Ursula von der Leyen, European Commission President, speaking at the virtual launch of the Access to COVID-19 Tools (ACT) Accelerator virtual launch

In the largest global collaboration to address the COVID-19 crisis so far, the World Health Organization, European Commission, and other partners including the Bill and Melinda Gates Foundation (BMGF), launched a new campaign to accelerate development of COVID-19 diagnostics, drugs, and vaccines – and just as critically ensure that they are affordable and accessible worldwide.

The European Commission will be hosting a rolling pledging campaign, beginning 4 May, to raise the 7.5 billion Euros to bankroll the massive effort, said Ursula von der Leyen, EC President.

In a striking display of multi-lateral unity, launch of the new ‘Access to COVID-19 Tools’ (ACT) Accelerator was made in a WHO public webcast featuring UN Secretary General Antonio Guterres, Melinda Gates, 11 heads of state, including Germany’s Angela Merkel, France’s Emmanuel Macron, and South Africa’s Cyril Ramaphosa, as well as other leaders across Africa, Asia, and the Americas, and Europe.  

Strikingly absent were the United States and China, which have been locked in bitter dispute with each other over the management of the COVID-19 crisis. But Macron specifically addressed the political tensions, saying he hoped to “be able to reconcile this initiative” with both superpowers.

“I hope that both of these countries will be able to fight against COVID-19 by developing vaccines together,” said Macron. “There should not be any divisions between countries, we need to join forces.” Clinical trials for five of the seven leading vaccine candidates identified by the WHO are being conducted in either the United States or China. 

“Human health is the quintessential global public good, and today we face a global public enemy like no other. COVID-19 requires the most massive public health efforts,”  said Guterres in prepared remarks. “For too long we have undervalued, underinvested in global public goods. Data must be shared, production capacity prepared, resources mobilized, and politics set aside.”

UN Secretary-General Antonio Guterres calls into the ‘Access to COVID-19 Tools’ (ACT) Accelerator launch event.

“The ACT Accelerator brings together the combined power of several organizations to work with speed and scale,” added WHO Director-General Dr Tedros Adhanom Ghebreyesus at a 90 minute virtual launch, co-hosted with French President Emmanuel Macron and the BMGF. “Each of us are doing great work, but we cannot work alone. We’re coming together to work in new ways to identify challenges and solutions.” 

Leaders of other global health organizations echoed Guterres’ and Tedros’ calls urging countries to collaborate in the pandemic response.

Melinda Gates, co-founder of the BMGF, said “COVID-19 knowns no borders, and defeating it will require action across sectors and countries.”

“Beating coronavirus will require sustained actions on many fronts,” said von der Leyen, president of the European Commission. “This is a first step, only, but more will be needed in the future.” 

Search for a Vaccine Dominates

As new COVID-19 cases continue to rise in newly affected hotspots, and some states begin to weigh the risks of a resurgence as cases plateau, there was wide agreement among the leaders that developing and deploying an effective COVID-19 vaccine was the priority. Von der Leyen and Chancellor of Germany Angela Merkel called for such a vaccine to be treated as “a universal public good.”

Hope of curbing the pandemic was pinned on a vaccine just as early COVID-19 drug trial results, revealed that remdesivir, the most promising therapeutic so far, may not be as effective as initially suspected. The pre-print study was accidentally posted by WHO and obtained by STAT News.

“COVID-19 is not a human endemic infection, this will not disappear. The only true exit strategy is science,” said Jeremy Farrar, director of the Wellcome Trust.

“Finding and distributing the vaccine is the only way to win this battle,” said Guiseppe Conte, president of the Council of Ministers of Italy. “The role of governments is to promote good governance, transparency, and mutual accountability to ensure universal, equitable access to the vaccines.”

Guiseppe Conte, president of Council of Ministers of Italy, speaking at a virtual ACT Accelerator launch

So far, vaccine developers have reported that an acceleration of funding is required to bring candidates through later clinical trials and market approval. The Coalition for Pandemic Preparedness and Innovation (CEPI), which has been supporting three of the six vaccine candidates that have entered clinical trials around the world, is still facing a US $1 billion shortfall to bring a successful vaccine candidate to market.

“The establishment of the ACT Accelerator is a watershed moment in the world coming together to develop a global exit strategy from the COVID-19 pandemic,”  said Richard Hatchett, CEPI CEO. “Everyone must have access to the tools and countermeasures, including vaccines, that we will develop through the Accelerator.”

Hatchett’s comments were echoed by several heads of state and leaders of global health organizations from around the world, who stressed the importance of making any new COVID-19 tools accessible in an equitable way.

“We must commit to a system of clear global access goals as long as the virus is active somewhere. We are all at risk. The fight against COVID-19 must leave no one behind,” said Prime Minister of Norway, Erna Solberg.

