Peru – Mobile truck screens for Tuberculosis in one of the poorest districts of Lima, Carabayllo.

A 3-month long lockdown could lead to an additional 1.4 million TB deaths and an additional 6.3 million cases over the next five years – if existing tuberculosis services are put on a prolonged hold, reports a new study by the Stop TB Partnership, which estimated the global impact of COVID-19 lockdowns on TB. The study has important implications for policymakers as they struggle to balance the length of lockdowns with other impacts, including on health systems. 

However, if TB services are rapidly restored, the long-lasting impacts of the COVID-19 lockdown on TB could be minimized, concludes the study, released on Wednesday. In the best case scenario of a 2-month lockdown and an ‘enhanced’ 2-month long recovery period, there would be a 4% increase in TB deaths (342,500) and 3% increase in TB cases (1,826,400) over the next 5 years, predicted the researchers.

Existing TB services thus need to be restored as quickly as possible; otherwise COVID-imposed lockdowns could set back the fight against tuberculosis by 5-8 years, warned the Stop TB Partnership’s Executive Director, Lucica Ditiu, in an interview with Health Policy Watch:

“In the agitation of COVID, it appears people forgot that there are other diseases…all existing financial efforts and tools have been disrupted or diverted, and all the efforts you have made for the past 5-8 years may be gone.

“By disrupting existing services, we will pay this price later and it will cost us much more,” said Ditiu.

TB is the biggest infectious disease killer worldwide, leading to 1.5 million deaths and 10 million cases every year.  The mortality rate from TB is about 3% – equal or even greater to that of COVID-19, depending on the estimates. It is estimated that about a quarter of the world’s population has at some time in their lives been infected by TB – although many infections also remain latent and are eventually overcome by the body’s own defenses. 

TB incidence and mortality dynamics following COVID-19 lockdown

The USAID-supported study, carried out by Imperial College, Avenir Health, and Johns Hopkins University examined two scenarios for how the pandemic might impact TB prevention, treatment and control.  

In the study, a number of scenarios were modelled, including 2-3 month lockdowns and 3-10 month recovery periods. The study finds that on average, for every month of lockdown, there would be an excess of 130 000 deaths and 600 000 cases of TB per month. 

In the worst case scenario,  a 3-month long lockdown and a slow 10-month long recovery period could lead to an additional 1,367,300 deaths in the next five years, increasing total TB deaths by 16%. In this scenario, TB cases would increase by 10% to 6,331,100 cases over the next 5 years. 

The “worst-case scenario” reported by the study is probably an underestimate, said Ditiu.

“The restoration period is likely to be more than 10 months because it looks like lockdowns are going to continue. I think that we will see a much bigger mortality than the modelling study suggests.”

The study’s authors contend that these are probably underestimates of true TB infection and death trends, mainly because they did not include underlying comorbidities like direct interactions between the Tuberculosis bacterium and the SARS-CoV-2 virus. There is already some evidence that people with TB history or existing TB are more vulnerable to the SARS-CoV-2 virus, just like any other patient with an underlying illness, said Deputy Executive Director of the Stop TB Partnership Suvanand Sahu, in a webinar Tuesday launching the report.

Increased poverty due to COVID-19 lockdowns can further increase TB burden over the next few months because TB disproportionately affects people living in poverty. Poverty was not included in the study’s model, however.

However, COVID-19 will increase poverty for the first time in 22 years, according to a recent report by the World Bank, which predicts that over 8% of the world’s population will sink below the poverty line as a result of COVID-19.

Carabayllo, one of the poorest districts at the edge of Peru’s Capital, Lima

Rapidly Restoring Existing Tuberculosis Services Can Minimize Negative Impact Of COVID-19 Lockdowns

The lockdown has already led to a worrying drop in TB diagnosis in the two countries with the highest TB burden in the world – Indonesia and India. Identification of cases has dropped by 80% in India and by 70% in Indonesia, said Ditiu.

Lockdowns can have a profound effect on TB burden because people are often unable to visit health clinics for more routine care, and this leads to missed opportunities to diagnose and treat undetected TB cases.

“Rapid restoration of TB services is critical for minimising these adverse impacts [of COVID-19 lockdowns]…Long term outcomes can be strongly influenced by the pace of short-term recovery,” said the study.

As the pandemic drags on, a range of supplementary measures and resources can be used to recover pre-pandemic TB detection rates, the study highlights:

“Such measures may include ramped-up active case-finding, alongside intensive community engagement and contact tracing…[as well as ensuring an]…uninterrupted supply of quality assured treatment and care for every single person with TB.” 

It’s Not Rocket Science To Address Both COVID-19 & TB; Romania’s Timis County Tests and Treats Both Simultaneously

Executive Director of the Stop TB Partnership Lucica Ditiu spoke at the Stop TB Webinar on Tuesday

It is not difficult to address both COVID-19 and existing diseases, and it is not necessary to disrupt existing services. “The solution is not rocket science”, said Ditiu, in an interview with Health Policy Watch.

“There is no need to disrupt existing services for which treatments are available such as immunization programs or malaria, especially for diseases that cause millions of deaths. 

“Furthermore, we can address TB and COVID-19 simultaneously because we already have the infrastructure to do both in parallel,” said Ditiu.  The Geneva-based, UN-hosted organization, includes   more than 2,000 partners worldwide.

‘There are many intersection points between TB and COVID-19, that’s absolutely clear. Firstly, healthcare staff working for TB programs know a lot about diagnosis, treatment and infection control measures for COVID-19. Secondly, we can also use the GeneXpert machines [to diagnose both TB and COVID-19] as well as other putting other measures that are already in place like contact tracing [to work].”

In March, Cepheid, the manufacturers of GeneXpert, a widely-used TB diagnostic, received emergency US Food and Drug Administration approval for a COVID-19 test on the platform.

In Western Romania’s Timis County, the TB situation is “very good” because it is protocol to maintain existing TB services during the emergency period, said Adriana Socaci, TB Coordinator for the Timis County, in an interview with Health Policy Watch. 

Timis County has thus maintained ambulatory TB diagnosis and treatment services in the region, administering some 400 tests in the past two months. So far, ambulatory TB services have identified 2 patients with both TB and COVID-19, said Socaci. However, TB hospital visits are being spaced further apart snce the lockdown to respect COVID-19 social distance guidelines, and that has led to an overall reduction in the number of patients that can be seen. 

During routine COVID-19 testing in Timis County, healthcare workers also collect sputum samples to test patients for TB when lung X-rays are suggestive of the bacterial disease. 

Sputum samples, which are analyzed for TB using a combination of already-existing smear testing and the higher-throughput GeneXpert tests, were used to identify 8 patients with TB that did not have COVID-19, said Socaci. In the past two months, almost 125 suspected COVID-19 cases have also been tested for TB.

Romania – Healthcare worker prepares for routine Tuberculosis screening in Victor Babes Hospital, Timis County

National Policies Must Adjust To Regional And Local Conditions; Funding Must Triple

As countries try to address COVID-19 and TB, Ditiu warns that policies need to adjust based on each country’s conditions and the location of available services.

