoming the next DG then I will ensure that at least half of the WTO’s most senior leadership team are women.”

Liam Fox, UK’s former secretary of state for international trade

An Existential Crisis at the WTO

Even before COVID-19, the Organization faced a minefield of much-needed reforms as it struggled to respond to the realities and needs of diverse populations, companies and consumers, said candidates on Wednesday. Mamdouh:

“The international trade landscape has dramatically changed, and the WTO system has been unable to update its rule book. In order to prevent the Organization from becoming obsolete and outdated, it is important that mechanisms be adopted to modernize it.”

A Swiss Take on the Bottom Line

Although there are British, European and Korean candidates who could represent the G-7 economies, none of the big trade players seemed to have publicly picked a favorite nominee yet, including the United States, the European Union – or Switzerland.

However, one desired quality in the new WTO DG will be ‘political clout’ – the head of the Swiss Permanent Mission to the WTO Didier Chambovey, declared in an interview with Swiss Info. He was referring to rising tensions within the Organization that have slowed down the Organization’s progress.

Said Chambovey, “We need a personality with managerial skills who can carry out WTO reform, which is a tall order, and who is able to listen to Member States and build a consensus.”

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Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates.

Image Credits: WTO.

UN Under-Secretary General for Humanitarian Affairs and UN Emergency Relief Coordinator, Mark Lowcock

The United Nations has requested US $10.3 billion to help lower income countries struggling to deal with the direct effects and aftershocks of the COVID-19 pandemic, doubling its ask from May, according to a new UN Humanitarian Response Plan launched today. 

The ask comes just as Finance Ministers and heads of central banks of the G20, who represent the world’s most developed countries and largest economies, are set to meet via video conference for the third time this year on Saturday. UN Emergency Relief Coordinator Mark Lowcock directed the ask at the G20 countries, specifically referencing the upcoming Finance Ministers’ meeting. 

“I do have to say that… wealthy nations [have rightly] thrown out preset fiscal and monetary rulebooks to protect their people and their economies. Their response has been grossly inadequate when it comes to helping out the poorer countries, and that is dangerously short-sighted,” said Lowcock.

Rich countries would need to invest less than 1% of the trillions of dollars they have already put into their countries’ own coronavirus responses in order to protect poorer countries from more drastic effects of the virus, according to Lowcock.

“I want to contrast between the global response to the 2008-2009 financial crisis, where there was good coordination and real stepping up by better-off countries, through the G20, particularly in reinforcing the International Monetary Fund, the World Bank to help the poorer countries,” he added. “It’s an unfortunate contrast to what we’re seeing now.

“It is a much bigger crisis, and every country is affected by it. But unfortunately, we don’t yet have a commensurate from the wealthier countries in support of the poorer countries.

“Our advice is that needs to change if the whole world does not want to look back in 2-3 years time after multiple, cascading crises and wonder why we didn’t address them better.”

Pandemic Could Cause New Conflicts To Erupt
A child holds up bullets collected from the ground in a village near North Darfur, Sudan. Many people from the area have been displaced by surges of violence.

“An additional 13 countries are projected to experience new conflicts between 2020 and 2022 relative to pre-pandemic forecasts. If that materializes, global instability will reach a new 30-year high,” Lowcock told reporters, citing an analysis prepared by Oxford University and Lowcock’s team. “Conflict is expensive.

“The minimum cost incurred during an average civil war to both host and neighboring countries has been estimated at approximately $60 billion.”

The pandemic could induce the first rise in global poverty levels in three decades, and cause new refugee outflows.

“At least 70 to 100 million people could be pushed back into the extreme poverty category. In addition, an extra 130 million people could be pushed to the brink of starvation,” he said.

UN Plan Will Help Conflict-Affected & Poor Countries Recover From Pandemic
Volunteers at Bidyanando Foundation, a local NGO in Bangladesh, distribute cooked food.

Some 63 fragile countries facing unrest and conflict in the background of the COVID-19 pandemic will benefit from the funding, according to the costed plan. A draft of the plan was published earlier this week by The New Humanitarian. 

Approximately US $8.4 billion will be directed towards country-level responses, and US $1.8 billion will be directed towards “global requirements,”  said Lowcock. Some US $1 billion alone will be used for transporting aid workers and supplies.

An additional US $300 million will be allocated for NGOs directly, and US $500 million will be used for famine prevention.

