A growing bloc of aerosol scientists, epidemiologists, and infectious disease experts are urging the World Health Organization to acknowledge that particles containing SARS-CoV-2, the virus that causes COVID-19, can remain suspended in the air for hours and be inhaled, potentially representing another route of transmission.

Some 239 scientists from around the world urged the WHO to acknowledge the evidence of “airborne” transmission of the virus at short distances in a commentary published Monday in the Clinical Journal of Infectious Diseases. 

“There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission,” wrote the main authors of the CJID commentary, Lidia Morowska, a scientist at the Queensland University fo Technology, and Donald K. Milton, a professor of Environmental Health at the University of Maryland.

WHO has firmly maintained that the “COVID-19 virus is primarily transmitted between people via respiratory droplets and contact routes,” referring primarily to large, liquid droplets expelled by coughing or sneezing, and which rapidly fall to the ground.

But talking and breathing can produce much tinier particles containing SARS-CoV-2, experts now believe. These particles can “remain suspended in air near the person who generated them” for sometime longer than previously believed, Dr Lisa Brosseau, an industrial hygienist researching aerosols at the Center for Infectious Disease Research and Policy (CIDRAP) told Health Policy Watch. 

“The way WHO thinks droplets – or large, liquid particles containing the coronavirus – transmit disease, is that they are propelled into your face into your nose your mouth, your eye. There is no inhalation involved with droplet transmission,” according to Brosseau. However, if tinier virus particles can remain airborne for longer, then chances are greater that someone standing close an infected person could inhale infectious virus – even if that person didn’t cough or sneeze directly into their face.

“In my opinion, infection probably does occur by both droplets and fine particles [suspended in air], but we don’t know how important each is. And since there’s a distribution of particle sizes, the answer may not be quite so simple, either,” Stephen Morse, an infectious disease epidemiologist and influenza expert from Columbia University told Health Policy Watch. 

False Dichotomy Between “Droplet” & “Airborne” Transmission
Small, virus-containing particles are more likely to remain suspended in air in closed conditions, like subway cars.

At the heart of the debate around SARS-CoV-2’s viability in air is a false dichotomy between “droplet” and “airborne” transmission, said Brosseau and Morse.

“I think the problem is that [infection prevention and control specialists] didn’t have better words to use when they were developing the guidelines, leading to some of the confusion we have today,” said Morse.

According to the WHO and US Centers for Disease Control definitions, so called “airborne transmission” of diseases occur when infectious pathogens can be dispersed via tiny particles “over long distances” by air. Droplet transmission refers to transmission driven by infectious persons’ short-distance expulsion of particles bigger than 5 micrograms in size, which quickly evaporate and drop to the ground.

In hospitals, “airborne” infection prevention and control protocols are much more stringent than droplet precautions, requiring healthcare workers to don N95 respirators, special masks designed to prevent inhalation of small particles, before attending to patients. “Airborne pathogen” protocols also generally recommend that patients be placed in isolation rooms with special ventilation systems that prevent the pathogen from being carried room to room by air currents.

But Brosseau says this classification system is outdated. It fails to capture the potential for tiny virus-containing particles of 2 to 3 micrograms in size to remain suspended in air near the source of infection, and then infect someone else who happens to be in proximity.

“These definitions are wrong in the context of today’s understanding of particles suspended in air,” said Brosseau. SARS-CoV-2 transmission could be better described by examining the characteristics of different sizes of virus-containing particles suspended in air – also known as aerosols.

“It’s really important that we use the data and science that we have to inform us about what’s going on, and not hold on to these sacred cows; like droplet versus airborne,” she said.

A recent preprint study mimicking aerosol transmission of SARS-CoV-2 under laboratory settings found that the viable virus could remain suspended in air for up to 16 hours, according to Brosseau. While the study did not test the effects of different temperatures and humidity levels on aerosolization of the virus, it’s been proven that coughing, talking, and even exhaling can release tiny droplets that remain suspended in the air for hours, potentially available to infect nearby people.

“That 16 hour thing really makes me think this is a pathogen that’s pretty good at staying viable in particles in air,” said Brosseau.

Transmission of aerosolized virus-containing particles could explain why COVID-19 cases occur in clusters.

“We’re getting clusters of disease traced back to these small spaces with lots of people. They’re spending time… in enclosed spaces with usually not a lot of ventilation, they’re breathing out infectious particles other people are inhaling them,” explained Brosseau.

Improved Ventilation – May be Key to Preventing Widespread Aerosol Transmission Of COVID-19
Without ventilation, uninfected persons are exposed to higher concentration of aerosolized virus (top), but with ventilation, aerosolized viral particles are dispersed. (Source: Clinical Journal of Infectious Diseases)

Acknowledging the possibility of wider transmission caused by aerosolized virus would lead to some major changes in prevention tactics, Brousseau said. Those could include:  encouraging the use of fit-tested respirator masks in all healthcare settings, limiting the time spent in indoor settings with strangers, and improving ventilation of shared spaces.

“If there is significant ‘airborne’ (fine particle) transmission, our regular precautions (6 ft. social distancing and most masks) wouldn’t be enough…This is especially true for indoor spaces, including, of course, the elevator. Most are not well ventilated and therefore the small particles could stay in the air for a long time and, under normal environmental conditions of temperature and humidity, the virus in these particles could remain infectious for a considerable time,” said Morse.

“You should spend as little time indoors as you can with people whose infection status you do not know,” stressed Brosseau.

“Even if you sit far away from somebody who’s infectious in a small space, eventually the proximity won’t matter… because you will be breathing in the particles that they are breathing out… as particles are distributed throughout the room. And eventually, you may breathe in enough to reach an infectious dose.”

Improving ventilation of indoor spaces is thus an important tactic to quickly disperse aerosolized virus and reduce transmission, especially as people begin reopen offices and workplaces. But such ventilation systems must be designed carefully, said Brosseau.

“You have to be very careful about directionality,” she said. For example, using fans could simply blow particles from one person to the next. Rather, employers managing large office spaces need to adapt lessons learned from factories, which often feature ventilation systems designed to minimize workers’ exposures to dangerous aerosolized chemicals.

“It isn’t an easy solution, necessarily, but there are solutions,” said Brosseau. “The solution is definitely not just face coverings, guaranteed.”

Two women chat on a park bench, both wearing surgical masks
More advanced masks may also be required in more healthcare settings

Still, in health care settings, more advanced masks may also be required to protect health care workers better.

“Ideally, healthcare workers are supposed to be using N95 respirators with COVID-19 patients anyway,” said Morse.

But WHO currently recommends that respirator masks be restricted to use in healthcare workers during medical procedures that are known to generate aerosols, such as intubations. During other times, staff in healthcare settings should wear surgical masks, which provide a physical barrier against droplet transmission.

But if infectious, respirable virus particles can be generated simply by talking, then the use of special respirator masks  should be recommended in all healthcare settings, said Brosseau. Surgical masks do little to prevent transmission driven by small infectious particles that can remain suspended in air.

This story was updated 7 July 2020.

Image Credits: Flickr: michael_swan, Marc A. Hermann / MTA New York City Transit, Morawska, L. & Milton, D. (2020) , Flickr: Joseph Gage.

