WHO experts at a July 7 virtual press briefing

The World Health Organization said Tuesday that it would reconsider its longtime stance that airborne transmission of the SARS-CoV-2 virus occurs only rarely – after a group of over 239 scientists published a commentary on Monday in the Journal of Clinical Infectious Diseases, urging the agency to acknowledge the greater role played by tiny virus particles emitted from route breathing and speech in driving COVID-19’s spread.

Currently, WHO maintains that the main route of virus transmission is via larger droplets – expelled by people coughing and sneezing at close range into the noses, mouths, and eyes of uninfected people nearby.

While the distinction may seem esoteric to some – it is critical to disease control policy decisions. Since most large, liquid droplets fall quickly to the ground, assuming disease spread is via droplets has also precluded a strong WHO position on the usefulness of masks, or on the infection risks within indoor settings, from restaurants to offices.

“We have been engaged with this group since April, when they first wrote to us,” said WHO COVID-19 Technical Lead Maria Van Kerkhove. “We have been talking about the possibility of airborne and aerosol transmission, as one of the modes of transmission of COVID-19, as well as droplets, fomites [surface contamination], fecal-oral, mother-to-child, and animal-to-human transmission. We are producing a scientific brief summarizing where we are… [and] we will be issuing our briefing in the coming days.”

“We acknowledge that there is emerging evidence in this field… regarding the COVID-19 virus and pandemic, and therefore we believe that we have to be open to this evidence, and understand its implications regarding [the virus’] mode of transmission and precautions that need to be taken,”  added Benedetta Allegranzi, Infection Prevention and Control Lead at WHO.

Some of WHO’s recommendations already account for the possibility of airborne spread of the virus, according to WHO Chief Scientist Soumya Swaminathan, speaking at the press event. For example, WHO recommends avoiding crowded settings and ensuring proper ventilation in indoor areas.

Emerging infectious disease epidemiologist Stephen Morse explains ‘social distancing’ in a video produced by Columbia University Mailman School of Public Health

However experts interviewed by Health Policy Watch and other media have complained that WHO’s guidelines are based on out of date evidence, overly rigid and medicalized – thus failing to account for the rapidly evolving evidence about virus transmission via tiny airborne particles that can travel much further than liquid droplets, remain suspended for longer in the air, and spread further over time closed or poorly ventilated rooms.

“The infection control folks sort of helping WHO set their policies think of particles in two ways – Droplets, which are very large, or…. small droplet nuclei, which is their term for particles in air… the can travel far from the source,” said Lisa Brosseau, an industrial hygienist studying aerosol transmission at the Center for Infectious Disease Research and Policy. “What they don’t seem to recognize in that dichotomy, is that when you cough and sneeze and talk and breathe, you actually generate lots of smaller particles.”

“Personally, I think the WHO should stop arguing what looks like semantics to much of the outside world. Science adapts to new information,” Stephen Morse, emerging infectious disease epidemiologist and influenza expert at Columbia University told Health Policy Watch. “The terminology is terribly confused, and therefore unfortunately leads to a great deal of confusion.

“When someone sneezes, coughs, talks loudly, etc., it generates a range of particles. The larger ones are droplets, which are fairly heavy and generally go only a short distance before falling to the ground (hence the “6 ft” rule).  Finer particles can stay in the air longer and go further; some can stay airborne for long periods and go long distances in the wind (remember the Sahara dust that just passed our way?). Unfortunately, the varying definitions give people the wrong impression that there is some sort of dichotomy.  It’s not an ‘either/or’.

“In my opinion (nothing more), infection probably does occur by both droplets and fine particles [that can remain 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.

“The confusion may arise, in part, from the distinction between “droplet” and “airborne” transmission made by infection control practitioners [in hospital settings]. I think the problem is that they didn’t have better words to use when they were developing the guidelines,” said Morse.

Experts Head to China in Quest for Animal Sources of the Virus

In a parallel development, WHO scientists will also be going to China this weekend in order to track down the zoonotic origins of COVID-19, Dr Tedros announced. The WHO team will be collaborating with Chinese counterparts to define a scope of work and terms of reference.

“The mission objective is to advance the understanding of animal hosts for COVID-19 and ascertain how the disease jump between animals and humans,” said Dr Tedros.

Still, hunting down the animal origins of the virus is not as simple as it sounds. The virus may circulate in some host animals in the wild, and then pass through other animals that are more likely to pass the disease onto humans. These so-called ‘intermediate hosts’ can be difficult to identify, according to WHO Executive Director of Health Emergencies, Mike Ryan.

“The narrative of this virus into the human population is extremely important, but it’s not always a straightforward process of being able to get that answer. I know that sounds obtuse, but there are many dead ends to study these things,” said Ryan. “We spent many years trying to look up the source for Ebola and the intermediate host, and we still, even in Ebola, have difficulties with identifying the intermediate hosts.”