“COVID-19 and the associated global recession are about to wreak havoc in fragile and low-income countries,” said Lowcock.

“My message today… to rich nations is that, unless we act now, we should be prepared for a series of human tragedies, more brutal and more destructive than any of the direct impacts of the virus itself in action,” he added, speaking at a press briefing Friday hosted by the World Health Organization. 

Fragile countries will need an estimated total of US $90 billion to recover from the direct and indirect effects of the COVID-19 crisis, and the UN ask for US $10.3 billion represents merely a fraction of the total amount required.  

However, even US $90 billion would be less than 1% of the stimulus packages wealthy countries have already passed to shield their own citizens from COVID-19 related shocks, Lowcock said. 

So far, the UN has raised US $1.7 billion to fund the plan, leaving a shortfall of US $8.6 billion. The humanitarian needs have increased at a faster rate than funding is rising.  

“The gap between the need and the funding is growing. And we’re seeing another compounding problem, we’re seeing more countries under economic distress and being dragged down to the level of requiring humanitarian aid,” said Lowcock.

Image Credits: UN Photo/Mark Garten, UN Photo/Albert Gonzalez Farran, UN Women.

Ebola response workers in the Western DRC

Just as the nearly 2 year long Ebola outbreak that ravaged the eastern Democratic Republic of the Congo has drawn to a close, a new cluster of cases is growing in the Mbandaka area of Equateur province, an area in the DRCs northwest region.

Some 56 cases have been reported since the first case in the province on 1 June. More than half of the cases were reported in just the past three weeks, and the outbreak has since spread to six health zones. As of July 14th, 21 people have died, according to the WHO DRC country office.

Amidst a massive redirection of global health financing towards containing the COVID-19 pandemic, funding for containing the DRC’s eleventh Ebola outbreak is running dangerously low. WHO has mobilized US $1.75 million for the response, which is estimated to last only a few more weeks.

The United States, which was one of the largest funders of the WHO’s Ebola response in the 2014-2015 West Africa epidemic and the more recent Eastern DRC epidemic, has remained quiet on the current situation.

The Trump administration had previously supported the Ebola response in the Eastern DRC as one of its major global health priorities, with Health and Human Services Secretary Alex Azar himself meeting with DRC President Felix Tshisekedi in Kinshasa in September 2019. However, since Trump announced the United States’ withdrawal from the WHO, the administration has not made any public comment regarding the most recent Ebola outbreak in the Western DRC.

The DRC is also battling it’s own COVID-19 epidemic at the same time, with more than 8000 cases so far reported.

Since the coronavirus pandemic has gripped global attention, regular information on the most recent Ebola outbreak has been difficult to find. While the WHO DRC country office Twitter page releases regular updates on case numbers, the agency has not been releasing more comprehensive regular disease outbreak notices or situation reports. The last official WHO situation report on Ebola was dated 23 June, the day the Eastern DRC outbreak was declared over.

“Responding to Ebola in the midst of the ongoing COVID-19 pandemic is complex, but we must not let COVID-19 distract us from tackling other pressing health threats,” said WHO Regional Director for Africa Matshidiso Moeti in a press release. “The current Ebola outbreak is running into headwinds because cases are scattered across remote areas in dense rain forests. This makes for a costly response as ensuring that responders and supplies reach affected populations is extremely challenging.”

Over 12000 people have been vaccinated so far in this outbreak. Community engagement has been a pillar of the response, largely thanks to lessons learned from communities’ and responders’ experience in containing a 2018 outbreak in the province that sickened 54 people. Some 90% of vaccinators are from affected locales.

Image Credits: WHO AFRO.

A notorious hacking group with ties to Russia’s intelligence network has been targeting COVID-19 vaccine developers, according to the United States, United Kingdom, and Canadian government.

APT29, also known as ‘The Dukes’ or ‘Cozy Bear,’ has been organizing cyber attacks in an effort to steal confidential information regarding COVID-19 vaccine development and research, according to an advisory released by the UK’s National Cyber Security Centre (NCSC), Canada’s Communications Security Establishment (CSE), and the US National Security Agency.

The advisory warns that the group has been deploying spearphishing, a tactic used to trick email users into disclosing personal credentials, and custom malware called “WellMess” and “WellMail” to target organizations involved in coronavirus research. “WellMail” has not been previously named on public servers, meaning it may be a newly recognized type of malware.