Erna Solberg, PM of Norway, speaking at a virtual ACT Accelerator launch

But while the search for a vaccine dominated the discussion, other speakers reaffirmed the importance of supporting a holistic COVID-19 response, focusing on providing equitable access to diagnostics, therapeutics, and strengthening the public health system for future pandemic threats. The standing president of the G20 group of most called pandemic preparedness the “smartest investment for us to make today.”

“We might face a similar threat in the future,” said G20 president and Minister of Finance of Saudi Arabia, Mohammed bin Abdullah Al-Jadaan. “In order to deal with future pandemics effectively, we have to invest in strengthening our preparedness  and response systems. G20 is working with relevant organizations to assess that gaps with the view to establish a global mechanism for response.”

Key Commitments Under the ACT Accelerator

Under the ACT Accelerator, 11 major global health agencies, organizations, and pharma industry representatives made five major commitments in a statement released Friday:

  1. Aim to ensure equitable global access to innovative tools for COVID-19 for all;
  2. Commit to an unprecedented level of partnership to proactively engaging stakeholders and existing collaborations to align and coordinate efforts;
  3. Commit to create a strong unified voice to maximize impact;
  4. Build on past experiences towards achieving this objective;
  5. Stay accountable to the world, to communities, and to one another.

Some 11 heads of state including the United Kingdom’s first Secretary of State Dominic Raab, Spain’s President Pedro Sánchez Pérez-Castejón, Chairperson of the African Union Commission Moussa Faki Mahamat, Malaysian Prime Minister Muhyiddin Mohd Yassin, and Rwanda President Paul Kagame, among others spoke at the launch event to support the collaboration. Costa Rica President Carlos Quesada Alvarado, who called on WHO to create an accessible pool of COVID-19 intellectual property rights, also called in to support the launch. 

The initial group of collaborators includes the Bill & Melinda Gates Foundation (BMGF); the Coalition for Epidemic Preparedness and Innovations (CEPI), Gavi, the Vaccines Alliance; the Global Fund for HIV/AIDs, Tuberculosis and Malaria; UNITAID; the International Red Cross and Red Crescent Movement, and the Wellcome Trust.

Pharma industry representatives including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA); the Developing Countries Vaccine Manufacturers’ Network (DCVMN); and the International Generic and Biosimilar Medicines Association (IGBA) have also joined as founding members of the Accelerator.

The combined impact of Covid-19 and malaria in regions where malaria is widespread “could be catastrophic,” warned David Reddy, CEO of Medicines for Malaria Venture (MMV), the Geneva-based product development partnership, just ahead of World Malaria Day, which is celebrated on Saturday, 25 April.

His commment to Health Policy Watch,  came in the wake of WHO’s publication of a new study that forecast malaria deaths could double in sub-Saharan Africa in 2020 – effectively winding the clock back to levels seen two decades ago – if the delivery of core malaria control tools, including bednets and antimalaria drugs, is interrupted due to the pandemic response.

Under the worst-case scenario, in which all insecticide-treated net (ITN) campaigns are suspended and there is a 75% reduction in access to effective antimalariala,  malaria deaths in sub-Saharan Africa in 2020 would reach 769 000, nearly twice the number of deaths reported in 2018 and comparable to levels seen at the turn of the millennium, the new WHO study warned.

“Having witnessed the devastating impact of the pandemic on health systems around the world, we know this intuitively to be the case, and this study backs that up with modelling data,” Reddy said. “We need to act now and do all we can to avoid this catastrophic loss of life. Among other measures, this means ensuring bednets and antimalarials are available and accessible to people that need them – especially children under 5 years of age and pregnant women who are at greatest risk of malaria morbidity and mortality.”

Children and Pregnant Women Among the Most Vulnerable

According to the World malaria report 2019, sub-Saharan Africa accounted for approximately 93% of all malaria cases and 94% of deaths in 2018. More than two-thirds of deaths were among children under the age of five.  Altogether, there were an estimated 228 million cases of malaria worldwide and 405 000 malaria-related deaths.

Malaria was also one of the top 5 killers of adolescent girls and young women aged 15-19 in 2019.  Due to physiological changes that reduce natural immunity during the first pregnancy,  pregnant teenagers and young women may become seriously ill and even die from malaria, experts point out. In 2016, malaria caused some 10,000 maternal deaths, mostly in sub-Saharan Africa, where there is moderate to high transmission of the parasite, according to expert reviews.

“Across the world, this pandemic has surfaced a deep anxiety for the loss of lives of our loved ones,” Reddy said, noting that was also “an anxiety that echoes the deep, unheard concern of millions of parents of malaria-infected children every day. ”

The new WHO analysis considers nine scenarios for potential disruptions in access to core malaria control tools during the pandemic in 41 countries, and the resulting increases that may be seen in cases and deaths.