Brazilian President Contracts COVID-19 After Months Of Scorning Measures To Slow The Pandemic

Meanwhile, as new COVID-19 cases continued to rise sharply in the Americas and India – the latest global hotspots – WHO  Director General Dr Tedros Adhanom Ghebreyesus told reporters that the world has “not yet reached the peak of the pandemic” .

His dire warning came as Brazil’s President Jair Bolsonaro tested positive for COVID-19 and more than 400,000 new COVID-19 cases were reported worldwide over the past weekend. In comparison, it took 12 weeks for the pandemic to hit the first 400,000 cases.

Cumulative (red) and Active (orange dots) COVID-19 cases around the world as of 7:35PM CET July 7 2020. Numbers change rapidly.

Bolsonaro’s infection came after months in which his government continually downplayed the seriousness of the COVID-19 pandemic, even while Brazil now has the largest number of confirmed cases in the world, second only to the United States, with India trailing in third place.

In a fairly dismissive announcement of his test results, Bolsonaro declared on Brazilian national television Tuesday that “everyone knew that it would reach a considerable part of the population sooner or later.

“On Sunday, I wasn’t feeling very well. On Monday, it got worse when I started feeling tired and some muscle pain. I also had a 38-degree [Celsius] fever. Given those symptoms, the presidential doctor said there was suspicion of COVID-19,” Bolsonaro said.
Bolsonaro’s diagnosis comes as Brazil recorded more than 1.6 million cumulative COVID-19 cases. Like parts of the US, many places in Brazil are operating “business-as-usual,” with retail shops, restaurants, bars, and churches open for public use.
“The number in Brazil has stabilized… and moved down in the past days. However, the hospital system still remains under pressure,” said Ryan.
But Brazil isn’t the only area in trouble – cases are on the rise across Latin America in hotspots like Mexico, Peru, and Chile. The case seems dire in Mexico, which has the eighth highest number of coronavirus cases in the world, but ranks 4th in the highest number of deaths.

“The whole of Latin America doesn’t look good. Cases are on the rise. Deaths are on the rise,” said Dr Tedros, adding that the only country WHO was not concerned about was Canada, where new cases have dropped to a few hundred a day. In one bright spot, the Caribbean countries also appear to be controlling the virus’ spread.

Elsewhere, India and Russia have also seen a surge in cases. India’s number of new cases reported daily is still on the rise, and the country now has over 700,000 cumulative cases. Russia has more than 690,000 cases, but new cases seem to be on the decline. Currently, the US has the most COVID-19 cases in the world with almost 3 million cumulative cases.

Image Credits: Columbia University Mailman School of Public Health, Johns Hopkins CSSE.

Healthcare workers in the Western Cape suit up to take care of COVID-19 patients.

Cape Town, South Africa  – The US government’s recent purchase of almost the entire available stock of Gilead’s remdesivir – a medicine shown to help speed up the recovery of people who are moderately sick with COVID-19 – has raised fears about whether poorer countries will also be left in the dust if a vaccine is developed.

South Africa recently appealed to the World Trade Organisation (WTO) to explore “multilateral cooperation” to find “an innovative solution” in light of such concerns.

“In anticipation that intellectual property may pose a barrier to access, several ad-hoc unilateral initiatives have emerged,” South Africa’s Dr Mustaqeem de Gama told a recent informal meeting of the WTO’s ’s Council on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

“However, these initiatives, while commendable, are simply inadequate to address the intellectual property barriers,” added De Gama.

For example, pharmaceutical companies with patents could opt not to join these mostly voluntary initiatives, or issue licenses for generics of their medicines to manufacturers in only a few select countries, warned De Gama.

In the case of remdesivir, Gilead has issued voluntary licenses to manufacturers to produce the medicine for 127 countries including South Africa – but Brazil, China and Mexico are excluded. A single vial of the generic version will cost US $55 according to South African reports, while the medicine in will cost US $390 per vial in US hospitals.

Taking Concerns About Access Barriers to the WTO
WTO TRIPS Council meeting, pre-pandemic.

Sidwell Medupe, spokesperson for South Africa’s Department of Trade and Industry, said that South Africa aimed to “to encourage a discussion within the WTO TRIPS Council that will promote multilateral cooperation”, including “pooling rights to technologies that are useful for the detection, prevention, control and treatment of the COVID-19 pandemic.”

De Gama stressed that “an effective response to the COVID-19 pandemic requires rapid access to affordable medical products” – but many developing countries faced “legal, technical and institutional challenges in using TRIPS flexibilities.”

A key TRIPS flexibility allows governments to issue compulsory licenses to generic companies to make pharmaceutical products without the permission of patent holders.

But many countries’ own patent laws either don’t allow for compulsory licenses or involve “time-consuming” processes, warned De Gama.

South Africa itself has yet to amend its 1978 patent law to allow for compulsory licensing, despite adopting a national policy committing it to doing so two years ago.

And despite the TRIPS flexibilities, the issuing of compulsory licenses is not common – partly because pharmaceutical companies are often involved in intense lobbying of governments to prevent this.