“It is completely unacceptable that the Russian Intelligence Services are targeting those working to combat the coronavirus pandemic,”  said UK Foreign Secretary Dominic Raab in a press statement. He labeled the cyber attacks “selfish” and “reckless.”

NCSC Director of Operations, Paul Chichester, further denounced the attacks:

“We condemn these despicable attacks against those doing vital work to combat the coronavirus pandemic,” said Chichester in a statement. “We would urge organisations to familiarise themselves with the advice we have published to help defend their networks.”

The advisory urges organizations to review cybersecurity systems and protocols to avoid being compromised by the hackers. It provides “Indicators of compromise” (IOCs) – or lines of codes used to identify hacks – for the common attacks used by the group of hackers.

While APT29 has never been claimed by the Russian government, the NCSC is “almost certain (95%+) that APT29 are part of the Russian intelligence services.” However, the advisory declined to name specific organizations that had been targeted by the group.

APT29 has previously been implicated in the 2016 hack of the Democratic National Convention in the US, and the information leak was largely credited with contributing to Democratic candidate Hilary Clinton’s loss in the 2016 Presidential election.

Image Credits: Yuri Samoilov.

Anthony Fauci, the US’ top COVID-19 expert, and director of the US National Institute for Allergies and Infectious Diseases for nearly four decades.

In an unusually frank statement, the United States’ embattled top infectious disease expert, Dr Anthony Fauci, expressed hopes that the US would resolve its conflicts with the World Health Organization. 

Fauci, an expert on the White House Coronavirus taskforce and director of the National Institute for Allergies and Infectious Diseases (NIAID), in an interview with ABC News. The candid interview follows on the heels of a rash of criticism aimed at him by allies of President Donald Trump, as well as indirect jibes by Trump himself, who has not met with Fauci for the past month.

“They are an imperfect organization, they have made mistakes, But i would like to see the mistakes corrected, and for them to be much more in line with the kinds of things we need… So I hope this kind of tension between the US and the WHO, somehow or other, ultimately gets settled in a favorable way. Because the world does need a WHO,”  said Fauci in an interview with ABC News.

Fauci, who has advised six presidents as head of the NIAID, has been weathering increasing attacks from Trump allies, including some calling for his resignation. But the infectious disease veteran told The Atlantic that the “problem [of the pandemic] is too important” to consider resigning.

“I just want to do my job. I’m really good at it. I think I can contribute. And I’m going to keep doing it,”  Fauci told The Atlantic.

White House Deputy Press Secretary Dan Scavino most recently posted a political cartoon deriding Fauci’s comments against in-person school reopenings in the fall, among other issues. The Trump administration has been pushing schools to reopen with in person classes in the fall, and the President has complained that the US Centers for Disease Control recommendations cautioning against full reopenings are too strict. 

White House Deputy Press Secretary posted a caricature of Fauci in another jab at the infectious disease veteranEx

While WHO had no comments on Fauci’s comments per say, the agency did speak out about school reopenings. WHO experts on Monday warned against using school reopenings as “political football.”

“ We can’t turn schools into yet another political football in this game. It’s not fair on our children,” WHO Health Emergencies Executive Director Mike Ryan said on Monday. “So we have to look at this carefully, in light of the transmission in any given country or any given setting. And we have to make decisions that are based in the best interest of our children, either their education interest or their health interest.” 

Image Credits: National Institutes of Health, Dan Scavino Jr..

Some 75 new countries have submitted expressions of interest to join the COVAX Facility, potentially supporting 90 other countries who have already joined the COVAX Advanced Market Commitment initiative created to pool demand and secure lower prices for bulk purchases of a COVID-19 vaccine.

Meanwhile, Moderna is pulling ahead in the COVID-19 vaccine rat race as the first company to publish results from Phase I clinical trials in a peer reviewed journal, the New England Journal of Medicine, on Tuesday. Some 21 vaccine candidates are in human trials, although none have yet been given full regulatory approval.

The COVAX Facility is one initiative to set up a global system to buy and distribute an approved COVID-19 vaccine as soon as it hits the market in an effort to minimize the lag normally experienced between a vaccine receiving regulatory approval, and its deployment to people in need, particularly in low- and middle-income countries. Hosted by Gavi, the Vaccine Alliance, the Facility aims to subsidize lower-income countries’ vaccine purchases with voluntary donations to GAVI’s Advance Market Commitment. 