In a press release issued ahead of World Malaria Day, WHO urged countries to move fast and distribute malaria prevention and treatment tools at this, still early, stage of the COVID-19 outbreak in sub-Saharan Africa, and to do their utmost to safely maintain essential malaria control services even if the regional epidemic accelerates.

COVID-19 Cases Comparatively Small – But Rapidly Rising In Africa 

At 17000 cases and 748 deaths as of Thursday, the number of reported COVID-19 infections in WHO’s African Region has represented a comparatively small proportion of the global total, though hundreds of new cases are now being reported every day.

But countries across the region still have a critical window of opportunity to minimize disruptions in malaria prevention and treatment and save lives at this stage of the COVID-19 outbreak, WHO says.

The organization advised that mass malaria vector control campaigns be accelerated, while ensuring that they are deployed in ways that protect health workers and communities against potential COVID-19 transmission. WHO and partners commend the leaders of Benin, the Democratic Republic of the Congo, Sierra Leone and Chad for initiating ITN campaigns during the pandemic. Other countries are adapting their net distribution strategies to ensure households receive the nets as quickly and safely as possible.

Preventive therapies for pregnant women and children must be maintained. The provision of prompt diagnostic testing and effective antimalarial medicines are also essential to prevent a mild case of malaria from progressing to severe illness and death.

WHO and its partners have developed guidance on maintaining malaria services in COVID-19 settings.  The document, Tailoring malaria interventions in COVID-19 response includes guidance on the prevention of malaria infection through vector control and chemoprevention, testing, treatment of cases, clinical services, supply chain and laboratory activities.

 

 

Image Credits: UNICEF USA , Elizabeth Poll/MMV.

The World Health Assembly in Geneva, Switzerland.

In the wake of the COVID-19 pandemic, there could be “a window of opportunity… that would be suicidal to miss” to revise the International Health Regulations that govern countries’ behaviour during health emergencies, said Gian Luca Burci, former World Health Organization head legal counsel and now professor of international law, at a panel hosted by the Geneva Graduate Institute and Global Health Centre.

The present system may have led to delays in ramping up levels of alert at key points in the crisis to an international health emergency, Burci suggested at Tuesday’s panel entitled “What’s law got to do with COVID-19.”

“The system of alert right now is either we have an emergency or we have nothing. There is a growing consensus [that this system must be replaced by] something much more incremental,” Burci said.

The International Health Regulations (IHR), the legal framework for WHO’s emergency coordination and countries’ response, also has a “very weak” system for commanding sovereign states’ compliance with its provisions to prevent, prepare and respond to infectious disease outbreaks, Burci underlined.

But it remains up to Member States of the World Health Assembly to decide whether the WHO should wield more power, said Steven Solomon, principal legal officer for governing bodies at the World Health Organization.

As the only binding international law that governs international and member state response, and last updated in 2005 under very different global conditions, it is time for IHR to be revised, agreed Solomon and Gian Luca Burci. The question is how? 

The World Needs The WHO For Leadership And Coordination 
Top: Steve Solomon, current WHO Principal Legal Officer.
Bottom: Gian Luca Burci Former WHO Principal Legal Officer and Professor of International Law.

“To respond with two words, what can be done now [by WHO within the IHR system]…is leadership and coordination”, said Solomon.

Yet despite WHO’s attempts to coordinate such outbreak response for the world, countries have not always complied.

Export restrictions, which can block critical supply chains for essential products like personal protective equipment or medicines, have been adopted by 28 countries despite WHO guidance that such barriers impede efficient emergency allocation of resources, said Sueri Moon, Co-Director of the Geneva-based Global Health Centre.

“While many recommendations by the WHO have been implemented at the national level,” said Burci, the same level of adherence has not been observed in the international arena, with regards to trade, travel and related areas, “and we have to wonder why,” said Burci.

Countries have not complied because they simply do not have the incentive to do so under the current IHR rules, he added. 

“The system of accountability is weak. States can do whatever they want, without much accountability and with impunity,” Burci said. “There is resistance [by the WHO] to naming and shaming. There is no system of assessment of compliance [decreasing incentive for members to comply]”, he added.

Needed: “Agile” System For Resolving Trade Desputes

To address some of the trade barriers that have emerged during the emergency, the IHR would also requrie an ‘agile’ mechanism for settling trade disputes. The current system is “very weak”, and with countries shutting down their exports in a desperate attempt to prioritize sovereign supply, such revisions have become more important than ever. 

“There is no system of dispute settlement. The one we have is very weak. Look at what’s happening now, with border closures and trade limitations. These are the seeds of major dispute…There are evident gaps in travel restriction and trade restriction policies,” said Burci. 

At the broader level, a stronger compliance assessment system, integrated into the IHR, could make Member States more likely to comply with WHO recommendations because their responses to outbreaks would be evaluated and communicated to the public, agreed Solomon and Burci.