Passengers aboard a Lagos-Abuja flight, a few weeks before Nigeria announced a nationwide lockdown that suspended air travel in the country.

Ibadan, Nigeria – The first time that businessman Soji Adegbite missed his flight, he was heading to Addis Ababa, Ethiopia from Nigeria’s Murtala Muhammed International Airport located in Africa’s largest city of Lagos.

“I got there just five minutes late but that was all it took to miss the flight,” he told Health Policy Watch.

In Nigeria, prior to the COVID-19 pandemic, international travellers were expected to be at the airport about three hours before takeoff. For those travelling from Lagos, they also had to add several hours to just get to the airport, in light of the city’s notorious traffic. 

“I would have to set aside three hours for traffic,” he said. “Adding to the airport’s three-hour rule, I would set aside a total of six hours anytime I wanted to travel.” 

Now, the waiting period for international travel may become even longer.  Would-be travellers will have to be at the airport at least five hours before take off, according to a new set of COVID-era flight safety rules being introduced by the Nigerian government as the country gradually begins to reopen air travel. Local flights that used to require arrival one hour before takeoff, will now require passengers to arrive three hours ahead of their flights, according to the new rules. 

The longer period includes time for implementing a range of new COVID-19 safety measures at the airport including social distancing in queues, hand sanitization, baggage decontamination, and scanning of personal items. 

Following WHO Travel Recommendations  In the New Normal – As West African States Reopen

In fact, Nigeria is doing what the doctor, or in this case WHO, has recommended. As African countries begin to reopen borders and air spaces, there is a risk of infection surges, and effective measures to mitigate those risks need to be taken, the Organization has warned.

“Air travel is vital to the economic health of countries,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. She was speaking at a virtual press conference Thursday, hosted by the Geneva-based World Economic Forum, which focused on safely reopening Africa’s aviation sector.

“But as we take to the skies again, we cannot let our guard down. Our new normal still requires stringent measures to stem the spread of COVID-19.”

In fact, during the early days of the pandemic, WHO’s Director-General Dr Tedros Adhanom Ghebreyesus staunchly argued against any travel restrictions whatsover – a view initially heeded by some senior African health policy leaders. However, as reality overtook principles, African governments swiftly adapted, implementing tough air travel restrictions.

Some 36 countries in WHO’s Africa region, including Nigeria, closed their borders to international travel altogether, while eight more suspended flights from high-burden COVID-19 countries in Europe, the Americas and elsewhere.

WHO has belatedly acknowledged that the travel limitations helped reduce the spread of COVID-19.  It  now warns that the reopening of borders, while welcome, also carries risks that must be managed. For example, Seychelles had not had a locally transmitted case since 6 April 2020, but in the last week it recorded 66 new cases – all crew members of an international fishing vessel. 

To resume international air travel, WHO has recommended that countries assess the epidemiological situation to determine whether maintaining restrictions outweighs the economic costs of reopening borders if, for instance, there is widespread transmission of the virus. It is also crucial to determine “whether the health system can cope with a spike in imported cases and whether the surveillance and contact tracing system can reliably detect and monitor cases,” according to the WHO Africa Office. 

Local Travel Resuming – ECOWAS Expected To Reopen Regional Airspace

On July 21, the 15 countries of the Economic Community of West African States (ECOWAS) are expected to begin reopening their regional airspace – although individual countries such as Nigeria have not yet confirmed when they will actually resume international flights, as such. So far only Cameroon, Equatorial Guinea, Tanzania and Zambia have resumed commercial flights, according to WHO’s Africa Regional Office.

According to Nigeria’s aviation ministry, local air travel will, however, formally resume on July 8 at the country’s two major airports – Murtala Muhammed, Lagos and the Nnamdi Azikiwe International Airport in the capital city of Abuja. Flights will resume at three more airports on July 11 while the remaining airports will begin operations on July 15.

Nigerian Federal Government acquires profiling robots to process passengers at airport departure halls.

In readiness for the resumption of flights, Nigeria is reducing the number of seats at the departure lounge. At the airport in Lagos, seats have been reduced from 500 to 50 – a move that the government said is in line with the new social distancing policy. All passengers are also required to wear face masks before entering the airport terminals while aviation authorities will also provide alcohol-based hand sanitizers.

Profiling robots have also been acquired to help with contactless temperature check and to identify unwanted items.

Past Epidemics Prepared African Airports 

Speaking at the virtual press conference, Moeti said past outbreaks had already prepared and equipped African countries with disease management at the airports.

“Through preparedness for Ebola, temperature screening at airports is well-established in the region and we know that this has had an important contribution in identifying cases and also in enabling the tracing of their contacts once they left the airport because information was being collected of who was travelling and who was sitting where in a plane,” Moeti said.

Considering that asymptomatic, pre-symptomatic and mild cases of COVID-19 play a significant role in transmission, Moeti said follow-up of passengers for 14 days and strong contact tracing systems are “incredibly important to identify imported cases as travel by air is opening-up”

By practising physical distancing, hand hygiene, and wearing a mask over mouths and noses, Moeti said the risk of transmission of COVID-19 can be reduced – but not to zero as the global health community is constantly learning about the virus and what works in suppressing transmission.

Still, resuming travel will also bring important benefits: “The resumption of commercial flights in Africa will facilitate the delivery of crucial supplies such as testing kits, personal protective equipment and other essential health commodities to areas which need them most,” Dr Moeti said. “It will also ensure that experts, who can support the response can finally get on the ground and work.”

While awaiting the moment he can travel again, Adegbite, noted that efforts geared towards reopening the aviation sector affirmed that the COVID-19 pandemic has “gone full cycle” considering the pandemic berthed in the various African countries largely through air travel.

Stopping the economic bleeding

A local airline staff checks passengers in at the Murtala Muhammed airport in Lagos, Nigeria, ahead of next week’s formal airport reopening.

The aviation sector is one of the worst affected by the COVID-19 pandemic, racking up losses of up to US$ 391 billion with 3 billion fewer passengers flying, according to a recent report published by the International Civil Aviation Organization (ICAO) .

The International Air Transport Association (IATA) also estimated that revenues would drop by 50% from 2019 to $419 billion, predicting 2020 will be the industry’s worst financial record, although IATA’s CEO Alexandre de Juniac, adds, “Provided there is not a second and more damaging wave of Covid-19, the worst of the collapse in traffic is likely behind us.”  

IATA in a semi-annual report added that 32 million jobs supported by aviation (including tourism) are also at risk: “Restoring air transport connectivity will be critical in the post-COVID period to support the recovery in economic development,” IATA stated.

Regarding Africa, IATA describes the continent’s aviation sector as particularly hard hit: “The pandemic has added to an already challenging operating environment and as a result airlines in the region are expected to post a $US 2.0 billion net loss in 2020,” the IATA report stated.

According to the ICAO, in the worst-case scenario, international air traffic in Africa could see a 69% long term drop in international traffic capacity, and 59% decline in domestic capacity.

Speaking at Thursday’s press briefing, Dr. Amani Abou-Zeid, Commissioner for Infrastructure and Energy at the African Union Commission (AUC) noted that prior to COVID-19 Africa’s aviation and tourism sectors were looking forward to 2020 to be a year of growth.