““For the vast majority of countries, whether they can afford to pay for their own doses or require assistance, it means receiving a guaranteed share of doses and avoiding being pushed to the back of the queue, as we saw during the H1N1 pandemic a decade ago,”  said CEO of Gavi Seth Berkley in a press release. 

“Even for those countries that are able to secure their own agreements with vaccine manufacturers, this mechanism represents, through its world-leading portfolio of vaccine candidates, a means of reducing the risks associated with individual candidates failing to show efficacy or gain licensure,”  he added.

However, some critics have cautioned that the COVAX Facility could inadvertently allow rich countries to buy up vaccines more quickly than poor countries. High-income countries could sign their own deals with pharma companies, and also benefit from allocations from Gavi, without being required to contribute to the Advance Market Commitment, according to Associated Press. 

““By giving rich countries this backup plan, they’re getting their cake and eating it too,” Anna Marriott of Oxfam International told Associated Press. “They may end up buying up all the supply in advance, which then limits what Gavi can distribute to the rest of the world.”

Berkley has dismissed such criticisms.

The Facility’s ambitious goal is to deliver two billion doses of safe, effective COVID-19 vaccines by the end of 2021. So far, the US $300 million of the US $2 billion goal for the Advance Market Commitment has been raised from high-income donors.

Moderna Releases Positive Phase I COVID-19 Vaccine Results in Peer-Reviewed Journal

Colorized electron micrograph of SARS-CoV-2 (yellow) attacking a dying cell (red)

All 45 participants in Moderna’s Phase I COVID-19 vaccine trial developed neutralizing antibodies, the type of antibodies able to bind to the virus and prevent it from infecting human cells.

Two 100 microgram doses of the vaccine spaced 28 days apart were able to induce antibody levels 4.1 times higher than levels seen in recovered COVID-19 patients. The vaccine, mRNA-1273, was also able to induce a Th1-biased CD4 T cell response. Phase II study participants have already been enrolled.

“These Phase 1 data demonstrate that vaccination with mRNA-1273 elicits a robust immune response across all dose levels and clearly support the choice of 100 µg in a prime and boost regimen as the optimal dose for the Phase 3 study,” said Chief Medical Officer of Moderna Tal Zaks in a press release.

Moderna plans to begin testing a 100 microgram dose of the vaccine in over 30,000 volunteers for a Phase III study set to start in late July. The Phase III trial, titled COVE, will measure how well the vaccine protects against symptomatic COVID-19 disease, infection by the COVID-19 causing virus SARS-CoV-2, and severe COVID-19. 

The highly anticipated results from the Phase I trial, a collaboration between Moderna and the United States National Institute of Allergies and Infectious Disease, comes as the US continues to hit sober new highs for the number of new coronavirus cases, with new records set daily for the past week. The US reported more than 67,400 new cases on Tuesday, according to Johns Hopkins University’s COVID-19 cases tracker.

Image Credits: US NIH, NIAID.

Chronic diseases claim up to 50 million lives a year

On Monday, the Geneva-based NCD Alliance launched the first-ever fund to bolster the efforts of NGOs worldwide fighting chronic diseases alongside the COVID-19 pandemic with some $US 300,000 in initial seed capital. 

The effort is unique in that it links major pharma interests that develop and produce drugs for non-communicable diseases (NCDs) to the support of NGOs in some 20 low- and middle-income countries (LMICs) and regions that are focused on prevention and access to affordable treatment. 

The new fund, the Civil Society Solidarity Fund on NCDs And COVID-19, also tackles a neglected aspect of the COVID-19 pandemic. 

Cardiovascular and lung diseases, as well as cancer and diabetes, make people much more vulnerable to serious COVID-19 illness and death. And mental illness can actually be triggered by the disease itself.

Even so, while donors have responded with billions of dollars to support the pandemic response, funding to NCD groups addressing root causes of those diseases has become all the more volatile. The new fund addresses that gap by supporting NGOs at the grassroots where action can make the biggest difference.   

“This is a first-of-its-kind fund to support NCD civil society organisations respond to COVID-19”, said Katie Dain, CEO of NCD Alliance. “During pandemics, momentum in several health and sustainable development issues, notably HIV/AIDS, Ebola and climate change, have repeatedly reinforced the critical role of civil society organizations and community-led efforts in accelerating action from local to global levels. Civil society are proven campaigners, change agents, experts, implementers, and watchdogs.”