Public scrutiny, or ‘naming and shaming’, could be a useful tool to improve the WHO’s capacity to lead and coordinate an effective response at an international level.

An enforcement compliance mechanism can be created if Member States were interested in creating one, suggested Solomon. The WHO would also be ready to support countries if they decided on a new Mandate for that within the IHR context.

“Member states or countries decide…[if] something needs to be changed; that’s certainly an area where WHO would support, but that mandate has to come from Member States. That mandate can only be provided from the countries themselves,” he said.

The IHR revisions mentioned by Solomon and Burci, ranging from a compliance assessment to an improved trade dispute resolution mechanism, are not, however, compatible with the current architecture of WHO financing.  When most of its budget is controlled by a handful of large stakeholders, WHO’s hands are often tied in terms of inspecting, auditing or compelling countries to adopt emergency measures. 

Legal Experts Call For Sustainable WHO Financing Mechanism 

Top contributors to WHO’s Budget (2018)

Funding was dramatically highlighted last week when US President Donald Trump decided to suspend US funding, which amounts to about 15% of WHO’s annual budget. In addition, the regular annual “assessed” contributions of member states comprise only about one-fifth of the total WHO budget, while the rest comes from national “voluntary” commitments, which may be short-lived and are often earmarked for specific purposes.  

Solomon and Burci advised Member States to invest in a “sustainable financing mechanism” with a view to strengthening public health systems in the long-run.

“It’s irrational to have an organization like the WHO funded at 82% with voluntary contributions. You cannot have a fire brigade that has to raise money when it catches fire, that is irrational.”

Furthermore, it is important that funding be directed more strategically toward long-term strengthening of core capacities of public health systems like prevention, surveillance and response to disease outbreaks, the two legal experts said.

“Investments cannot immediately respond to a short term profit or political gain…Long term investment in public health care [is needed]…I hope that the WHO would play a role in that”, said Burci.

“It is not a do it once and it’s done”, said Solomon. “Maintaining core capacities is much more like brushing your teeth. It needs to be done every single day in a determined way”.

Image Credits: WHO/L. Cipriani, WHO .

Polio eradication is on WHO program that will likely take a big hit in light of US funding suspension.

Essential health programmes such as polio eradication and trauma management, and programmes in the World Health Organizations’ Emergencies program, will be hit hardest by the suspension of US funding to the WHO. 

“The reality is for my programme, a lot of that US funding is aimed at direct life saving services to people in the most destitute circumstances in the world,”  said Mike Ryan, WHO’s Executive Director of Health Emergencies. “We have a huge operational, technical, and financial relationship with the USA, and we’re very grateful for that relationship… I very much hope that it will only be a 60-day stay [on funding].”

Ryan made the statement in response to a line of questioning regarding whether WHO would be hard hit by a loss of US funding. A WHO spokesperson had previously told reporters that approximately 81% of WHO’s 2020-2021 budget had already been funded, and the Health Emergencies program had been allocated an additional US $1billion for the global COVID-19 response.

Approximately a quarter US funds would have been directed towards ‘core’ health programs outside of the COVID-19 response, and over US $650 million had been pledged to support other specific health areas such as polio eradication, immunization, and nutrition programmes. In Iraq and Syria for example, WHO programs there were concerned about the impact of loss of funding on health services, not as much on the COVID-19 response, according to Ryan.

“I hope that the US believes funding WHO is an important investment not just to help others, but for the US to remain safe itself,” added WHO Director General Dr Tedros Adhanom Ghebreyesus. “As former Minister of Health for Ethiopia, I am a living witness to appreciate the US support at the country level, and now as Director-General I am a living witness to appreciate the support the US gives the WHO. I hope the freezing of the funding will be reconsidered, and the US will once again support WHO’s work and continue to save lives.”

However, it’s unclear whether the US president has broad authority to put a moratorium on all funding WHO receives. However, the President could instruct US agencies to scale back funding for the organization. 

Ryan added that the WHO team is focusing on the health work on the ground, instead of “where the next paycheck will come from.”

“We’re concerned about supporting our friends and colleagues in the frontline who risk their lives every day, every single day to deliver life saving interventions to people around the world,” said Ryan. 

Just two days ago, one staff member, Pyae Sone Win Maung, was killed and another critically injured while transporting COVID-19 samples in Myanmar. “I don’t think their families are that concerned about the overall funding situation,” Ryan said. WHO Southeast Asia Regional Director Poonam Khetrapal Singh also condemned the attack on Twitter, saying, “As they deliver essential lifesaving services, our health workforce deserves gratitude, respect, appreciation and support for their selfless services.”

“But one thing we would like to assure to the world is that we will work day and night. And we will not be deterred by any attacks,” Dr Tedros said. “And as our colleagues say, attacks like this only strengthens our resolve.”