“There is no one solution that can be generalized across countries, as every country is different. Policies need to adjust based on the country’s conditions and the location of available services.We will have to be mindful of whether these services are centralized or not.”

Funding will also be a big question, said Ditiu. We will need to triple current spending to get back to where we were with respect to TB. 

We will also need to find ways to ensure that money currently earmarked and available for TB gets used, he stressed.

“While Africa’s funding for TB has not been suspended, Africa’s capacity to spend the money for TB right now is 0.”

Tuberculosis – a disease of the poor

 

Image Credits: Socios en Salud, Svĕt Lustig Vijay, PLOS Medicine.

Geneva Health Forum 2018 (Photo Credit: Louis Brisset/HUG)

From a small and modest gathering of booths and stands in 2006, the ​Geneva Health Forum​ has grown into an international event with a strong array of scientific sessions. ​Although the GHF was forced to postpone its eighth annual conference, from March to 16-18 November due to the COVID-19 pandemic, that has not prevented the Forum’s leadership, including GHF Director, Dr Eric Comte, from responding to the unprecedented challenge created by the crisis.

A medical doctor and epidemiologist by training, who worked for Médecins Du Monde (MDM) and Médecins sans Frontières, Comte also witnessed the spread of Ebola in West Africa. Geneva Solutions interviewed Comte to hear about the role GHF is playing in the present emergency, and his views gleaned from years in epidemic management.

Geneva Solutions (GS): What role is the Geneva Health Forum trying to play in this crisis?

Eric Comte (EC): Geneva benefits from a special position due to the presence of the World Health Organization and many organizations which revolve around it. We are fortunate to have this extremely rich environment and the advantages of a small city which greatly facilitates contacts.

We generally have two objectives: On the one hand, to facilitate discussions between the various health stakeholders who are willing to work together but who are caught up in their fields of activity and their schedules. Getting people to work together is not so natural. On the other hand, promote links between actors based here and those from countries with more limited resources. The objective is to see what the innovative practices are to improve access to health, in Europe as well as in developing countries.

Since the start of the crisis, our interlocutors have been contacting us to tell us about their initiatives and to collect information that we may have, thanks to our network. We are exploring how we might better organize these initiatives. We also are called upon by those who are active in global health, including medical practitioners, policymakers, and academics, including various actors working in Africa who need guidance about how to respond. In this context, we are also trying to bring together various strategic documents produced by WHO, the African Center for Diseases Control, as well as MSF operational documents, that provide guidance in the establishment of emergency response healthcare structures, adapted to the conditions of resource-limited countries. Our role is to share them. We are not the only ones doing it, but this an example of the type of work we are trying to do.

GS: ‘Coordination’ seems to be the key word in this crisis?

EC: Yes, but there is also information sharing and anticipation. I would like to point out that WHO has been widely criticized on Ebola, but as a result has set up an emergency department which activates a Task Force during crises. In this pandemic, in their coordination function, they were very proactive and produced a lot of useful guidance with clear messages, which comes back to the mantra: test the cases as soon as possible and trace the affected patients to isolate them.

GS: Have we not totally missed the point despite the warnings of the WHO? Many countries have failed to follow their recommendations.

EC: The only thing I can say is: we have to follow these measures. Often in epidemics, there are recommendations that should be followed but there are limitations in the field. You will always find problems with implementation in the field. A month ago, [for example] tests were not available. There are two possible ways to react. The first is to do everything to make them available. The second, is to cope with the scarcity, which many countries did. We are late, yes.

GS: The second key word you mentioned is ‘sharing information’, is that happening?

EC: I think there is a lot of sharing going on. The big difficulty is that many documents are in English and much less available in other languages like French or Spanish. This is a major obstacle for areas like West Africa, it creates an important barrier. But it is also true that we are also sharing much more than a decade ago thanks to the electronic network. This effort must be continuous.

GS: But there is no withholding of information as there is sometimes in the medical field due to issues of ego, commercial strategies, etc.?

EC: There are certainly economic interests. This is not a big open generous market, but there is a desire for openness and sharing – without being naive.

GS: What about the third key word, ‘anticipation’?

EC: As the experience with the lack of tests in Europe shows – governments are just starting to acquire tests – the ideal would have been to have them a month ago. The mobilization should ideally have been done earlier. Now there has been a surge of cases in Africa, but the mobilization of African actors is still quite weak. There the epidemic will definitely reach a critical point within 10 days to two weeks and in an epidemic that is a lot. In such a rapid epidemic like COVID-19, you must be early and proactive. Mobilization for and in Africa is certainly insufficient.

GS: What is the big challenge for Africa?

EC: Clear strategy guidelines are needed so that each country does not act alone. We must learn from other countries that have gone through the crisis. Additionally, resource shortages can make it difficult to treat severe cases, so the decisive impact that can be made would be in case detection. It is important to test, identify positive cases and isolate them at home. So, the challenge is to set up massive testing very quickly. But test availability is not the only problem. Once you obtain tests you have to have a clear strategy for where to test and who to test. Like the new drive-in test initiatives, we have seen elsewhere, Africa needs decentralized testing locations, outside of the regular hospital quarters, so as to speed up results and avoid infecting other patients and health workers. It’s not that difficult but it’s a race against the clock to make sure the strategies are in place when the tests arrive.

GS: People are very afraid for their future. What scares you the most in this crisis?

EC: When you work in Africa on cholera epidemics, you have all the ingredients that we are facing here today. Local players are confronted with overloaded hospitals, racing against the clock to detect positive cases, containing the epidemic, and treating serious cases. What’s going on here isn’t so exceptional. What is exceptional is that it has happened in Europe where we were no longer used to this, and obviously did not have the necessary structures in place. This is exceptional by the geographic scale and the number of patients, but it is a classic epidemic pattern. We had this with Ebola in West Africa. It was the same scenarios. The trauma in Sierra Leone and Guinea were the same: destruction of health systems, exceptionally large number of deaths among health workers, fear within the population, destruction of local economies.

GS: Based on your experience, what would you say?

EC: We need to keep calm, mobilize communities, which is being done. The reactions are not bad. We are always late in a crisis. The lockdown measures of “confinement” are being respected; the tests came late but they are on the way. If we compare with Ebola, in this crisis we are much responding much faster, only five years later.

GS: What are your hopes?

EC: With what is in place, we will succeed in limiting the cases. One must not feel afraid. Fear in an epidemic is not a good reflex. We must try to implement the WHO guidelines and normally we should have an influence on bending the curve.

________________________________________________________

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: Louis Brisset/HUG, Geneva Health Forum.

WHO Kenya’s Community Health Coordinator educates communities on hand-washing – a crucial personal protective measure against COVID-19

A new report published Wednesday provides guidance to African governments on how to use data to chart a way out of COVID-19 lockdowns. Concerns that the economic impact of stringent stay-at-home orders may become too tough to bear for families has some African countries considering adapting or easing public health restrictions.