Brazil and Thailand used compulsory licenses to get access to cheaper antiretroviral medication to address HIV, but South Africa did not take this route despite having the largest HIV positive population in the world.

Instead, South Africa largely imported cheaper ARVs via generic companies in countries such as India with the help of a number of global initiatives. These include  UNITAID’s Medical Patent Pool (MPP). Set up in 2010, the MPP negotiated with pharmaceutical companies to issue voluntary licenses to generic manufacturers to make ARVs for developing countries, particularly sub-Saharan countries.

Compulsory Licenses may be the ‘Most Powerful’ Access Instruments Available to Countries
WTO Headquarters in Geneva

Hu Yuan Qiong, senior legal and policy advisor for Médecins Sans Frontières’ Access Campaign, says that in the context of TRIPS, “compulsory licenses are the most powerful instrument that countries can use right now.”

Even some high-income countries, who don’t normally talk about these licenses, are starting to take notice.

“Many countries have talked about compulsory licenses since the start of the pandemic. We have seen countries like Germany, Canada and Australia changing their laws to make compulsory licenses easier and more automatic and comprehensive so they can quickly issue one to allow for importation, local production or whatever they need to get access to the technology to address COVID-19,” says Hu, who is based in Geneva.

Chile, Ecuador and Brazil are also considering making it easier to issue compulsory licenses.

Still, “we haven’t seen this with developing countries, although it isn’t easy to do a compulsory license in many of these countries, including in South Africa,” says Hu.

She adds that “compulsory licensing is still a territorial response that relies on national laws and how flexible the law is.”

In addition, manufacturing some medical products – such as ventilators – might involve more than one patent, “so more regional and ultimately global flexibility would be more ideal.

“From MSF’s perspective, a better solution would be to suspend the application of intellectual property rights on medical tools related to COVID-19 for the time being,” said Hu

Upfront, Global Agreements Required to Secure Access

Andy Gray, a senior lecturer in pharmaceutical sciences at the University of KwaZulu-Natal in South Africa, agrees with Hu that, in the case of the development of a vaccine or COVID-19 treatment, “country-by-country flexibility isn’t that helpful when what we need is an upfront agreement.”

“With a COVID-19 vaccine, for example, it is unlikely that one company will be able to meet global demand. So if a company develops a vaccine, it should commit to issuing voluntary licenses to other companies before it is even granted a patent,” says Gray. “There has also been a lot of public investment in the development of vaccines. A condition for the investment of public money in vaccine development should be that the company which has benefited commits to issuing voluntary licenses. This should be an upfront agreement as a condition for the use of public money.”

The COVID-19 Vaccine Global Access (COVAX) initiative announced recently by the global vaccine alliance, GAVI, has been criticised for failing to extract upfront access agreements from the pharmaceutical companies that are getting public funds for vaccine development.

In a letter to the GAVI board, 45 civil society organisations criticised COVAX for being based on a “business as usual” approach to intellectual property in which “pharmaceutical  companies are allowed to retain and pursue rights to  vaccines under development, resulting in vaccines that are  proprietary  and  under  the  monopoly  control  of  individual  companies.”

“Since  there  has  been  no  change  in  how  intellectual  property  is  handled  during  the  pandemic,  pharmaceutical  companies  are  able  to  monopolise  future  COVID-19 vaccines and decide who does and does not get access,” the NGOs warned.

A COVID-19 Vaccine Must be a ‘People’s Vaccine’
Shabir Madhi, Principal Investigator of the first Covid-19 vaccine trial in South Africa

South Africa is a key partner in a global lobby for a “people’s vaccine” for COVID-19, and it has united with 139 other countries and prominent leaders to advocate that “all vaccines, treatments and tests be patent-free, mass produced, distributed fairly and made available to all people, in all countries, free of charge.”

Announcing the initiative, South African president Cyril Ramaphosa and head of the African Union said, “As the countries of Africa, we are resolute that the COVID-19 vaccine must be patent-free, rapidly made and distributed, and free for all. All the science must be shared between governments. Nobody should be pushed to the back of the vaccine queue because of where they live or what they earn.”

The “people’s vaccine” initiative advocates for a “global agreement on COVID-19 vaccines, diagnostics and treatments” that “ensures mandatory worldwide sharing of all COVID-19 related knowledge, data and technologies with a pool of COVID-19 licenses freely available to all countries.” The World Health Organization would be responsible for overseeing this agreement.

MSF’s Hu says it cannot be business as usual with COVID-19.

“If we look at the COVID-19 vaccine, there are so many companies involved and so many people are joining clinical trials worldwide trying to find solutions,” she said. “But eventually, governments and global health institutes end up negotiating with the same pharmaceutical companies.

“It’s the same old business model,” she laments. “The vaccine and technologies are held by the same companies. It is a piecemeal solution where different countries have different laws. It’s going to be an endless story unless there is a global agreement.”

 

Image Credits: Government ZA, WTO, Kerry Cullinan.

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.