“We were expecting to see an increase in cargo and air transport. The blow is really hard – between the job and economic losses and the livelihood of the people,” she said. 

Don’t Sneeze – You Might Be Denied Boarding  

Abou-Zeid predicted that some of Africa’s airlines will not make it post-COVID-19 but indications are emerging that things may not return to normal anytime soon. 

In Nigeria, Aero Contractors is one of the local airlines that is expected to resume flights. While announcing measures being taken by the airline, its CEO, Ado Sanusi is taking a strict line.  He advises intending passengers who have a cold or malaria not to come to the airport at all. Anyone that sneezes on the airplane will be isolated and treated as a potential COVID-19 patient:

“If you have malaria or a common cold, do not come to the airport because there is a high possibility that you are going to be denied boarding. This is the new normal that we are going to see. The main thing for the airlines is to make sure that the aeroplanes are safe and that is what we’re doing and that’s why we still believe that air transportation is the safest way to travel,” Sanusi said.

He added that the airline will no longer provide meals in-flight, considering passengers will have to remove their face masks to eat. 

But when asked if his airline will practice social distancing on its planes by leaving the middle seats empty, Sanusi said not for now. 

“If we have data that shows that if we block the centre seats, it will reduce the rate of transmission then we will do that and increase the flight costs because somebody must pay for the centre seats,” Sanusi said.

Image Credits: Paul Adepoju/HealthPolicyWatch, NTA News.

Dexamethasone tablets

Access to life-saving dexamethasone will be expanded to some 4.5 million COVID-19 patients in low- and middle-income countries through an advance bulk purchase of the drug in bulk, UNITAID has said. The move is the first concrete step by a global health agency under the umbrella of the WHO ACT accelerator partnership to boost access to critical COVID-19 treatments beyond national borders.  

“With this advanced purchase we aim to ensure equitable access for low- and middle-income countries for treatment of COVID-19 with the life-saving drug dexamethasone, and avoid shortages resulting from high-levels of demand from other parts of the world”, said Unitaid Executive Director Philippe Duneton in a statement about the initiative with the Wellcome Trust and others. “It will allow UNICEF, the Global Fund and other partners to procure quality dexamethasone.”

Advance Purchase of Dexamethasone – Precautionary Response to Recent US Moves

The advance purchase of dexamethasone – the first drug to significantly curb mortality in critically ill COVID-19 patients – may represent a precautionary response to hoarding by countries hungry for COVID-19 vaccines and treatments.

On Monday, US Health and Human Services (HHS) secured almost all of Gilead Sciences’ projected production of remdesivir for the next three months, sparking concern that there won’t be enough of the treatment for people elsewhere in the world – one of the other few with demonstrated efficacy against the SARS-COV-2 virus. 

And behind the scenes, various European countries have sealed deals with vaccine manufacturers, effectively bypassing the WHO’s mechanism to ensure ‘equitable access’ to COVID-19 technologies – the Act Accelerator.

While this purchase is “good news”, it’s more of a “defensive purchase” rather than an ‘advanced purchase’, Ellen ‘t Hoen, director of Medicines, Law & Policy, told Health Policy Watch:

“Donors want to ensure that supply for LMICs is assured and created a defence against hoarding by high-income countries that could buy up supply – including by offering higher prices,” she said, adding. “One would wish to live in a world where supply was based on solidarity automatically.”

While the UNITAID announcement was also welcomed by Health Action International, a spokesperson warned that “top-down stockpiling” cannot be the long-term answer to facilitate access toquality-assured medicine in LMICs:

“Essential medicines should be available to countries through regular supply chains, economically sustainable procurement mechanisms and fairly paid, skilled health workers.”

The WHO’s pre-qualification programme, for instance, is a concrete mechanism that can facilitate access to high-quality medicines in LMICs, said the spokesperson to Health Policy Watch.

COVID-19 Transmission From Humans to Animals 

Meanwhile on Friday, WHO said that humans were apparently transmitting coronavirus to animals such as dogs, minks or even tigers.  The WHO statement follows increased reports of animals becoming infected with COVID-19 in several countries, including a tiger in a New York Zoo.

Tigers have tested positive for COVID-19 at Bronx Zoo in New York

The WHO statement about human-to-animal transmission came at the conclusion of a two-day virtual scientific summit involving some 1000 scientists around the world, which assessed progress on vaccine research, therapeutics, as well as pandemic trends.

“More evidence is emerging that transmission from humans to animals is occurring, namely to felines (including tigers), dogs and minks,” WHO said.  The WHO statement follows reports in June by the US Centers for Disease Control, observing that transmission from infected people to animals, particularly felines, had occurred.

While humans may be infecting new animal species with coronavirus, some of those animals may also in turn infect humans. WHO cited infections at a Dutch farm in mid-April as likely evidence of the vicious cycle, stating: “In a few instances, the minks that were infected by humans have transmitted the virus to other people.” WHO described the cases as “the first reported cases of animal-to-human transmission” – beyond the original presumed leap of the virus from an animal species to humans in China, where the pandemic first originated. 

As of 3 July, about 20 mink farms in Holland had been infected with COVID-19. In one of the Dutch farms where mink-to-human transmission was first documented, it is “most likely” that “at least one” of the three COVID-19 patients on the farm was infected by the minks, two Dutch ministers told Parliament in late May. 

The  United States Department of Agriculture (USDA) has also identified one lion, four cats and four dogs as infected with COVID-19. 

However, so far, there is still “no evidence” that other animals like ferrets, cats and tigers can transmit the disease to humans and thus spread COVID-19, according to WHO.  And even if some animals can feasibly catch and transmit the coronavirus, they do not drive the spread of COVID-19, says the World Organization for Animal Health (OIE):

“There is no evidence that companion animals are playing an epidemiological role in the spread of human infections with SARS-CoV-2”, the OIE states.

Even so, in light of current evidence, the OIE recommends that suspected or confirmed individuals with SARS-CoV-2 limit their contact with animals.

A better understanding of animal-human transmission will be important as the world tries to halt the rampant virus, as animals can become reservoirs of the virus and contribute to outbreaks.

However, it is “very difficult” to directly prove animal-to-human transmission, said virologist Linda Saif from Ohio State University in a Nature article.

Most International Research Favours High-Income Countries

The two-day WHO scientific meeting also reviewed the latest data from the WHO “Solidarity Trial” which has tested four potential COVID-19 therapeutics including: hydroxychloroquine, lopinavir/ritonavir, remdesivir and dexamethasone. Scientists agreed on the need for more trials to test antivirals, immunomodulatory drugs and anti-thrombotic agents, as well as combination therapies, at different stages of the disease.

Excessive blood-clotting, leading to thrombosis and stroke is one of the outcomes of serious COVID-19 cases

The meeting analyzed 15 vaccine trial designs from different developers, and criteria for conducting robust trials to assess safety and efficacy of vaccine candidates. Participants discussed the use of a global, multi country, adaptive trial design, and clear criteria to advance drug candidates through the various stages of trials.