Some 69% of people in 28 African cities surveyed for the Responding to COVID-19 in Africa: Using Data to Find a Balance report said that getting adequate food and water would be a problem if they were required to remain home for more than 14 days, and 51% said they would run out of money. In Western and Central Africa, 83% of those surveyed worried about running out of food and water if required to stay home for 14 days. The surveys covered 20 countries. 

Approximately one third of the respondents also said they did not get enough information about the coronavirus, including how it spreads and how to protect themselves. Almost two thirds believed that the pandemic would have a major impact on their countries, but only 44% believed that the virus would be a personal threat. 

“This report highlights the large information gaps on COVID-19 which exist in Africa and threaten response efforts,” said Dr Matshidiso Moeti, World Health Organization Regional Director for Africa. 

“The findings of this report, along with COVID-19 trend data, will help countries make strategic decisions on relaxing their lockdowns. What we’ve learnt from Ebola and other outbreaks is that countries need to decentralize the response to the community level and increase their capacity to identify and diagnose cases.”

The report recommends that governments closely monitor data on how public health measures meet local needs; build capacity to test, isolate and treat while case numbers are low; and engage communities to adapt any public health measures, such as business closures, to the local context.

A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo, with PPE and diagnostics supplies

‘Finding the Balance’ – Special Considerations for Africa

The recommendations are specifically tailored to Africa, where many nations have rapidly responded to early cases by stepping up contact tracing and enacting some of the earliest stay-at-home orders, which have appeared to slow the spread of the virus. However, pre-existing weak social welfare have led to widespread fears that food insecurity and poverty may threaten just as many, if not more people during lockdowns.

Many countries are considering relaxing or adapting lockdown measures as they consider the threat to livelihoods against the threat from COVID-19.

“There are three factors that will be particularly important to weigh in this concept of finding the balance in Africa,” said Tom Frieden, chief executive officer of Resolve to Save Lives and former head of the United States Centers for Disease Control.

“The first is the age structure of population – with fewer elders, there is less risk of widespread illness and death among the elderly population. But still, there is the risk in vulnerable populations and a lack of information by who is most in need,” he added. 

The report found that there was rampant misinformation across the continent. For example, more than 58% of survey respondents believed that taking vitamin C could ward off the virus, and 53% believed that hotter climates could prevent the spread of the virus. While there has been scientific speculation around both of those claims, neither has been proven in peer-reviewed studies. 

“Second,” adds Frieden, “There are limited safety nets. As the report shows, the ability for communities and individuals to thrive and flourish during a lockdown is even less than in many other parts of the world.”

The report found that the lowest-income households expected to run out of food and money in less than a week. Some 42% of non-violent COVID-19 related security incidents, such as peaceful protects, were organized around seeking additional government support during the crisis. Many African nations have had stay-at-home orders in place for more than three weeks now. 

“And finally, there is a critical scarcity of healthcare workers, even before COVID-19, and therefore it’s crucially important that every step is taken to protect those who protect the rest of us, and ensure that healthcare workers and other essential workers are protected,” said Frieden. The global shortage of protective equipment has hit the continent especially hard, with approximately a third of all peaceful protests across the continent organized around demanding protections for healthcare workers, according to the report.

But despite the limitations, communities in cities have largely supported public health and social measures enacted to protect them against the coronavirus.

Over 90% of respondents across all surveyed regions supported halting sporting matches and concerts; and closing schools, restaurants and nightclubs. Around 70% of those surveyed supported halting prayer gatherings, and closing churches and mosques. However, more people opposed transportation shutdowns, closing workplaces, and shutting down markets – activities deemed by many citizens to be essential for their livelihoods.

Gathering such data points is crucial to understanding how public health measures are impacting the general public – and how likely they are to follow guidance. 

“As we prepare for a long term response, there’s too much to be learned about the virus and the impact you have on people, and systems on the continent,” said John Nkengasong, Director of the Africa CDC. “Therefore, we must use evidence to drive decision making, and apply lessons from the past so we can implement the most effective and responsible policies, while protecting lives and livelihoods.”

Along with the public survey conducted in 28 cities across 20 African Union Member States, other indicators of disease transmission, population movement and unrest, were used to inform the report. The final document was produced by the Partnership for Evidence Based Response to COVID-19 (PERC), which consists of the Africa Centres for Disease Control and Prevention; Resolve to Save Lives, an initiative of Vital Strategies; the World Health Organization; the UK Public Health Rapid Support Team; and the World Economic Forum. Private market research and data analytics firms Ipsos and Novetta Mission Analytics also supported the partnership.

Gauri Saxena contributed to this story

Image Credits: WHO African Region, Matshidiso Moeti.

Rows of artemisia annua in West Virginia

Research into traditional medicines for COVID-19 should be welcomed, so long as it is held to the same standards as research into other drug candidates, the World Health Organization Africa Regional Office expressed in a statement issued Monday.

The diplomatically-framed WHO statement came after widespread media coverage of Madagascar’s president and other African leaders over the weekend, who suggested that the medicinal plant artemisia annua (sweet wormwood) was effective against the coronavirus.

“WHO recognizes that traditional, complementary and alternative medicine has many benefits, and Africa has a long history of traditional medicine,” said the WHO statement. 

Several decades ago, the same plant was found to be effective against malaria parasites, leading to the development of modern artemisinin-based combination therapies (ACTs), which are now a worldwide standard for malaria. 

While no such studies of the plant’s effect in COVID-19 patients have been published, initially promising results from cell studies conducted by Chinese researchers in 2005 showed that artemisia annua extract may have activity against the SARS-CoV virus – a cousin to the SARS-CoV-2 virus that causes COVID-19. The Max Planck institute in Germany recently announced a collaboration with researchers in the United States and Denmark to investigate the plant’s efficacy against SARS-CoV-2.

According to WHO COVID-19 Technical Lead, Maria Van Kerkhove, there are “hundreds” of ongoing clinical trials exploring the use of traditional remedies for the coronavirus. “The idea of traditional medicines, particularly for COVID-19, is something that is is well under investigation,” she told reporters Monday.

However, WHO warned that, “caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies.

“Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.””

The statement comes as hydroxychloroquine, an anti-malarial drug is making headlines as a potentially dangerous COVID-19 therapeutic. While hope is still being pinned on the drug, recent studies showed that it could cause heart arrhythmias at high doses, underlining the importance of conducting proper clinical trials before approving a drug for use. The naturally-occurring source of hydroxychloroquine is the chinchona tree, a national symbol of Peru.

Global Trends

Number of cases by WHO region

Of the 27 000 new cases recorded Sunday in Europe, almost a third of cases, some 10 000 new cases, were in the Russian Federation, and 20% of new cases were in the UK, according to the latest WHO situational report. So far, Europe hosts about half of COVID-19 cases and 60% of deaths worldwide.