Africa at the Beginning of the Infection Curve

The WHO Health Emergencies Executive Director additionally warned today that many countries in the WHO Africa region were at the beginning of the COVID-19 infection curve. But leveraging innovation and agile public health systems could help countries “avoid the worst of the pandemic.”

“We’ve seen an almost 250% fold increase in cases in Sudan. In the last week, in Tanzania,Mali, Congo, Gabon, Guinea, Cabo Verde and Eritrea we saw increases of more than 100% in the last week. In many other countries in Africa, cases increased somewhere between 30 and 90%. So, we are at the beginning in Africa,” Ryan said on Wednesday. There are currently 15,394 confirmed cases and 716 deaths in the WHO Africa region. 

But some African nations have rapidly rose to meet the COVID-19 challenge – South Africa has so far tested 120,000 people with a 2.7% positivity rate. The country focused on a prevention and surveillance based strategy, rapidly training 28,000 community health workers in case detection and rolling out 67 mobile lab units across the country. 

“That much testing for that return, it’s incredible,” said Ryan. “We need to leverage the capacities that exist in Africa. The innovation, the science. We need to connect scientists and laboratories across Africa.”

For a number of African countries the case load remains under 100, and most of them are imported cases according to WHO COVID-19 Technical Lead Maria Van Kerkhove.

As such, Ryan said, countries across the continent must keep focused “on preparation, on surveillance, on community mobilization.”

WHO DG Urges Eastern Mediterranean Countries to Step Up Response

Dr Tedros urged Health Ministers from WHO Eastern Mediterranean countries to strengthen their COVID-19 response as infections accelerated in countries across the region. The WHO Director-General met online with Minister of Healths from the Eastern Mediterranean Region on Wednesday, just a day before the holy month of Ramadan.

“The epidemic in the Islamic Republic of Iran now appears to be waning, but most other countries in the region are seeing increasing numbers of new infections every day,” said Dr Tedros in prepared remarks.

“We have been impressed by the progress being made across many EMRO countries. The active outreach to almost 70 million people in Iran through the national campaign; the rapid scaling up of testing in United Arab Emirates; the commitment to establishing temporary isolation units in Pakistan; the use of polio assets in Afghanistan and in Somalia.

“In spite of this clear progress, I am of course asking you to do more. First, the response to COVID demands a whole-of-government approach. As Ministers of health, you play a vital,  central role, but you cannot do it alone so continuing with the whole of government approach will be very important to beating this virus.

“Second, we call on countries to implement proven public health measures aggressively: detect, test, isolate and care for every case, and trace and quarantine every contact.

“And third, we urge you to pay careful attention to ensuring that essential public health services continue safely and effectively.”

Dr Tedros further affirmed WHO’s support and highlighted resources available at countries’ disposal, including a United Nations Supply Chain System, launched last week to ramp up the distribution of essential supplies to countries in need. The Organization is also coordinating global Solidarity Trial to explore therapeutic options for COVID-19, monitoring healthcare worker infections and prevention, and updating technical guidance.

Total cases of COVID-19 as of 10:00PM CET 22 April 2020, with active case distribution globally. Numbers change rapidly.

Regional Trends in Europe, the Americas, and Southeast Asia

Following a downward trend in new COVID-19 cases, the federal council has released a three-step re-opening plan, starting from April 27. In Switzerland, the Federal Office of Public Health (FOPH) has confirmed 28,268 positive coronavirus cases with 1217 deaths.

In conjunction with this plan, the FOPH has also widened the criteria for coronavirus testing, now allowing for asymptomatic people at risk of spreading infection to be tested. This measure comes as a study shows that the current testing regime in Geneva has confirmed only one of every six cases and calls for increased testing to avoid a second wave of infections. 

The European Council is drafting a recovery plan to bolster corona-hit economies. A roadmap released on Tuesday emphasizes strengthening Europe’s “strategic autonomy” to reduce reliance on foreign suppliers, as the EU leaders prepare to endorse a 540 billion euros ($587 billion) package that would help pay lost wages, keep companies afloat and fund health care systems. The European Centre for Disease Prevention and Control currently records 1,101,681 cases of coronavirus in Europe, with 107,453 deaths.

United States President Donald Trump will be signing an executive order today implementing a 60-day ban on issuing permanent residency cards to immigrants. A bipartisan $484 billion coronavirus relief package was passed by the Senate on Tuesday, which would replenish a depleted loan program for distressed small businesses and provide funds for hospitals, states and coronavirus testing. 

Public health officials in the US have been retracing the path of the virus across the country and have found that the earliest deaths occurred in early February in California, almost three weeks before the first officially confirmed coronavirus death in Seattle – indicating the virus may have begun circulating in the community much earlier than expected.  A second wave of COVID-19 may occur in the fall, coinciding with seasonal flu to cripple the weakened healthcare system, warned Robert Redfield, director of the Center for Disease Control and Prevention in an interview with the Washington Post. The United States of America has the world’s highest number of positive coronavirus cases and confirmed deaths, with 825,306 cases and 45,075 deaths.