The scientists also concluded that most internationally-funded research projects have so far favoured high-income countries, with very few funded in low- and middle-income countries, highlighting the importance of the ACT-Accelerator Initiative to speed up the development and equitable deployment of COVID-19 tools.

Meanwhile, the Pan American Health Organization (PAHO) published a new 77-page report on Friday outlining the epidemiological situation and its response in the Americas, which have become the epicentre of the pandemic.

 

Image Credits: World Conservation Society, Twitter: @WHO, Cardiovascular and Interventional Radiological Society of Europe.

59.5 million people depended on fisheries and aquaculture in 2018.

In the past three decades, global fish consumption has surged by a stunning 122%. Yet today, only 66% of global stocks are fished within sustainable levels, in comparison to 90% in the 1970s.

“There is no healthy planet without a healthy ocean, and the healthy ocean is currently in decline”, said Peter Thomson at a conference Tuesday on overfishing co-hosted by Geneva Environment Dialogues and the World Economic Forum. “There are too many boats chasing too few fish.”

Marine Ecosystems Feed People & Generate Jobs

If more sustainable fishing policies aren’t adopted now, marine ecosystems will bite us back with devastating economic and health consequences. Here’s why:

  • Livelihoods – 59.5 million people depended on fisheries and aquaculture in 2018.
  • Nutrition – Fish is a major protein source for some 3.3 billion people around the globe, accounting for one-fifth of global animal protein consumption, said Keith Rockwell, a WTO official at Tuesday’s event.

How to Combat Overfishing

It is possible to reduce overfishing while still supporting the fishing sector, which is so important to health and livelihoods. One of the key ways to achieve that is to re-think how fisheries are subsidized.

In 2009, global fisheries received a whopping $35 billion in subsidies, but 22% were geared towards making fuel cheaper for fishers – an “alarming” figure, said executive director of the Global Tuna Alliance Tom Pickerell, as policies that subsidize fuel are the “most likely” to promote overfishing, as well as illegal, unregulated and unreported (IUU) fishing, according to research by the Organisation for Economic Co-Operation and Development (OECD).

Another drawback of fuel subsidies is they tend to favour big businesses, who can more easily access the subsidies, while providing little benefit to fishermen themselves, particularly small boats and businesses in low income countries, who fish closer to shore and use less fuel.

Other policies that also promote overfishing and illegal or unreported fishing are those that subsidize gear or bait – also mostly accessible to big fishing enterprises.

“Fishing subsidies disproportionately benefit big businesses, which generally only really provide jobs and significant incomes to few people”, said Pickerelll.

“Illegal fishing is a crime, and yet we have public funds being spent in the form of subsidies to support [overfishing and IUU fishing]. It’s just not rational”, said Thomson.

Smart Subsidies for a Sustainable Future

Subsidies that support efficient business operations, develop human capital and help fishers deal with disasters can all prevent overfishing while delivering significant benefits to fishers, according to the OECD. These include programmes that hone fishers’ business or operational skills.

The OECD estimates that, if $US 5 billion in fuel subsidies were funneled towards more training of fishers, the benefits would be significant – their incomes would improve by $US 2 billion, all while reducing depletion of fish stocks.

“Ensuring that fishers have access to working capital, have the skills needed for their businesses….can bring greater benefits to fishers at lower cost to governments, all while reducing the negative impact of support on the sustainability of fish stock”, according to the OECD report.

An Opportunity to Upend the Status Quo – WTO Negotiations on Fishing Subsidies

Five years ago, leaders from 192 countries pledged, under Target 6 of the UN’s Sustainable Development Goal (SDG) 14 on Sustainable Oceans, to prohibit subsidies that contribute to overfishing by 2020, and to eliminate subsidies that contribute to IUU fishing – such as fuel, gear and bait subsidizes.

A WTO agreement regarding the elimination of these subsidies was supposed to have been reached at the WTO’s 12th Ministerial Conference in Kazakhstan, on 8-11 June 2020, but COVID-19 derailed negotiations as well as the planned conference.

Last week, the WTO presented a consolidated draft text in preparation for upcoming negotiations scheduled virtually on 21 July. Their aim is to seal the debate on fishing subsidies once and for all.

But the WTO agreement has been particularly complicated to negotiate for a simple reason – fish swim long distances.

”Unlike steel factories, or herds of cattle, fish swim great distances, they move in and out of territorial waters. Promoting sustainable fishing through WTO subsidy rules is extremely difficult, as the WTO is not a regional fisheries management organization. It’s not the FAO, which has a strong record of identifying [harmful] subsidies for industry and agriculture..[and which has the] means to discipline those subsidies,” according to Rockwell.

The Time To Reform Fishing Subsidies is Now

The WTO’s draft text provides the technical tools to do the job, but political issues still need to be resolved, says Rockwell.

“For the first time in 20 years, we now have a single paper from which members can work. The text covers most all of the key areas in the negotiations, though some thorny issues will require a bit more time. There are no surprises. It is based on the work of this specific issue facilitators and proposals submitted directly by members. The text is solution-oriented. The language is clear, and Members will know precisely how and why it has evolved in the way that it has.”

It’s up to Member States, but time is running out. There remain “very political issues” to be resolved, says Rockwell, and since WTO is a member-driven organization, the ministers, ultimately, will have the final say. But time is running out.

“If we don’t set aside our differences in these negotiations [in July 2020], we will wake up one day and find there are no longer any fish over which to argue,” said Rockwell.

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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: FAO, UNCTAD.

Artist’s rendition of SARS-CoV-2, the virus that causes COVID-19

The United States has secured almost all of Gilead Sciences’ projected production of remdesivir – an antiviral that was shown to reduce hospitalization times for COVID-19 patients- for the next three months.

US Health and Human Services (HHS) has secured 100 percent of Gilead’s projected production for July (94,200 treatment courses), 90 percent of production in August (174,900 treatment courses), and 90 percent of production in September (232,800 treatment courses), in addition to an allocation for clinical trials, HHS announced in a press release.

But while painted as a win for United States patients, some are worried about what the supply looks like for the rest of the world.

Word Health Organization Health Emergencies Executive Director Mike Ryan on Wednesday said the agency was investigating reports on the US’ allocation of remdesivir, and also closely monitoring a strain of swine flu that may have pandemic potential.

“We’re aware of the reports in the media around this purchase or procurement of remdesivir stocks, and we’re obviously working through our colleagues and our partners and the access to Covid Tools Accelerator to clarify and verify this this report,” Ryan said in response to a query from the Financial Times regarding the US potentially “hoarding” remdesivir.

Swine Flu ‘G4’ Variant Being Monitored Closely

A swine flu variant, G4 EA H1N1, that captured headlines on Tuesday for its ‘pandemic potential’ has been monitored by WHO and health authorities since 2011, WHO Health Emergencies Executive Director Mike Ryan said Wednesday, attempting to ease fears that a pandemic flu strain could appear on top of this year’s deadly COVID-19 pandemic.

“It’s important I think to reassure people that this is not a new virus. This is a virus that is under surveillance,” said Ryan, in response to a query from Bloomberg News. “We are concerned with any viruses that your potential to infect humans, we will continue with our collaboration centers and the global influenza surveillance and response system to keep this virus under close surveillance.”