As countries like Italy, Portugal and Austria relaxed their lockdowns on Monday, and Spain recorded its lowest numbers since a peak in March, COVID-19 is still not over in Europe, nor in any other region of the world. 

This week, the UK will announce a comprehensive roadmap to lift its month-and-a half- long lockdown despite the meagre reductions in cases since mid-April, with 5000 new cases reported over the past day.

On Sunday morning, the third flight from China delivered 2.1 million face masks and 32,000 surgical gowns to Ireland’s capital, Dublin. The three flights were organized and funded by Dublin-based aircraft leasing company Avolon, which has raised a total of €350,000 in a crowdfunding campaign. Rock band U2 contributed € 10 million to the cause.

In the Americas, meanwhile, the USA, Brazil and Peru accounted for over 80% of new cases reported in the continent in the past day, according to the latest WHO situational report. As of Monday, 26 000 new cases were confirmed in the USA and 6000 new cases were reported in Latin America’s epicentre Brazil, with a total of 102,717 cases and 7,025 deaths. 

The Amazonian city of Manaus emerged as the new hotspot of the virus, experiencing widespread chaos in morgues and coffin shortages after recording most of the country’s new cases. On Monday, Brazilian Health Minister Nelson Teich arrived in the Manaus to expand testing and to ensure that the region received reinforcements of some 270 health professionals.

In the Western Pacific, two countries have experienced an uptick in cases in recent days – Singapore and Japan. Singapore’s outbreak declined in mid-April, but it has reported the most new cases in the Western Pacific in the past day, with 650 cases on Monday and 932 new cases on Friday.

The majority of Singapore’s cases in past days have been traced to dormitories of foreign construction workers and common worksites, said Lawrence Wong, Minister For National Development, in a statement on Monday. To curb the outbreak, Singapore has halted the movement of workers in and out of all dormitories, and put the construction workers living outside the dormitories on a stay-home requirement. Like Singapore, Japan’s cases have also risen since last week, mostly in Hokkaido and the capital, Tokyo, with 300 new cases reported in the past 24 hours.

In the Eastern Mediterranean region, cases are growing in Afghanistan and Saudi Arabia.

In the past day, Saudi Arabia became the Eastern Mediterranean region’s hotspot. Over 70% of civilians in the holy city of Mecca could be infected with the virus, according to senior Saudi medical sources, reported Middle East Eye late last week.Like in Mecca, up to a third of people in the capital Kabul could have COVID-19 according to a random test of 500 Afghanis, reported AP on Sunday.

Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly.

-Updated on 6 May 

Image Credits: Jorge Ferreira, WHO, Johns Hopkins CSSE.

Ursula von Der Leyen, president of the European Commission, announced the EU pledge at the Coronavirus Global Response Pledging Event on 4 May

Countries from around the world committed 7.36 billion Euro for the global coronavirus pandemic response Monday, nearly reaching the ambitious 7.5 billion Euro initial goal that had been set out only a week ago in a press conference with heads of state from Europe, Africa, Asia, Latin America and the World Health Organization. 

The United States, the world’s biggest global health donor and country with the most COVID-19 cases and deaths, was noticeably absent in this show of multilateralism, at the pledging event hosted by the European Commission. 

Leaders from most of the other G20 group of the world’s most industrialized countries made pledges, including China, whose permanent ambassador to the European Union announced a commitment of over USD $20 million to the global coronavirus response.

The European Commission kicked off the event with a 1 billion Euro pledge.

“Today, the world is coming together. Governments from every continent will join hands and team up with global health organizations, and other experienced partners. The pandemic is affecting every single country in the world. The goal is one; to defeat this virus,” said Ursula Von der Leyen, European Commission president.

But funding committed at the initial pledging event, which aimed to raise 7.5  billion Euros, is just the first “downpayment” for accelerating the development of new tools, said United Nations Secretary General Antonio Guterres. 

“To reach everyone everywhere, we likely need five times that amount, and we call on partners to join in this effort… to sustain our momentum,” he added.

Many country leaders explicitly designated that funding pledged would also go to the World Health Organization, which is facing a significant budget shortfall after US President Donald Trump announced a temporary suspension of its nearly US $ 500 million annually in funding, pending an investigation into the agency’s handling of the coronavirus crisis.

Erna Solberg announces Norway’s pledge, leading with renewed funding for the WHO

Norway, one of the co-hosts of the event, led the movement with an additional 50 million krone infusion into WHO’s coffers. 

“Norway supports the leadership of the World Health Organization. Without the WHO, an effective and coordinated response to the pandemic will not be possible,” Norwegian Prime Minister Erna Solberg said. “Cooperation is more important than ever.” 

The pledging event was co-led by the leaders of France, Germany, Japan, Norway, Canada, Italy, Spain, the United Kingdom, and Saudi Arabia. The package of new grants, loans, and repurposed global health funding from bilateral donors, philanthropic foundations, and the European Investment Bank will be directed towards accelerating the development of COVID-19 tools, and support countries most vulnerable to the pandemic.

Accelerating Development of & Ensuring Access to COVID-19 Diagnostics, Drugs, & Vaccines

A majority of funding announced at the pledging event will fund various efforts to speed up the development of COVID-19 diagnostics, therapeutics and vaccines. As of now, there are no approved drugs or vaccines for the virus.

“This is now a human endemic infection,” said Jeremy Farrar, director of the Wellcome Trust, which together with the Gates Foundation and Mastercard, is supporting the new COVID-19 Therapeutics Accelerator, another funnel for funding pledged. “We will need all three; diagnostics, therapeutics, and a vaccine.”

In one of his first international appearances since recovering from a serious case of COVID-19, UK Prime Minister Boris Johnson added, “ We must work together to build an impregnable shield around all our people – and that can only be achieved by developing and mass producing a vaccine.”

Boris Johnson announces the UK pledge

The UK has committed up to  £744 million to the global COVID-19 response, of which at least £388 million will be directed towards research and development of COVID-19 therapeutics and vaccines. 

A large portion of all country pledges were also directed towards the Oslo-based Coalition for Epidemic Preparedness and Innovation (CEPI), which is supporting nine COVID-19 vaccine development initiatives. In a commitment to ensuring access to any COVID-19 tools, many countries also announced initial pledges to Gavi, the Vaccine Alliance, the public-private partnership that supports low-income countries’ national vaccine delivery programmes. The UK is hosting Gavi’s sixth replenishment on 4 June. 

Pharma industry and civil society representatives joined in to support the pledging event, and leaders of both have underlined that ensuring access to any new tools is an essential priority, echoing calls from country leaders that a COVID-19 vaccine should be treated as a ‘global public good.’

“Never before has the biopharmaceutical industry moved as quickly and decisively to channel our innovation and mobilize our knowhow in response to this pandemic. We are driven by a deep sense of responsibility towards patients and society as a whole,” said Dave Ricks, chief executive officer of Eli Lilly and chairman of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

“Global demand will outstrip production and supply capacity for some essential medical tools, including personal protective equipment and COVID-19 therapeutics, diagnostics and vaccines. Ensuring the equitable allocation of these tools should therefore be central to any discussions around financing and access,” representatives of Médecins sans Frontières (MSF) wrote in a public comment released on Monday.