Every year, chronic diseases cause over 50 million premature deaths and affect 1.7 billion people around the world, added Todd Harper, President of the NCD Alliance, at a virtual launch of the fund on Monday.

WHO Director General Dr. Tedros

But a “deadly interplay”’ between chronic diseases and COVID-19 is taking even more lives than before, as underlying conditions increase vulnerability to COVID-19, said WHO’s Director-General Dr Tedros Adhanon Ghebreyesus, who also spoke at Monday’s event.

“We cannot go back to the same health systems model, which has failed the majority of people living with NCDs…We need a paradigm shift to include the prevention, screening, early diagnosis and appropriate treatment of NCDs as a part of primary healthcare for universal health coverage….We need to build back better”.

“In Italy, 68% of the people who died from COVID-19 had high blood pressure, and 31% had diabetes”, said Norway’s Minister of International Development Dag Inge Ulstein.

Even before COVID-19, there was a “huge need” to fund NCDs, Ulstein said, especially in low and middle income countries (LMICs).

Currently, 86% of NCD-related premature deaths (before the age of 70) occur in LMICs, but NCDs still only receive about 1-2% of all global health related development aid.

Massive Disruptions Being Seen in NCD Treatments

The Fund comes as NGOs on the ground scramble to maintain their operations and to secure funding in the midst of the pandemic and a global economic crisis, according to an internal survey conducted by the NCD Alliance in late May.

“In the survey from late May of 40 national and regional NCD alliance groups, some 87-90% of respondents said that disruption of NCD treatment and care operations for people living with non-communicable diseases, less access to healthy food and physical activity; and more increased alcohol and tobacco use, were key issues they face during the pandemic”, said Dain to Health Policy Watch. Also, 70% of organizations experienced difficulties in securing future funding as a result of the pandemic.

Ilona Kickbush, Founding Director The Graduate institute’s  Global Health Centre in Geneva

Massive disruptions in essential services – combined with a “long-time global under-investment in NCD prevention and control” – are contributing to an uptick in chronic diseases around the globe, said Ilona Kickbush, Founding Director and Chair of the the Global Health Centre at Geneva’s Graduate institute, who moderated the launch event. 

“This is not a crisis that’s going to stop tomorrow, and even if COVID-19 stops tomorrow, the impact is going to be with us for years to come”, she added.

“The fund, totalling $300,000, will competitively award grants of up to US$15,000 to national and regional NCD alliances to support them in addressing the critical needs of people living with NCDs during the COVID-19 pandemic”, said the NCD Alliance. “The funds will support: advocacy and communication efforts for the continuity of essential NCD health services; inclusion of NCDs in national COVID-19 response and recovery plans;  and community-led awareness-raising campaigns on the linkages between NCDs and COVID-19”.

The Fund will amplify the voices of people living with chronic diseases, promote advocacy and communications strategies, and spearhead health policy reform through the grants, awarded on a competitive basis, to 20 national and regional NCD alliances around the world – including Brazil, Uruguay, Togo, Benin, Bangladesh, Cambodia, among other countries, said the NCD Alliance.

While the pandemic has created stiff new obstacles to NCD treatment, it also creates a political moment where policymakers are more aware of the need to address underlying conditions that make people more vulnerable to COVID-19.  

“You can’t underestimate the importance of a political moment, and you have to do the work to translate that political moment into an ongoing dividend”, added Jennifer Cohn from Resolve To Save Lives, an initiative launched by New-York based Vital Strategies.

The pharma companies that contributed to the Fund include: Takeda, AstraZeneca, Upjohn (Pfizer), and Access Accelerated – a partnership of some 20 biopharmaceutical companies working on NCD treatments and cures. The US-based Leona M. and Harry B. Helmsley Charitable Trust also contributed.

We Already Know How To Fight NCDs – But Governments Need To Pull Their Weight

While the new fund represents an alliance between the private sector and civil society, it is governments, ultimately, that need to act more assertively on the NCD challenge, said Cohn. 

Jennifer Cohn, Senior Vice President of Resolve To Save Lives

“Who will pay? It will be governments, it will not be an industry…we must use the opportunity to get commitments [and] ensure there’s transparency on these budgets, so that we can hold decision makers accountable”, she said. 