In Latin America, WHO PAHO is dispatching an additional 1.5 million PCR tests this week, followed by another 3 million next week to strengthen laboratory surveillance networks across member states, PAHO Director Carissa F. Etienne said in a press briefing Tuesday. As cases started to ramp up across the region, countries have faced increasing difficulty keeping up with the demand for testing.

“We need a clearer view of where the virus is circulating and how many people have been infected in order to guide our actions,” Etienne said in a press release.

In Southeast Asia, India’s central government has approved an amendment to the Epidemic Diseases Act, 1897 that aims to end violence against health care workers. Anyone found guilty of attacking a healthcare worker could be imprisoned for 6 months to 7 years, according to Union Minister Prakash Javadekar. The move comes after several complaints from the medical fraternity on the acts of violence against doctors and other medical staff during the COVID-19 crisis in India, which has now bloomed to more than 20,000 confirmed coronavirus cases and over 600 deaths.

Gauri Saxena contributed to this story

Image Credits: WHO Africa Regional Office, Johns Hopkins CSSE.

Melting glaciers could release millions of new bacteria to which people have never been exposed.

Will the blue skies and rainbows seen in Delhi and other heavily polluted cities of the world be a fleeting image of the COVID-19 lockdown – or can it signal a change in trends around the world about how countries treat their environments?  

Save the shot – it may not recur soon. 

“This drop of emissions of 6%, that’s unfortunately (only) short-term good news”, Petteri Taalas, World Meteorological Organization (WMO) Secretary-General told UN News 

While there has been an estimated 5.5-5.7%  fall in levels of carbon dioxide due to the pandemic, once the global economy begins to recover from the new coronavirus, WMO expects emissions to rebound. “There might even be a boost in emissions because some of the industries have been stopped”, Taalas cautioned. 

https://www.youtube.com/watch?v=5o-EimWEOtE&feature=youtu.be

CO2 At Record Levels Last Year

The last five years have already been the hottest on record, WMO also noted in a report published Wednesday, coinciding on with the 50th anniversary of the first Earth Day celebration on 22 April, 1970  – a date oft-used to mark the dawn of the modern environmental movement. 

Carbon dioxide (CO2) levels and other greenhouse gases in the atmosphere rose to new records just last year, and levels were 18% higher on average between 2015- 2019 than in the previous five years, according to WMO’s Global Climate 2015-2019 report. 

Since CO2 remains in the atmosphere and oceans for centuries, “this means that the world is committed to continued climate change regardless of any temporary fall in emissions due to the Coronavirus epidemic”, the report states. 

Tackle COVID-19 and Climate Together

Even so, a growing number of both climate and health scientists and environmental advocates have called on global leaders to use the COVID-19 moment for a sharp about-face in the way societies produce carbon emissions, pollute air and water resources, encroach on biodiversity, and produce massive waste. 

“We need to tackle both, the corona pandemic at the same time we tackle the climate and environmental emergency,” said Swedish activist Greta Thunberg, in a video broadcast over Twitter. 

“This brief period of cleaner air should send a message to people to push for longer-term changes,” pointed out Maria Neira, director of the World Health Organization’s Department of Environment, Climate and Health.

“By lowering air pollution levels long-term we can help populations to be more resilient to the current pandemic – and any future health threat,” she said. She was referring to recent studies from the United States and Italy showing that people who  live in areas with higher air pollution levels, also had significantly higher mortality rates from COVID-19.  One already well-documented fact of the pandemic is that people living with pre-existing cardiovascular and respiratory conditions have much higher risks of serious disease and death. And these diseaes, in fact, are often air-pollution linked.

“If we truly care about the health of our communities, countries and global commons, we must find ways of powering the planet without relying on fossil fuels,” said Neira. “When we eventually take off our face masks, we want to keep breathing clean air!”

Health Professionals Issue Massive Appeal

An open letter from 12 million young health professionals released on Wednesday demanded that governments “protect planetary health” as part of “sustainable recovery and relief efforts,” associated with CVID-19 lockdown.

“Why Earth Day is more important than ever”

The group urged governments to put “universal access to renewable energy” at the heart of COVID-19 stimulus plans, and redirect millions of dollars of fossil fuel subsidies into renewable energy. 

The letter also included a call for global and national leaders to better prepare for future pandemics by strengthening regulations against deforestation and illegal wildlife trading – which both increase the risk of emerging viruses spilling over into human populations and ecosystem degradation. Scientists largely believe that the novel coronavirus first jumped from bats to humans through an intermediary animal – tapped by some to be the pangolin – sold at a Wuhan wet market. 