12-year old female genital mutilation survivor in her husband’s village -Tarime District, Tanzania

Women’s and children’s health advocates have lauded a landmark move by Sudan to finally criminalize the practice of female genital mutilation and cutting (FGM/C) – punishing perpetrators for up to 3 years in prison to ward them off the crime.

Last Thursday, Sudan’s National Council for Child Welfare endorsed a long-awaited amendment to Criminal Law Article 141 in Sudan’s Criminal Act. The new law aims to end FGM in healthcare settings, as over three quarters of FGM procedures in Sudan are undertaken by nurses, midwives and other healthcare workers.

Sudan’s move to criminalize medicalized forms of FGM is an important step forward not only because it has one of the highest prevalence rates in the world, but also because most FGM in Sudan takes places in healthcare settings, said Jasmine Abdulcadir, head of the FGM/C Outpatient clinic and Obstetrics and Gynecology Emergency Unit at the University of Geneva, in an interview with Health Policy Watch.

Some 86.6% of girls in Sudan are subjected to FGM, according to United Nations data. FGM is an umbrella term for any practice that involves partial or total removal of the external part of a female’s genital organs for non-medical reasons. A woman can bleed to death or die from infections as a result from FGM, and the practice can also cause childbirth complications, sexual health problems and chronic pain, health experts state.

UNICEF welcomed the move on Wednesday as well. “This practice is not only a violation of every girl child’s rights, it is harmful and has serious consequences for a girl’s physical and mental health,” said Abdullah Fadil, UNICEF Representative in Sudan, in a UNICEF press release. “This is why governments and communities alike must take immediate action to put an end to this practice.”

About a half of FGM occurs before the age of 5, and the majority of girls are mutilated before they reach 15 years of age, according to a 2016 UNICEF report. 

More Action Is Needed To Ensure End Of Practice, says FGM Expert

More than three-quarters of girls in Sudan are cut by health personnel

Legal reform and awareness-raising is not enough to put such culturally ingrained practices to a halt, Abdulcadir warned. “Legislation and awareness-raising is only one of many steps towards abandoning a practice that can survive despite its illegality, as we have seen in other countries in the past.“ 

Abandoning the practice fully must start with community engagement, added Fadil.

“We need to work very hard with the communities to help enforce this law. The intention is not to criminalize parents, and we need to exert more effort to raise awareness among the different groups, including midwives, health providers, parents, youth about the amendment and promote acceptance of it,” he said.

The exact amended text of the the approved law reads, ‘There shall be deemed to commit the offence of female genital mutilation whoever, removed, mutilated the female genitalia by cutting, mutilating or modifying any natural part of it leading to the full or partial lost of its functions, whether it is inside a hospital, health center, dispensary or clinic or other places.”

Of the 29 countries in Africa where female genital mutilation (FGM) is traditionally practiced, Sudan has joined the 26 who now have laws prohibiting some form of FGM, reports Equality Now, a global woman’s rights advocacy group. In most countries where it is still practiced, the majority of women think it should end, according to a UNICEF survey from 2013. 

While there may be laws banning FGM, they don’t always work well. In some countries like Mauritania or Liberia, FGM is officially prohibited for under-age women, but the law has been scarcely enforced, and there are few arrests or judicial proceedings to address FGM, reports Equality Now.

There is a spectrum of culturally engrained beliefs that motivate FGM, according to 28 Too Many, a UK-based NGO that advocates against FGM. A commonly-held belief is that FGM is a sign of fertility and  social status, improving a woman’s capacity to marry and often being a prerequisite for marriage. Other beliefs also include: fear of female promiscuity; sexual hyperactivity; preservation of virginity; purification; aesthetic purposes; improved sexual pleasure of men.

Experts have documented roughly 5 different types of FGM, one of which involves partial or total removal of the female body’s sexual pleasure hotspot – the clitoris.

Over three quarters of the world’s FGM takes place in Sudan, Egypt, Ethiopia, Kenya and Somalia, according to a 2016 study from Norway’s CHR Michelsen Institute. 

About 200 million women are survivors of FGM, and about 3 million girls are at risk of FGM every year.

FGM/C is concentrated in a swath of countries from the Atlantic Coast to the Horn of Africa.

Image Credits: UNICEF, UNICEF.

China’s “wet markets” sell fresh meat, fish and vegetables; but the sale of exotic animals at some of them is believed to have faciliated the spread of COVID-19 from animals to humans

In a mild statement touching on a politically wired issue, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus said that the agency would step up its investigations of the original animal source of the SARS CoV-2 virus that causes COVID-19. 

His comment came in response to a recommendation of the WHO Emergency Committee that met Thursday 30 April to review the status of the COVID-19 pandemic as a ‘public health emergency of international concern.’

“We accept the committee’s advice that WHO works to identify the animal source of the virus through international scientific and collaborative missions, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) of the United Nations,” said Dr Tedros, speaking at Friday’s WHO press briefing. 

The Emergency Committee had recommended that WHO “work with the OIE, 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,” and “provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.”

The issue of the virus’ origins became highly politicized after US President Donald Trump claimed to have evidence that the virus had escaped from a laboratory, although he never provided any support. Trump referred again to this claim at a press briefing Friday.

Scientific assessments have generally concluded that the virus came from a natural source, most likely a bat that possibly transmitted it to a pangolin or a reptile, which are widely used in traditional medicine as well as food sources in China. 

Even so, Chinese claims that the virus first was transmitted to humans at the Wuhan, China wild animal market, seem less well-founded, insofar as some early cases had no connection to the market. 

That has led some observers to suggest that the virus, while natural in origin could have also escaped from the Wuhan Virology Institute or the Wuhan Centre for Disease Control, near the wild animal market – which had also collected bat coronavirus specimens. 

When asked about the origin of the virus, WHO’s Executive Director of Health Emergencies Mike Ryan declined to speculate on whether the virus escaped from a lab or emerged from a wet market. 

“We were assured that this virus is natural in origin, and what is important is that we establish what the natural host for this virus is,” said Ryan. “The primary purpose of doing that is to ensure that…we understand how the animal-human species barrier was breached, [so] that we can put in place the necessary prevention and public health measures to prevent that happening again. Anywhere.”

Environmental health advocates have underlined that increased contact between wild animal species and humans in developing countries of Asia and Africa, as a result of urbanization and the degradation of wild animal habitats, as well as illegal wild meat capture, containment and consumption, has led to the ever more frequent transmission of zoonotic diseases to human populations in past decades, including HIV, Ebola and Nipah virus.  

And outbreaks of new diseases will pose an even greater risk in the future if the underlying environmental health and food safety drivers are not addressed.