In past decades, public health professionals have tried and tested strategies that can effectively prevent and treat chronic diseases.

“We know very well that the majority of non-communicable diseases can be prevented or treated with smart policy measures and sound investment in universal health coverage”, said Harper.

However, governments needs to make core NCD investments, and adopt smarter policies and regulations. 

“Just like any other epidemics, the costs from NCDs will only grow if we don’t activate [proven] interventions to prevent and treat these diseases”, said Cohn.

Measures that can nudge people towards healthier lifestyles include higher taxes and plain packaging on tobacco products, as well as other policies recommended by the WHO Framework Convention on Tobacco Control, which 181 countries worldwide have ratified.

Processed foods have excess salt, leading to hypertension

As for hypertension, some 100 million lives could be saved over the next 30 years from the deadly effects of high blood pressure – including strokes and heart diseases – mainly by eliminating artificial trans fats in food supplies, reducing dietary sodium intake, and better front-of-package labeling for healthy and unhealthy foods, added Cohn.  

“We can successfully reduce [salt intake] through…policies and legislations that reduce sodium in packaged or institutionally prepared foods,” she said.

Governments also need to invest “a lot more” to prevent children and adolescents from developing NCDs like obesity, added Sir George Alleyne, PAHO’s Director Emeritus, and former UN Special Envoy for HIV/AIDS in the Caribbean:

“It is almost criminally negligent to [let children] become fat. Governments can stop children from becoming fast [by investing] progressively and more aggressively”. 

Last But Not Least – Community Engagement To Synergize With Policy 

Bente Mikkelsen, WHO Director for NCDs

Policy reforms offer a useful starting point to improve chronic disease management, but people with underlying conditions must not be left out of decision-making processes and interventions, added panelists.

“We need to do better…and secure seats at the table for people [with NCDs] because there are big decisions that need to be made”, said Bente Mikkelsen, WHO’s Director for NCDs.

People with chronic illness need to move from passive participation to “active collaboration and action”, added Nupur Lalani, a diabetic and founder of the India-based Blue Circle Diabetes Foundation. 

Sometimes, community engagement can address chronic diseases in ‘relatively simple and ‘relatively cheap’ ways, said Kickbush. 

In a hallmark initiative to slash cervical cancer – the largest killer of women in sub-saharan Africa – groups of young women with HIV were mobilized to support widespread screening for cervical cancer and to fight stigma associated with the disease. 

As a result, in only two years, over one million women with HIV were screened and treated for cervical cancer in 8 sub-Saharan African countries.

UNAIDS Executive Deputy Director Shannon Hadder

“Our lessons from HIV are that it needs to be community-led, community-led, community-led”, said UNAIDS Executive Deputy Director Shannon Hadder. 

Multi-disease screening can also be a game-changer, noted Hadder, describing a UNAIDS supported programme called Project Search – which monitors for diabetes, high blood pressure, eyesight and HIV all at one time: 

“We have seen [these initiatives] deliver sustainability, creativity and agility in ways that continue to serve.”

“Telemedicine is being scaled up in India as a really important intervention that can allow for treatment modifications from a patient’s home”, especially for chronic diseases, said Cohn, adding:

“Telemedicine can actually help us maintain lifesaving and sustainable pathways of care for those with NCDs. And these models can help us scale rational and sustainable and affordable models of care into the future, even when there’s not a global pandemic raging.”

Image Credits: WHO, Resolve To Save Lives.

   Rome, Italy – More people are going hungry, an annual study by the United Nations has found. Tens of millions have joined the ranks of the chronically undernourished over the past five years, and countries around the world continue to struggle with multiple forms of malnutrition.

The latest edition of the State of Food Security and Nutrition in the World, published today, estimates that almost 690 million people went hungry in 2019 – up by 10 million from 2018, and by nearly 60 million in five years. High costs and low affordability also mean billions cannot eat healthily or nutritiously. The hungry are most numerous in Asia, but expanding fastest in Africa. Across the planet, the report forecasts, the COVID-19 pandemic could tip over 130 million more people into chronic hunger by the end of 2020. Flare-ups of acute hunger in the pandemic context may see this number escalate further at times.