“It’s not an immediate threat where you’re seeing infections, but it’s something we need to keep our eye on, just the way we did in 2009 with the emergence of the swine flu,” Anthony Fauci, director of the United States National Institute of Allergies and Infectious Diseases (NIAID), told reporters Tuesday.

“The WHO has been collaborating on surveillance since 2011. The most recent publication is an [analysis] of that surveillance data over that time,” said Ryan on Wednesday.

The virus stirred attention after a paper published Tuesday described G4 EA H1N1 as having “all the essential hallmarks of a candidate pandemic virus.” The paper, Prevalent Eurasian avian-like H1N1 swine influenza virus with 2009 pandemic viral genes facilitating human infection, was published in the Proceedings of the National Academy of Sciences (PNAS) journal and authored by a team from the China Agricultural University.

The G4 EA H1N1 virus, part of a family of “G4” viruses that can make the jump from pigs to humans, may have characteristics of the H1N1 variant that caused the 2009 pandemic, or the deadlier variant that caused the 1918 Spanish flu, said Fauci.

And “of concern is that swine workers show elevated seroprevalence for G4 virus,” the authors wrote.

Some 10.4% of workers overall showed antibodies for the G4 virus, indicating they had likely been exposed to the virus at some point. The positivity rate in workers between 18 to 35 years old was almost double that.

However, there were no records of active, symptomatic infection.

“The likelihood that this particular variant is going to cause a pandemic is low,” Martha Nelson, an evolutionary biologist at the U.S. National Institutes of Health’s Fogarty International Center told Science News. Nelson studies pig influenza viruses in the United States and their spread to humans.

But other researchers, including Robert Webster, a retired influenza researcher from St. Jude’s Children’s Research Hospital, say flu can be a “guessing game.”

“We just do not know a pandemic is going to occur until the damn thing occurs,” Webster told Science News.

Image Credits: NIAID, Flickr: liz west.

Wind turbines in Derbyshire, United Kingdom, generate energy.

A landmark meeting hosted next week by the International Energy Agency (IEA) will bring together major powers to debate the key actions for a climate-friendly COVID-19 recovery in an online forum open to public viewing. 

The IEA Clean Energy Transitions Summit will be live-streamed July 9th, and bring together the world’s largest economies and developing countries, who generate 80% of global emissions. The meeting aims to develop plans to ramp up emissions-reducing projects to rapidly create new jobs in the wake of economic devastation wrought by the pandemic. 

Currently, major powers in attendance such as Germany, China and Indonesia already have recovery plans in the work that claim to center climate-friendly initiatives.

In a move counter to the administration’s usual dismissive stance on climate, the United States will also be sending a representative to a high-level virtual summit on a ‘green’ COVID-19 recovery on 9 July.

US Secretary of State for Energy, Dan Brouillette, will attend a meeting, according to the Guardian. 

“What kind of energy choices we make now will determine the decades to come,” IEA Executive Director Fatih Birol told the Guardian in an interview. “This will be critical for energy and climate change.”

Emissions have gone down dramatically as travel and trade came to a standstill during COVID-19 induced lockdowns, with clear waters in Venice canals and blue skies over New Delhi for the first time in ages. Emissions of noxious greenhouse gases such as NO2, monitored by the US National Aeronautics and Space Administration and the European Space Agency, have decreased in major cities around the world. 

But there is increasing worry that economic recovery efforts will cause a catastrophic rebound in emissions if there lacks a concerted effort to center climate-friendly initiatives.

Participation of Climate Dismissive Governments Key to Success

A global ‘green’ recovery can only succeed if countries dismissive of climate change – such as the United States – also sign on to the recovery plans.

“Even if governments do not take climate change as a key priority, they should still implement our sustainable recovery plan just to create jobs and to give economic growth. Renovating buildings, for instance, is a job machine,” Birol told the Guardian.

So far the US administration has been silent regarding a ‘climate-friendly’ pandemic recovery economy, even as UN agencies, the European Union, and individual countries like Norway and Germany endorse green recovery plans.

The US is set to withdraw from the 2015 Paris Agreement, a landmark deal meant to curb emissions to limit the rise of global temperatures, right before US presidential elections on 4 November, highlighting the importance of getting the major emitter on board for recovery plans now, said Birol. 

China’s energy minister, Zhang Jianhua, the EU commission’s vice-president, Frans Timmermans, and the UK’s business secretary, Alok Sharma, who is president of the 26th UN Conference of Parties climate talks (now postponed to next year), will be attending. Representatives from Indonesia, India, Brazil, and South Africa will also be in attendance.

Image Credits: Flickr: The Roaming Picture Taker.

Manufacturing COVID-19 vaccine at Pfizer

A COVID-19 vaccine candidate under development by pharma giant Pfizer and biotech firm BioNTech showed promise in interim results released Wednesday.

The vaccine candidate, BNT162b1, was able to induce the formation of antibodies that neutralized SARS-CoV-2, the virus that causes COVID-19, in all participants who received doses between 10ug to 30ug, according to a report posted on the preprint server MedRxiv. The report has not yet been peer-reviewed.

Seven days after the last injection, levels of neutralizing antibodies in those who received 10 µg and 30 µg of the vaccine 21 days apart were 1.8 to 2.8 times the level of neutralizing antibodies in recovered COVID-19 patients. 

“These preliminary data are encouraging in that they provide an initial signal that BNT162b1 targeting the RBD SARS-CoV-2 is able to produce neutralizing antibody responses in humans at or above the levels observed in convalescent sera – and that it does so at relatively low dose levels. We look forward to providing further data updates on BNT162b1,” said Ugur Sahin, M.D., CEO and Co-founder of BioNTech, in a press release.

The study placed 45 healthy volunteers between the ages of 18 to 55 into three groups for the initial analysis. Some 24 subjects received two injections of 10 µg and 30 µg, 12 subjects received a single injection of 100 µg, and 9 subjects received 2 doses of placebo control. However, the study did not include results from adults over 65 years of age and pregnant women. 

Three-quarters of the subjects in the first group experienced acute low-grade fever below 100 degrees Celsius, and some experienced minor to moderate pain at the injection site.

More trials must be done in order to test whether the vaccine can lower the likelihood of infection by 50%. But the preliminary results indicate that Phase ⅔ trials may be set to start in late July, as Pfizer Chief Executive Officer Albert Bourla told reporters in May. These trials may enroll up to 30,000 healthy volunteers

The Pfizer vaccine is one of 14 candidates currently in human trials. It is based on messenger RNA, a single-stranded construct that carries a blueprint for a protein immune cells can then learn to attack, the same model as the Moderna vaccine candidate.  

The Moderna vaccine also showed promising early results, inducing neutralizing antibodies in a small group of early volunteers, but further results have yet to be released.

Image Credits: Pfizer, Pfizer.

Dr Tedros at a June 2020 press briefing

The World Health Organization will be sending a mission to China on 6 July to investigate the origins of SARS-CoV-2, the virus that causes COVID-19, WHO Director-General Dr Tedros Adhanom Ghebreyesus subtly announced at a Monday press briefing.