Dr Tedros signs the WHO-EIB Memorandum of Understanding

WHO Signs MOU With European Investment Bank

At Friday’s press briefing, the WHO Director-General also signed a Memorandum of Understanding with the European Investment Bank – which aims to inject funding into the COVID-19 response into at least 10  African countries, as well as countries elsewhere with weaker health systems. 

The EIB’s commitments include freeing at least 1.4 billion EUR to address the health, social and economic impact of COVID-19 in Africa. However, Werner Hoyer, President of the European Investment Bank, told reporters that most of the funding would be provided in the form of loans.

The funding would also support continuation of other critical health services such as malaria elimination and antimicrobial resistance. 

The EIB president declined to comment on which nations would receive funding. 

“I must disappoint you, because this communication has not gone to the respective governments yet, and therefore I for the time being cannot respond to this. Together with our delegation with WHO, we will do this within the next couple of days,”  said Hoyer.

Werner Hoyer announces the European Investment Bank – WHO collaboration

The funding is yet another gesture of support from Europe at a time when US aid has been put on hold creating a funding crisis in WHO, which receives some 15% of its budget from Washington – much of it going to WHO’s African region.

In addition the United States Agency for International Development (USAID) this week issued a directive forbidding use of its overseas funding for the purchase of personal protective gear for health workers, such as masks and gloves, or for the purchase of respirators, The New Humanitarian reported.  

The move was widely seen as a political gesture by US President Donald Trump to his domestic base of support. As one Geneva-based NGO observer, said, “I think it’s because they’re afraid of Trump’s fan base saying, ‘we’re short of PPE, why are we giving it to foreigners?’” 

USAID also is one of the world’s largest bilateral donors to health systems in developing countries.

Cases Are Doubling In Nigeria’s Conflict Zones – Even As Cases Decline Elsewhere During African Lockdowns

Conflict-ridden areas in Nigeria have witnessed an uptick in new cases over the past week even as new cases declined elsewhere across the African continent. South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, which clamped down on movement three weeks ago, saw a decrease in new COVID-19 cases, said WHO Regional Director for Africa Matshidiso Rebecca Moeti, in a regular briefing on Thursday.

On Friday, about half of the 200 new COVID-19 cases were reported in historically unstable northeastern Nigeria, where over 180,000 people remain displaced after a fresh wave of violence in 2019. A hotspot of 80 new cases was reported in the northern Kano State, as well as smaller outbreaks in northeastern states Gombe, Bauchi, Borno. There are now a total of 1932 cases in the country. Daily new cases in Nigeria doubled on Tuesday compared to Monday’s numbers.

The main challenge in conflict-ridden zones is access, said Michel Yao, WHO Emergency Programme Manager for the Africa Region, in Thursday’s briefing.

“These [historically unstable] areas are a bit far from the capital city, and is where the centralization of some of the capacities like testing should be taken in place,” Yao said.

We need to be working closely with all humanitarian partners, the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees Agency (UNHCR), to assess these unstable areas, he added. The IOM, which frequently works with refugee and asylum seekers fleeing from conflict, is bracing itself for a potentially devastating COVID-19 outbreak in northeast Nigeria.

WHO AFRO Director Matshidiso Moeti speaks at Africa Media Leader Briefing on COVID-19 on April 30, 2020

In an unusual move by the WHO, the Regional Director for Africa pointed out by name countries who had been slow to implement WHO recommended strategies to slow the spread of the pandemic.

“Tanzania took some time to implement [their strategies] particularly the physical distancing measures” stated by Dr. Matshidiso Rebecca Moeti. “While schools were closed, places of worship were kept open. The gathering of people continued to happen in closed spaces. The prevention of travel from the epicenter also took some time to happen. After the lockdown was announced, many truck drivers left the country and have spread the infection to neighboring countries.”

Tanzania has 480 confirmed cases as of Friday, although concerns about test kit shortages have many experts concerned that cases are being undercounted across the continent.

Svet Lustig Vijay, Zixuan Yang and Grace Ren contributed to this story

Image Credits: Breaking Asia.

Pregnant women remain one of the groups at highest risk of complications from malaria infection.

Reducing new cases of malaria among pregnant women remains one of the key challenges on the road to malaria elimination – a goal that was celebrated last week, on World Malaria Day, 25 April.

Although malaria deaths fell by nearly a quarter between 2010 and 2018, pregnant women remain among the groups most at risk from the parasitic disease.

In response, MMV has recently ramped up a longstanding programme (first initiated in 2014) dedicated to fighting malaria in pregnancy, naming it the Malaria in Mothers and Babies (MiMBa) initiative.

MiMBa for short, the acronym is aptly named after the Swahili word for “pregnancy.”

Every year, malaria in pregnancy causes some 10,000 maternal deaths, mostly in sub-Saharan Africa.

In areas where malaria is widespread, it is estimated that at least 25% of pregnant women are infected with malaria. And more than 11 million pregnant women were infected in sub-Saharan Africa in 2018 alone – putting a third of all future mothers in that region at risk.

During pregnancy, the disease can also cause maternal anaemia, premature labor, and low birth weight in babies – some 872,000 babies alone were born with low birth weight in 38 sub-Saharan African countries in 2018. This puts newborns, as well, at much higher risk of early death in the first 12 months of life, according to the latest WHO World Malaria Report.

“Protecting pregnant women from malaria has been a key concern of the malaria community for many years, though today in the context of a burgeoning COVID-19 pandemic the stakes are even higher,” said Dr David Reddy, MMV’s CEO. “We need to move quickly to ensure pregnant women and others at risk of malaria can access the tools they need to protect them today, particularly because access to healthcare facilities will be compromised during the COVID-19 outbreak. Beyond this immediate need, we must continue to develop the new tools they will need for the future”.

A key tool to protect pregnant women – Intermittent Preventive Treatment

A key tool to protect pregnant women from malaria in areas with moderate-to-high malaria transmission in Africa is intermittent preventive treatment of malaria during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), which is a cost-effective intervention.

A minimum of three doses of SP from the second trimester onwards prevents maternal and foetal anaemia, reduces maternal malaria episodes, and decreases the risk of low birth weight.

“IPTp has been shown to reduce negative pregnancy outcomes and if well implemented, with good coverage, these interventions can drastically reduce the malaria prevalence in these specific populations,” said MMV Director of Access & Product Management, Dr André-Marie Tchouatieu.

Intermittent treatment with sulfadoxine-pyrimethamine (SP) can help prevent malaria during pregnancy.
Scaling Up Access to IPTp

However, right now, a complete three-dose course of IPTp only reaches about 31% of the pregnant women that need the treatment, according to the latest WHO data. This year the RBM Malaria in Pregnancy Working Group, which includes MMV, has launched the Speed-up Scale-up campaign to rally a larger community of stakeholders to bring IPTp-SP to all eligible women who need it in sub-Saharan Africa.

The challenge on the ground, Dr Tchouatieu said, is to “bring these interventions as close as possible to the affected communities.”