The letter was signed by the UN Major Group for Children and Youth – which represents some 20,000 youth groups and 10 million youth – and the International Federation of Medical Students Associations – which represents some 1.3 million medical students around the world – among others.

“Failing to confront climate change will irreversibly harm future public health,” said one signatory, Julia Simons, a medical student who graduated early to join the pandemic workforce. She told Health Policy Watch, “COVID-19 clearly illustrates we are vulnerable, let us not forget our global security relies upon an Earth System that can support human life not weapons…This is a crisis but also an opportunity to build a better future together recognising our global interdependence.”

The professionals also called for governments to respond ambitiously to the current global pandemic, while preparing for the next one; embrace “people-centred politics” and follow through on making universal health coverage a reality. 

“COVID-19 is increasingly exposing the political, social, economic, and environmental fault lines in our society. As young health professionals on the frontline of this emergency, we will play an important role in saving lives and protecting our communities in the weeks and months ahead,” Lucy Fagan, global focal point for the UN Major Group for Children and Youth told Health Policy Watch. “But this is a critical inflection point. As we look to recover from this pandemic, we need to build back better – responding with a people and planet-centered approach to guarantee a healthier future for all.”

The letter was signed by the UN Major Group for Children and Youth – which represents some 20,000 youth groups and 10 million youth – and the International Federation of Medical Students Associations – which represents some 1.3 million medical students around the world – among others.

Biodiversity, Habitat Encroachment & New Diseases Like COVID-19 Are All Linked
Jungle burned for agriculture in southern Mexico

“Mother Nature has provided us with all the tools we need to protect humanity from the violent and life-threatening spread of viral pandemics, rising seas, extreme weather, spiking temperatures, degraded habitats, uncontrolled wildfires and other catastrophes built from the sheer avarice of the human race,” said the United Nations Development Programme in an Earth Day message.  

“On Earth Day, we look at how nations across the globe are harnessing the power of Mother Earth to heal herself and to protect her people from interconnected global crises that threaten to push millions into poverty, trigger mass migration, fuel ever-more powerful disease outbreaks such as the COVID-19 pandemic.”

In fact, the likely roots of the pandemic have been traced to the illegal hunting and capture of endangered wild species such as the pangolin, which are then contained in cruel conditions before being slaughtered on the spot and sold in Asian “wet markets”.  While some theories hold that the virus escaped from a Wuhan laboratory, no one disputes that it was of natural origins.

Pangolin, Manis javanica

And already in Asia and Africa, epidemics ranging from H1N1, HIV/AIDS to Ebola and lesser known Nipa virus have also been traced to human encroachment into forests and consequent habitat destruction, as well as the hunting, capture and consumption of wild animals, also known as “bushmeat”. 

So far, those deeper drivers have not featured prominently on the agendas of policymakers, who are understandably focused on the nuts and bolts of containing the current outbreak, and  treating those who become ill. 

However, without attention to the underlying drivers, epidemics and even pandemics such as COVID-19 will occur more and more frquently, in the future, health emergency experts acknowledge – even if they paid scant notice to Earth Day.   

“It is clear that the animal to human species barrier has been breached once, and it can be breached again,” warned Mike Ryan in a WHO press briefing on Wednesday.

He added that he would welcome any opportunity to explore more thoroughly with China the origins of the COVID-19 disease. 

“It is important to understand where that came from; that is good science.  We have a team working closely on those issues with the OIE (World Organization for Animal Health) and FAO (Food and Agriculture Organziation).  We would be delighted to work with international partners and at the invitation of the Chinese government in order to be able to carry out a really good investigation around the animal origins….. We very much look forward to that opportunity.” 

 

 

Image Credits: Michal Balada/Shutterstock.com, Twitter (UNSplash/ Guillaume de Germain), Jami Dwyer, Piekfrosch/wikipedia.

Polymerase Chain Reaction (PCR) test for the virus that causes COVID-19 respiratory disease, SARS-CoV-2.

With COVID-19 pandemic curves beginning to flatten out in many parts of the Europe, Health Policy Watch presents a snapshot of infection and death trends in WHO’s European region through graphs that tell the story, using up-to-date data from the COVID-19 tracker of the Geneva-based Foundation for Innovative New Diagnostics (FIND).

Notably, some striking, but little discussed, differences in deaths, disease incidence and rates of testing exist among Switzerland, Czechia, Denmark, Norway and Sweden – countries with similar population sizes and age demographics, quality health systems and high development indices.While a great deal of attention has been focused on the situations faced by Europe’s big powers, including the United Kingdom, Italy, France and Spain, on the one hand, and Germany on the other, trends in these smaller, central and northern European countries are also revealing -with death rates in Czechia particularly low, followed by Norway and Denmark.

While it will take more time and expert review to etch out the basket of policies that worked best together, the snapshot of trends is suggestive of questions that will have to be asked and the mix of policies that may or may not be most effective.