The mission aims to fulfill decisions made in a unanimously passed World Health Assembly resolution in late May, which requested WHO work with World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and countries to “identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts.”

“We will send a team next week to China to prepare this and hopefully it will lead to a better understanding of how the virus started and what we can do in the future to prepare for it,” said Dr Tedros on Monday, in response to a query from a Brussel Times journalist following-up on the status of actions outlined in the resolution.

Two WHO experts will be sent on the initial scoping mission; an expert in animal health and an epidemiology expert with a background in investigating epidemics in the field, WHO Health Emergencies Executive Director Mike Ryan added on Wednesday.

While researchers largely believe that the virus jumped the animal-human barrier at a wet market in Wuhan, China, some have posited that the virus may have escaped from a high level virology lab within miles of the first cluster of confirmed cases.

The quiet announcement underlines the political tensions surrounding the investigation of origins of the virus, with WHO caught in an ongoing feud between China and the United States.

United States President Donald Trump has repeatedly slammed the World Health Organization for supposedly catering to China’s favor and delaying global responses to the pandemic, despite once praising the WHO and China response before COVID-19 reached US shores. Trump has made WHO’s supposed deference to China the main point of contention for withdrawing US support from the agency, even as the US continues to face an accelerating pandemic at home, reporting the highest numbers of new cases and hospitalizations daily.

But WHO has little authority over Member States’ actions, and must balance criticising pandemic responses with retaining access to data and knowledge.

The first WHO mission to China was delicately arranged at the end of January, after Chinese authorities locked down the Wuhan, a city of 11 million people, following a spike in cases due to a delayed response in early January. Since largely coming out of lockdown in May, the outbreak in China has been tightly controlled. However, new clusters of cases in Jilin province, Wuhan city, and the capital of Beijing have sparked great unease and second rounds of lockdowns.

Coal miners in India’s resource-rich Meghalaya State. A government tribunal banned coal mining in the region in 2015.

New Delhi, India – Prime Minister Narendra’s Modi’s ambitious plan to use coal to power India’s economic revival after his government’s strict lockdowns flattened the wrong curve, bringing economic growth to a halt even as the infection epidemic curve continued to rise, seems to have run into significant opposition from unexpected quarters.

Since the launch of his plan earlier this month, state after Indian state has expressed disagreement with the Centre’s plan to commercially auction coal mines to the private sector, including international players. The latest to join the clamour of opposition by the states of Chhattisgarh, Jharkhand and Maharashtra, where more than half of the 41 mines are located – is the politically powerful chief minister of West Bengal, Mamata Banerjee. 

Indian environmentalists have also decried a seemingly desperate announcement by the government to auction off 41 Indian coal mines, opening a largely government-controlled sector up to all private investment for the first time ever – and thus greatly accelerating domestic coal production. 

Coal mining by Eastern Coalfields Ltd., the company that operates national coalfields in Jharkhand and West Bengal states.

As of now, two government-owned mines produce over 90 % of India’s coal. Indian coal, known for its high fly ash content– and therefore pollution emissions – currently supplies about 80% of the country’s total coal needs, while the rest is imported.  Coal, in turn, powers about 44% of the total energy needs, compared to oil (24%) and biomass (22%) – though the latter is often burned in highly polluting domestic cookstoves emitting climate-changing black carbon particles. Also, hydroelectric power supplies 1.4% of the economy, leaving solar and wind to supply only around 0.8% of the country’s total power needs.

When it comes to electricity generation, the picture is just a little bit better. Coal powers 73% of electricity in India, while solar and wind fuel around 8% and hydro around 12% respectively, said Karthik Ganesan, Research Fellow, Council on Energy, Environment and Water.

Clean air campaigners had hoped that the glimpse of blue skies, clean water bodies and nature restoring itself in the limbo provided by the lockdown of all growth engines would encourage decision-makers to choose a growth recovery path that had low environmental impact. Health and environmentalist activists had expected the government to look at growth recovery more holistically, which meant including developmental indicators like health, education and quality of life – in the spirit of the recent WHO manifesto for a healthy green recovery, which calls to put a stop to fossil fuel subsidies using taxpayer money. 

Unfortunately, India seems to be ignoring all of the recent health and climate warming signals  –  the latest being the swarms of locusts that are invading parts of the country as it focuses on coal to fuel its recovery. 

Ostensibly, Modi’s rationale is that the move will help make India energy self-sufficient and quickly claw back the robust growth curve that had begun to fall off even before the COVID-19 pandemic struck the country.  However, investing heavily in coal also serves some of his key political alliances, some of whom – like the Adani Group – are also planning to export massive new coal reserves from Australia to India. 

Opposition to Modi’s Move Growing in India 
Existing, new, and planned coal mines in India (Credit: R. Pearce, T. Prater, S. Evans/Carbon Brief)

Despite the pressing economic challenges that India admittedly does face, some leading Indian politicians are beginning to speak out in opposition to the coal mining plans – bringing this sector back into centre stage for the first time since “Coalgate,’ a coal scam that tainted the previous government a decade ago. 

Jharkhand state has already approached the Supreme Court challenging this auction, followed by Chhattisgarh and Maharashtra writing to the central environment minister Prakash Javadekar objecting to the auction. The latest to join the rising voice of critics is the feisty Chief Minister of West Bengal (and Modi’s bete noire) Mamata Banerjee, known for her blunt statements and ability to stand up to the central government. 

Last Thursday, Ms Banerjee wrote to Modi on Thursday, asking him to reconsider the decision, saying that “this policy can neither bring foreign direct investments not can it bring technologies or know-how which we are unable to access today,” and noting that global investors are more interested in renewable energy projects rather than coal, which offers low returns. None of the 41 mines coming up for auction are located in her state. Her objection is in principle and adds political weight to the growing opposition.

States like Jharkhand, Maharashtra and Chhattisgarh, where more than half the mines coming up for auction are located, have already voiced opposition to this decision, citing huge environmental and social costs:

“Riding on coal could spur the economy in the very short term and an extremely high ecological and social cost”, said Niraj Bhatt, Researcher in Environment and Climate Action for the Chennai-based Citizen consumer and civic Action Group (CAG), who works in the coal sector. The long term costs of promoting coal are disastrous, even in the government’s very first Climate Assessment report. The report warns of a four-fold increase in heat wave frequency and a doubling in the length of heat waves in India by 2100.

“It is inexplicable why the government is prioritizing coal for fast track revival of the Indian economy since the pandemic”, given the knowledge that’s available, added Bhatt.

 Many local communities also are opposed to the government’s decision to privatize coal mining, fearing that this will degrade the environment. Most of the 41 coal mines in auction are in pristine forest areas. 

Even at the village-level, several panchayats (local governance bodies that make the fundamental building blocks of governance) have asked Modi to withdraw this auction. “Nine village panchayats from Hasdeo Arand forest region have written to the Prime-minister asking for withdrawing the auction of five coal blocks in the region for commercial mining as it would impact their livelihood and culture,” said Avinash Kumar Chanchal, a grassroots climate activist who has written on the degradation of the Singrauli coal belt and displacement of local communities. 