He explained that IPTp has so far been delivered primarily in health facilities, during antenatal care (ANC) visits. However, these ANC visits typically cost women money, while malaria preventive drugs are often freely provided.

Since pregnant women often skimp on ANC visits due to limited resources, they miss out on the opportunity to get the three doses of anti-malarial preventive treatment.

As part of a Jhpiego-led consortium, MMV and other partners are exploring ways to complement the existing delivery method for IPTp by bringing treatments more directly into the communities and homes of women who need them. Under the UNITAID-funded TIPTOP project, the consortium is exploring whether community-based delivery of IPTp-SP could successfully complement ANC-based delivery.

“We are exploring how to involve community health volunteers to both deliver IPTp and encourage women to attend ANC visits,” said Dr Tchouatieu. Results from the recently wrapped primary phase of the project showed that in four pilot countries – Nigeria, the Democratic Republic of the Congo, Mozambique, and Madagascar – coverage of the second and third doses of IPTp went up along with attendance at a fourth and fifth ANC visit.

WHO currently recommends at least six ANC visits in order for pregnant women to be screened for other pregnancy-related health problems. Ideally, says Dr Tchouatieu, recommendations on IPTp might also be expanded to a monthly administration to cover women more completely during the last two trimesters of pregnancy.

Malaria – A Particular Risk in the First Pregnancy    

Malaria is a particular risk to women and their foetus during their first pregnancy. In moderate and high transmission settings such as parts of sub-Saharan Africa, women tend to naturally have a higher level of immunity to malaria due to the constant exposure to the disease; but that immunity may be depressed during pregnancy.

“There is a breakdown of acquired immunity [to malaria] that occurs in pregnancy, especially in the first pregnancy,” said Dr Tchouatieu.

That may also explain the comparatively higher rate of malaria mortality seen in teenage girls and young women in some settings, where teenage pregnancy is more common. According to WHO, malaria remained one of the top 5 killers of adolescent girls 10 to 14 years old, and maternal conditions were the leading cause of death in young women age 15 to 19 around the world in 2016.  In subsequent pregnancies, on the other hand, immunity appears to be less impacted.

Many young women also carry asymptomatic infections, Dr Tchouatieu adds. This can lead to chronic anaemia, which is caused by a low level of parasitic activity that destroys red blood cells. Women who were previously asymptomatic or slightly anaemic may develop stronger symptoms during pregnancy, and even progress to severe disease.

In addition, during pregnancy, the malaria parasites may be attracted to a new, abundant source of healthy red blood cells – the placenta. The parasites infect the placenta, a condition known as placental parasitaemia, interfering with the circulation of nutrients between the mother and foetus, leading to low birth weight, still births, or even miscarriages.

In areas of unstable malaria transmission, such as Asia and Latin America, as well as in low transmission areas of Africa, where populations have a lower level of  acquired malaria immunity, the risks of developing severe disease upon being infected by malaria can be even higher for pregnant women, said Dr Tchouatieu.

Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in reducing maternal malaria episodes, and may help prevent low birth weight in babies.
IPTp – Part of a Wider MiMBa Strategy

Supporting the scale up of IPTp is just one part of a wider MiMBa strategy whose ambition is to improve equity and inclusion of the needs of future mothers, mothers and their babies in malaria drug development – MMV and its partners also want to accelerate the discovery, development, and monitoring of new antimalarial options – optimized for pregnant women and lactating mothers.

As other elements of the MiMBa initiative, MMV also aims to:

  1. Fill the gaps on existing compounds to inform on their use in pregnant women and neonates;
  2. Develop new antimalarial medicines to address the needs of pregnant women and neonates;
  3. Strengthen the capture of safety data from use of antimalarials in endemic countries during pregnancy;
  4. Advocate for changes in drug development that promote the proper inclusion of pregnant women into clinical studies, with the aim of generating data to support earlier access to innovative medicines for this population.

While the current IPTp strategy is important, it can only be administered from the second trimester onward. So, development of a new treatment that could also be safely administered to prevent malaria in the first trimester of pregnancy, would represent a breakthrough.

“The face for malaria is female. The disease disproportionately affects pregnant women resulting in severe illness, deaths, loss of productivity and missed professional development opportunities,” says Joy Phumaphi, the Executive Secretary of the African Leaders Malaria Alliance, speaking at a meeting last year. “We must ensure sufficient resources are available to remove barriers to treatment and prevention, including the fast tracking of new commodities and interventions.

Image Credits: Elizabeth Poll/MMV, Karel Prinsloo-Jhpiego .

The Bronx, New York City.

COVID-19 deaths per capita are twice as high in The Bronx, New York City’s poorest and most racially diverse borough, as compared to the predominantly white and more affluent borough of Manhattan, reported a new study published in JAMA on Wednesday. 

The study’s findings draw out the potentially stark differences in the way the virus can exacerbate existing social and health inequalities, suggest the authors, researchers at some of New York City’s leading medical centres and the Harvard Chan School of Public Health.

The proportion of black or African American persons is highest in the Bronx (38.3%) and it is also New York’s least educated and poorest area, as well as being home to twice as many people of Black, African American and Hispanic origin in comparison with Manhattan.

In the case of COVID-19, the findings are particularly striking insofar as the virus has hit hardest in the Bronx, even though the proportion of older adults (aged ≥65 years) there is lowest among all New York City boroughs (12.8%); as compared to Manhattan, which has the highest proportion of older residents (16.5%). Most COVID-19 mortality trends in Asia, Europe and elsewhere have shown a striking association between a higher average population age and higher mortality rates. 

The Bronx is also half as densely populated as Manhattan and also has the youngest population in the whole of New York. In other settings, high housing densities have also been associated with greater rates of disease transmission.

COVID-19 deaths are highest in New York’s deprived areas

In the Bronx, there had been 173 confirmed COVID-19 deaths per 100 000 people, as of 25 April, as compared to 91 in Manhattan. Similarly, there were 634 hospitalizations per 100 000 people in the Bronx compared to 331 in Manhattan. 

Along with economic and social disparities, it is possible that more Bronx residents also have been hospitalized for COVID-19, and subsequently died, due to a higher rate of pre-existing illnesses, which increase their vulnerability to the disease. However, the study was unable to collect such data from individuals due to its ‘ecological’ design, which can only be used to tease out broad differences between populations.

“Structural inequities” can also drive the number of deaths seen in the Bronx, suggest the authors. For many years, a growing body of evidence has shown that ethnicity and discrimination can affect a person’s health status in various ways – Racial minorities often grow up in deprived and unhealthy environments with less access to high-quality education and healthcare. 

In the Bronx, people are three times less likely to have a Bachelor’s degree compared to people living in Manhattan, and average household income for people living in the Bronx is less than half that of Manhattan, reported the study.

New York harbors almost one-fifth of the USA’s COVID-19 cases, and is the epicentre for the outbreak in the United States.

Image Credits: Phillip Capper , JAMA.