The State of Food Security and Nutrition in the World is the most authoritative global study tracking progress towards ending hunger and malnutrition. It is produced jointly by the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agriculture (IFAD), the United Nations Children’s Fund (UNICEF), the UN World Food Programme (WFP) and the World Health Organization (WHO).

Writing in the Foreword, the heads of the five agencies warn that “five years after the world committed to end hunger, food insecurity and all forms of malnutrition, we are still off track to achieve this objective by 2030.”

The hunger numbers explained

In this edition, critical data updates for China and other populous countries have led to a substantial cut in estimates of the global number of hungry people, to the current 690 million. Nevertheless, there has been no change in the trend. Revising the entire hunger series back to the year 2000 yields the same conclusion: after steadily diminishing for decades, chronic hunger slowly began to rise in 2014 and continues to do so.

Asia remains home to the greatest number of undernourished (381 million). Africa is second (250 million), followed by Latin America and the Caribbean (48 million). The global prevalence of undernourishment – or overall percentage of hungry people – has changed little at 8.9 percent, but the absolute numbers have been rising since 2014. This means that over the last five years, hunger has grown in step with the global population.

This, in turn, hides great regional disparities: in percentage terms, Africa is the hardest hit region and becoming more so, with 19.1 percent of its people undernourished. This is more than double the rate in Asia (8.3 percent) and in Latin America and the Caribbean (7.4 percent). On current trends, by 2030, Africa will be home to more than half of the world’s chronically hungry.

The pandemic’s toll

As progress in fighting hunger stalls, the COVID-19 pandemic is intensifying the vulnerabilities and inadequacies of global food systems – understood as all the activities and processes affecting the production, distribution and consumption of food. While it is too soon to assess the full impact of the lockdowns and other containment measures, the report estimates that at a minimum, another 83 million people, and possibly as many as 132 million, may go hungry in 2020 as a result of the economic recession triggered by COVID-19. The setback throws into further doubt the achievement of Sustainable Development Goal 2 (Zero Hunger).

Unhealthy diets, food insecurity and malnutrition

Overcoming hunger and malnutrition in all its forms (including undernutrition, micronutrient deficiencies, overweight and obesity) is about more than securing enough food to survive: what people eat – and especially what children eat – must also be nutritious. Yet a key obstacle is the high cost of nutritious foods and the low affordability of healthy diets for vast numbers of families.

The report presents evidence that a healthy diet costs far more than US$ 1.90/day, the international poverty threshold. It puts the price of even the least expensive healthy diet at five times the price of filling stomachs with starch only. Nutrient-rich dairy, fruits, vegetables and protein-rich foods (plant and animal-sourced) are the most expensive food groups globally.

The latest estimates are that a staggering 3 billion people or more cannot afford a healthy diet. In sub-Saharan Africa and southern Asia, this is the case for 57 percent of the population – though no region, including North America and Europe, is spared. Partly as a result, the race to end malnutrition appears compromised. According to the report, in 2019, between a quarter and a third of children under five (191 million) were stunted or wasted – too short or too thin. Another 38 million under-fives were overweight. Among adults, meanwhile, obesity has become a global pandemic in its own right.

A call to action

The report argues that once sustainability considerations are factored in, a global switch to healthy diets would help check the backslide into hunger while delivering enormous savings. It calculates that such a shift would allow the health costs associated with unhealthy diets, estimated to reach US$ 1.3 trillion a year in 2030, to be almost entirely offset; while the diet-related social cost of greenhouse gas emissions, estimated at US$ 1.7 trillion, could be cut by up to three-quarters.

The report urges a transformation of food systems to reduce the cost of nutritious foods and increase the affordability of healthy diets. While the specific solutions will differ from country to country, and even within them, the overall answers lie with interventions along the entire food supply chain, in the food environment, and in the political economy that shapes trade, public expenditure and investment policies. The study calls on governments to mainstream nutrition in their approaches to agriculture; work to cut cost-escalating factors in the production, storage, transport, distribution and marketing of food – including by reducing inefficiencies and food loss and waste; support local small-scale producers to grow and sell more nutritious foods, and secure their access to markets; prioritize children’s nutrition as the category in greatest need; foster behaviour change through education and communication; and embed nutrition in national social protection systems and investment strategies.

The heads of the five UN agencies behind the State of Food Security and Nutrition in the World declare their commitment to support this momentous shift, ensuring that it unfolds “in a sustainable way, for people and the planet.”

Image Credits: FAO.