UN Secretary General Also Decries Coal Plans 

 

United Nations Secretary-General Antonio Guterres has said there is no reason for any country to include coal in the COVID-19 recovery plans. Instead, investments should be made towards non-polluting energy sources; and opposition to a “black, coal-powered recovery” has grown in India.

It isn’t clear whether this diplomatic rap on the knuckles and growing opposition will succeed in stopping the government in its polluting tracks, especially if Modi’s public statements on privatising coal mines – framed in his signature style with the bells and whistles of patriotism and nationalism for “atma-nirbharta” or self-reliance – are anything to go by. Desperate for funds and eager to kickstart a sluggish economy threatening to fall into a recession, the central government seems prepared to roadroll its way through. Its desperation stems from predictions of the most severe recession in the past the four decades – The International Monetary Fund has predicted a global annual downturn of 4.5%, though ratings firm India Ratings has predicted the Indian economy to contract by 5.3% this year.

Renewable Energy Offers Untapped Potential 

Analysts say that the government is gambling on coal mining to generate over a million of jobs, as it is labour-intensive and rural communities are increasingly desperate for jobs following mass reverse migration since the pandemic began.

Additionally, there is built-in momentum for coal power development, since it is already well-established and subsidized by the government – whereas renewables are a new game altogether, and energy storage issues still remain unresolved – as some critics claim.  

Activists and economists counter that government forces have ignored the potential of alternative energy sources at the current juncture:

“There is huge potential to generate new jobs in renewable energy. Some analyses have estimated that more than one million jobs can be created by the renewable sector by 2022 if India can achieve its ambitious renewable target of 160GW,” said Chanchal.

“The illusion of low cost energy from coal has been debunked globally. Socially, environmentally and economically, coal is very costly. It’s bad economic policy to invest in high cost options when cheaper alternatives exist today,” added Laveesh Bhandari, an economist turned environmental advocate, who works at the intersection of sustainable employment and climate change.

“It’s almost as if we’re moving backwards. The whole world is moving away from coal. Several studies in India have shown the adverse effects of pollution caused by coal mining on the health of communities living within coal mining areas, especially on the respiratory system.”

Even before pandemic, deaths from air pollution have been a major issue in India. In 2016, household pollution led to over a million deaths in India, according to the WHO’s Global Health Observatory; and in 2012, ambient air pollution claimed 620 000 Indian lives, with a shocking toll of over 20 million disability-adjusted life years (DALY), according to the WHO’s global assessment of exposure and burden of disease.

However, now there is also the added factor of COVID-19, in which case chronic heavy exposures to air pollution will also increase vulnerability from the virus as well as mortality, said grassroots environmentalist and writer Rinchin, who goes by one name only and works with adivasis in Chhattisgarh. 

“Whether the Centre can still go ahead is a legal issue, but it will be bad form to go against the position of state governments. India is a federation, and something like mining that impacts not only the environment, but society itself therefore needs to be overseen, regulated and controlled by the state”, added Bhandari.

India’s Ambition – Regional Energy Supplier? 
Coal mining in India

While Modi is framing the coal auction as a move towards greater national self-reliance, the story is in fact more complex.  His plan may involve ambitions to become a regional energy-producing power. It also aligns national policy with the commercial interests of close political allies – such as Indian billionaire Gautam Adani, and head of the powerful Adani group.  

Adani is leading the Carmichael project – a massive mining initiative to export Australian coal to India. Just last year, the Australia’s government gave the go-ahead for the project, the world’s largest open pit mine, overriding stiff opposition from Australian environmentalists.  

Adani plans to use the Australian coal for a new $2 billion power plant that his company is building in India, which will also produce electricity for sale in neighboring Bangladesh. Ever since Modi was the chief minister of the western state of Gujarat – Adani’s birthplace and home region – Adani and Modi were known to have close links.

“The story of Adani and its Australian project illustrates why the world keeps burning coal despite its profound danger — and despite falling prices for options like natural gas, wind and solar,” the New York Times said last year.

In fact, India’s coal ambitions under Modi will not just undermine existing efforts to limit climate change and worsen air and water pollution within the country, they are also likely to compromise the entire region, setting an undesirable example of fossil fuel dependency in neighbouring countries.

Little Matter of Coal Gasification 
Air pollution in Delhi, India

Then, there is that little matter of Modi’s plans for coal gasification – a technology that could further reduce India’s dependence on imports, but at an even higher level of carbon emissions – as well as potential water contamination from coal pollutants.  

The government’s current plan is to promote “syngas” -a substitute for imported liquified natural gas produced by coal gasification – to produce urea in fertilizer. This will not only help reduce liquified natural gas (LNG) imports but also urea imports, leading to a lower import bill and greater self-reliance.

According to the Ministry of Chemicals and Fertilisers, urea is currently produced using pooled natural gas, which consists of both domestic natural gas and imported LNG. The usage of locally available coal for making fertilisers would help reduce the import of LNG, the Ministry has said.

“The big question is when we have cleaner, cheaper, and sustainable renewable energy sources why do we want to invest in dirty and polluting technologies and energy sources?
India is already facing a climate crisis,” said Chanchal.

While natural gas is considered a lower climate emitter than coal, syngas is just the opposite. A study by Duke University found that syngas produced by coal gasification emits seven times more greenhouse gases than natural gas, making it a  huge contributor to climate change. 

“It contaminates both surface water and groundwater, and also emits greenhouse gases. If renewable energy is available and becoming cheaper day by day, then why does the government want to start commercial mining to create coal based energy.”

“Right now, the government is speaking like a climate leader but acting like a climate laggard by betting high on coal and promoting it,” added Bhatt.

Mining Could Also Increase Dangerous Human-Wildlife Conflicts
Dog sleeps on a bed of coal in Asansol, India

Along with the climate and air pollution risks, activists have also warned that expanding mining operations in the areas up for auction could trigger increased human-wildlife conflict.

“Among the 41 coal mines up for auction, most are situated in the dense forest of central India,” said  Chanchal. “These forests are home to large populations of elephants and other wildlife. Some proposed coal blocks are also near tiger reserves, like in Maharashtra. 

“Along with vast forest destruction, coal mines will also increase the human-wildlife conflict. The implications are countless from the displacement of adivasis, to the violation of the Forest Rights Act, to public health,” said Chanchal, who has also written The Singrauli Files about the degradation of that region. 

“We have already seen how coal mines destroyed the rich biodiversity of places like Singrauli, Korba, and in other coal belts where thousands of adivasi and local communities were displaced, their forests, livelihood and human rights violated. They are already living with serious health crises,” he added.

In a parallel move, Modi’s Ministry of Environment and Forestry also has launched an initiative to dilute existing environmental impact assessment norms for the creation of industries in pristine areas, including, but not limited to coal – a move that has been staunchly opposed by environmentalists – but action on that has been postponed by the courts until August. 

Modi Still Likely to Face Bureaucratic Challenges 
India’s Prime Minister Narendra Modi

Despite the burgeoning opposition, Modi remains determined and eager to develop the private coal sector. Against the wave of new criticism he has remained silent  – a typical tactic of response. 

However, India’s federal structure of governance may still slow down the realization of his vision considerably – giving environmentalist valuable time to mount a more organized local and global opposition. 