One of the first children to receive the world’s first malaria vaccine in Ghana in April 2019. Photo: WHO/Fanjan Combrink

Routine vaccine campaigns, suspended worldwide in the wake of COVID-19 lockdowns, must be resumed immediately or else some countries could face a big surge in deaths from other preventable diseases, said Seth Berkley, CEO of Gavi, The Vaccine Alliance.

Speaking at a press briefing Thursday, Berkley warned that routine immunizations for other infectious diseases such as polio, measles, and rotavirus need to be resumed immediately in low- and middle-income countries. In Africa, deaths from other infectious diseases could outweigh COVID-19 fatalities by a factor of 100 to 1, he said, citing findings from a recent London School of Tropical Hygiene and Medicine study.

“I can’t emphasize enough [that halting routine immunization] is going to be a challenge, and we are going to see outbreaks, certainly for polio,” said the GAVI CEO. 

Berkley said the world needs to urgently “catch up” to bring previous levels of population immunity back up in areas where vaccines are now being neglected.

“If we don’t support those routine systems, those systems won’t be ready to move forward to roll out [existing and new] vaccines.” 

Berkley spoke at a GAVI press briefing today that laid out a vision for the organization’s work on vaccines in the coming months and years. The briefing also included Joe Cerell of the Bill and Melinda Gates Foundation and Gayle Smith, CEO of the ONE Campaign, a global health and development NGO.

Gavi Replenishment Drive, June 4, Aims to Raise US$ 7.4 billion for Routine Vaccines

GAVI aims to raise US$ 7.4 billion for its next five year plan for mass immunizations, in a virtual replenishment event to be hosted by the United Kingdom on June 4. The money will be used to immunize an additional 300 million children, over and above, the 760 million reached in the over the past two decade, preventing some 8 million deaths, Berkley said.

In parallel, Gavi, One Campaign and other partners are supporting a drive to raise another US$ 8 billion to fund R&D for development and manufacture of a COVID-19 vaccine, although this is only ‘part of what’s needed,’ said Smith, who is also a former administrator of the US Agency for International Development.

“For a global pandemic, we need a global response,” she said.

In a separate event, the WHO European Regional Office also warned that measles was already surging in Europe because of neglected routine vaccines during the crisis.  In just the first two months of 2020, over 6,000 people were infected with measles in the European region, said Hans Kluge, WHO European Regional Director. 

Said Kluge, “We cannot allow this situation to worsen. We should do everything within our powers to prevent children [from] becoming victims of this pandemic due to vaccine-preventable diseases such as measles, diphtheria, mumps, and rubella. Covid-19 cannot be permitted to claim this collateral damage.” 

As for low-income settings, Berkley cited past experience with the Ebola epidemic of 2018-20 in the Democratic Republic of Congo. While the world remained riveted to the Ebola emergency, two and a half times as many people died of measles.

Along with resuming routine vaccines, Berkley laid out four other key challenges associated with advancing development and rollout of a future COVID-19 vaccine, which said need “global coordination and leadership”, but also “transparency in R&D and manufacturing.” 

These challenges include: ensuring adequate production capacity of the vaccine; global leadership to identify and prioritize vaccine candidates; deployment of the vaccine; and protecting healthcare workers.

‘Vaccine Mortgages’ & Other Funding Innovations Could Help Boost Vaccine Development & Access

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

As the world struggles to finance vaccine development, countries or research institutions could be provided with money upfront to finance expedited R&D and pay it back later, just like a mortgage for a house, said Berkley. 

“In essence, it’s like buying a house where you have a mortgage payment you make out over 20 years, you can have that money up front. And that is something we’re looking at to support vaccine development.”

These so-called ‘vaccine mortgages’, more formally known as advanced market commitments (AMCs), have been successfully used by GAVI to support both development and scale-up of vaccines against bacterial pneumonia as well as the Ebola virus, with support from leading donors, including Norway, Canada, Italy, the Russian Federation and the United Kingdom. 

Prioritizing Vaccine Access: Health Workers, Hot Spots and Risk Groups  

When a new vaccine is rolled-out, it will have to be prioritized to key populations because production capacity will still take time to catch up with anticipated total demand. 

“It certainly won’t be on day one that enough doses are produced, no matter how big the [manufacturing] plants, no matter how much we prepare…We need to make sure that there is adequate production capacity for vaccines and that’s going to require working differently…we are going to have to prioritize [who gets the vaccine first].”

Before the vaccine is rolled-out in the general population, it must reach healthcare workers first, said Berkley, as they are the ones that will be most exposed to the virus. Healthcare workers may also spread the virus due to their contact with anyone seeking healthcare services, so they must be protected.

“We need to do everything in our power to protect healthcare workers.”

After reaching healthcare workers, the vaccine should be deployed in outbreak hotspots and then in at-risk groups. The world needs to discuss this issue and commit to such a priority list as soon as possible, he said.

“Discussions are going to have to happen and the thing that protects us the most is having the conversations before the issues occur,” he added, warning that otherwise huge distortions could emerge in available supplies, as per the experience with personal protective equipment (PPE).

Global Coordination To Pick The Best Vaccine: A Portfolio of Leading Candidates

Researchers are racing to find a vaccine for the novel coronavirus, 2019-nCoV; (Rendering/US CDC).

There are already some 90 COVID-19 vaccine candidates in the clinical trial pipeline, said Berkley, and he predicted there may be as many as 200 within a few months…

That’s all the more reason why the global community needs to collaborate closely to filter through the list, and pick the right lead candidates for further development, he and other panelists stressed.

“We’re going to need to down regulate [the large number of vaccine candidates] for the best potential products for the world and best means not only efficacious, but usable and scalable. That’s going to be critical,” said Berkley.

Not only does the ideal vaccine need to be selected based on its ability to mount an effective immune response, it also needs to be scalable – A vaccine portfolio can help the world pick the right vaccine.

“What you’re going to want is a portfolio of different types of approaches and ones that are scalable and manufacturable…the process that’s happening now is that people are beginning to [identify] what these criteria might be,” said Cerell.

Although some traditional vaccine approaches may seem slower to develop at first, they ultimately may be easier to scale, added Berkley. 

“You know the tortoise [traditional vaccine approaches] might win [the vaccine race], and the reason is that those vaccines may be better understood or simpler to use [or manufacture], needing only a single dose versus multiple doses.” 

Said Cerell, “We need much more coordination [at the global level] when it comes to narrowing down those [vaccine] candidates that show the most promise. We don’t want to have a lot of inefficient money being thrown out…We need to have a more coordinated approach to this [vaccine] portfolio management.” 

For coordination to be successful, transparency is also needed, said Cerell: “One of the ingredients is transparency. And right now the intentions are not in favor of transparency on a lot of these things [with respect to] pharmaceutical development.

– Tsering Lhamo contributed to this story.

Image Credits: WHO/Fanjan Combrink, Fanjan Combrink / WHO, US Centers for Disease Control and Prevention.