In the Indian governance model, the central government is expected to execute policy in consultation with state governments on a consensus model. More importantly, if the land is pristine forest land, as in this case, local self-governance laws and the FRA will make it challenging for it to move ahead with coal block allocation in such areas, which may still stave off this path to a quicker, but blacker, revival.

“Land is a state subject, the Centre cannot go ahead without support from the states,” said Bhatt. “The implementation of the Forest Rights Act is also very crucial in these regions. The government which is promoting ‘atma-nirbhar Bharat’ should consider these concerns of local communities and take appropriate action to strengthen the self-governance of the gram sabha,” adds Chanchal.

Image Credits: Environmental Change and Security Program, Flickr: Partha Sarathi Sahana, R. Pearce, T. Prater, S. Evans/Carbon Brief, Environmental Change and Security Program, Wikimedia Commons: Prami.ap90, Flickr: Partha Sarathi Sahana, Mike Bloomberg.

Vial of remdesivir

A six-vial five-day course of remdesivir – a promising COVID-19 treatment – will be priced at US $2340, or $390 per vial for developed countries, Gilead Sciences Chief Executive Officer Daniel O’Day wrote in an open letter on Monday.

“Earlier hospital discharge [thanks to treatment by remdesivir] would result in hospital savings of approximately $12,000 per patient,” wrote O’Day. “We have decided to price remdesivir well below this value.”

But the price is still high compared to the cost of manufacturing, according to medicines access experts, who say that remdesivir could be produced for below a dollar a day.

Private insurers in the United States will pay US $3,120 for a five-day course, or $520 per vial. Out-of-pocket payments will be determined by individuals’ coverage plans.

In 127 developing countries, Gilead has allowed generics companies to manufacture the drug, pricing a five-day course at about US $600.

Cost of production for the drug can be as low as US $0.93 per day, according to a paper by Dr Andrew Hill, a senior visiting research fellow at the University of Liverpool, and his colleagues.

“Gilead will turn a nice profit with its set price. Especially considering that the company has benefitted from significant government financing for the development of the drug; which apparently has not been discounted,” Ellen t’Hoen, director of Medicines, Law and Policy, told Health Policy Watch.

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

“Based on publicly available data, it has been estimated that taxpayers have contributed at least $70.5 million to develop this drug,” Jessica Burry, a pharmacist at Médecins Sans Frontières Access Campaign, said to Health Policy Watch. “Additionally, contributions were made by various health organisations, including MSF, which supported clinical trials with this drug for Ebola in 2019. Patients themselves have also contributed by their participation in the trials.

“Public funding and resources have contributed to the drug’s further development for COVID-19, and taxpayers will now end up essentially “paying twice” to  access this treatment,” added Burry.

The company could turn a US $2.3 billion profit on the “blockbuster” drug this year alone, according to a blog by Ellen t’Hoen.

“This does put pharma’s lofty promises of not profiteering during the pandemic into perspective. I hope governments begin to realise that the important investments they make for the development of drugs and vaccines to respond to COVID-19 need to come with strings attached to ensure fair pricing and global access,” she said.

COVID-19 Cases Surge Past 10,000,000, Deaths Reach Half A Million

Meanwhile, the World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus warned on Monday that “the worst was yet to come.”

Dr Tedros spoke at a press conference just as the number of deaths from COVID-19 topped half a million, and cumulative cases surged past 10,000,000. The US and Brazil continue to report around 40,000 new cases day.

In the state of Texas, which saw one of the fastest rising daily case counts after reopening, hospitals in the capital city of Houston are nearing ICU capacity.

Even as Vice President Mike Pence lauded the state’s reopening at a press briefing Monday, Texas Governor Greg Abbot warned that the epidemic had taken a “very swift and very dangerous turn.” Abbot shut down bars and clubs again across the state in an attempt to limit the fast-spreading virus.

Remdesivir Pricing Announcement Comes On Heels Of EMA Conditional Marketing Authorization Endorsement

Remdesivir, a failed Ebola antiviral, is one of the frontrunner drugs for treating COVID-19. It was shown to significantly reduce the length of hospital stay from an average of 11 days to an average of 15 days in a recent trial funded by the US National Institute of Allergies and Infectious Diseases (NIAID). However, the NIAID trial results were based on a 10-day treatment course, rather than the 5-day course that Gilead has currently priced. And studies have so far not reported any effects in reducing mortality.

Still, the European Medicines Agency recently renewed their endorsement of the drug, recommending the agency give remdesivir conditional marketing authorization – a stamp of approval that many European Union countries use as guidance for approving drugs for diseases with few cures.

Remdesivir is currently approved for use in Japan for COVID-19 patients. The United States Food and Drug Administration has approved the treatment for ’emergency’ use, just two days after the NIAID trial results were announced.

The announcement comes just as Gilead’s promise to donate remdesivir until the end of June 2020 hits its deadline. US Health and Human Services Secretary Alex Azar announced Monday that the government had secured another half a million treatment courses of remdesivir for U.S. hospitals through September, according to an interview with “Good Morning America.”

Health and Human Services will be paying the US $390 per vial price, and be responsible for allocating Gilead’s supply of remdesivir, according to O’Day’s letter.

But some middle income countries that are hoping to secure their own supply of remdesivir may be out of luck, according to Burry.

“Gilead has entered into license agreements with several generic companies in India, Pakistan and Egypt. The license, however, excludes nearly half of the world’s population, including most South American countries and a number of middle-income countries, such as Brazil, Russia and China,” said Burry. “Since the corporation has barely been able to supply enough quantities of this drug even to the US, it is highly unlikely that it will be able to meet the demands of all the other countries that have not been included in this license.”

Brazil Signs Contract To Produce AstraZeneca & Oxford COVID-19 Vaccine Candidate; China Approves CanSino Vaccine Candidate For Military Use

In a parallel development, Brazil on Saturday signed a contract with AstraZeneca and Oxford to manufacture an experimental COVID-19 vaccine candidate. Meanwhile, China approved the CanSino COVID-19 vaccine candidate for military use on Thursday.

Local vaccine manufacturer Fiocruz will be producing up to 100 million doses of the vaccine overall, Brazilian authorities announced at a press briefing. The country will pay $127 million to receive material to produce 30.4 million doses in two batches in December and January, with the rest to come later.

China’s Central Military Commission approved the CanSino vaccine for use by the military for a period of one year beginning 25 June 2020, according to a CanSino filing. The Academy of Military Sciences had jointly developed the vaccine candidate with CanSino.

Results from a small, non-randomized trial released in May found that about 75% of people who received high doses of the CanSino vaccine candidate developed antibodies that neutralized SARS-CoV-2, the virus that causes COVID-19, after 28 days. However, the developers highlight that large, randomized control trials must be done in order to determine if the vaccine truly protects against infection by the virus.

And other researchers pointed to old concerns with the Ad5 vector used in the CanSino vaccine. Previous Ad5-vectored vaccine candidates for HIV were dropped after early trials showed the experimental vaccine inadvertently increased the risk of HIV infection.

This story was updated 30 June 2020.

Image Credits: European Medicines Agency, NIAID, World Health Organization, NIAID.