The lesson in the data seems to indicate that there is no one policy that works on its own, but rather an integrated package  – as the World Health Organization has long stated. And countries that test more and test earlier have better curbed the spread of the virus, as well as deaths resulting from COVID-19 infection.

See below the three key indicators in data: death rate, testing and number of reported COVID-19 cases. Note these are presented in per million,  to make comparisons more equal.

Death Rates – The Ultimate Indicator
(HPW/Svĕt Lustig): Sweden’s death rate due to COVID-19 is much higher than Norway and Denmark. Based on national data collected by FIND (finddx.org), 20 April, 2020.

Death rates, if reported accurately, are the ultimate indicator of a country’s outbreak response policies – at least among countries with similar age demographics and underlying health conditions. Death rates can be seen to reflect the success of the whole range of measures taken, including testing and contact tracing and the quality of hospital care as well as physical distancing through quarantines and lockdown measures.

Whatever the combination of policies that worked and did not, it remains striking that deaths, per capita, have been much higher in Switzerland and Sweden as compared to Denmark, Norway and Czechia, which also tested more aggressively in the early days.

Denmark, Norway, and Czechia also cancelled mass events, closed leisure facilities and restaurants for dining, adopting strict social distancing measures comparatively early on in the initial epidemic surge, while Switzerland took those same measures more gradually and comparatively later in its outbreak, which began to spill over from Italy already in late February.

Czechia closed its borders early on, and ordered universal masking of its citizens. So did Czechia’s extraordinary measures keep its case load and death rates particularly low? And on the other hand, could it be that Norway’s more aggressive testing policies, also helped contribute to significantly lower mortality trends, much in the spirit of WHO’s admonition to “test, test, test”?

Sweden, which experienced relatively higher mortality, left most restaurants and shopping malls open throughout. Sweden’s ‘voluntary’ physical distancing measures were also much milder than those adopted in Norway and Denmark.

Israel, also a member of WHO’s European Region, is another country with very low death rates comparable to Czechia’s. Like Czechia, Israel adopted strict social distancing, quarantine and travel restrictions early on, although experts have also attributed the low death rate to the country’s comparatively younger population – an average age of about 30 as compared to 40-something averages of the the central and northern European countries featured here.

Countries That “Test, Test, Test” Can Reduce Death Rates – But Follow-Up Also Essential

WHO has stressed that testing lies at the heart of containing infectious disease outbreaks and helps save lives by allowing authorities to trace and isolate infected people accordingly.

“All countries should be able to test all suspected cases, they cannot fight this pandemic blindfolded, they should know where the cases are, and that is how they can take decisions,” WHO Director-General Dr Tedros Adhanom Ghebreyesus has stated repeatedly at WHO’s COVID-19 press briefings.

In Scandinavia, Sweden has lagged far behind Norway and Denmark in implementing widespread COVID-19 testing, a key World Health Organization-COVID-19 control strategy. Sweden has paid the price of low testing with significantly higher death rates.

Norway, on the other hand, has been the European country that consistently tested the most, from the early days of the epidemic until now. Norway’s testing rates were three times more than those in Sweden, while Norway’s deaths were only about one-fifth of its next-door neighbor. Denmark also tested twice as much as Sweden, while its death rate was less than half.
Switzerland has also tested more aggressively than any other country, just behind Norway. Despite having one of the highest ratios of cases, per capita, its death rate has been almost the same as Sweden. Once again, differences in testing may help explain these trends, as testing can help in case identification and reporting that reduces mortality. There are signs that Sweden has come to this conclusion too. The country plans to expand testing now by a factor of six to 100 000 tests a week, targeting ‘key roles’, such as policemen, firefighters, and healthcare workers, said Swedish Health Minister Lena Hallengren last Friday at a press conference. 
(HPW/Svĕt Lustig): Sweden focused less on testing than its neighbors. Based on national data collected by FIND (finddx.org), 22 April, 2020.
But testing is merely the first step in an outbreak response, public health experts have stressed.

“Testing is a hugely important central piece of surveillance, but we need to train hundreds or thousands of contact tracers [to follow up on positive cases and contacts]. We need to be able to find cases, we need to be able to isolate cases who were confirmed,” said WHO Executive Director of Health Emergencies Mike Ryan. 

In Norway and Denmark, the widespread availability of testing as part of a comprehensive ‘package’ of policies, has allowed authorities to quickly identify and quarantine people to effectively reduce deaths – although again, these measures were also accompanied by quarantines and physical distancing.

Drop-in testing clinic outside a health clinic in the ultra-orthodox city of Bnei Brak – one of Israel’s virus hotspots

Norway and Denmark are not the only European countries that have seen the fruits of testing.  Despite being hit by heavy waves of cases from Italy and France, Switzerland has had comparatively high testing, which could have helped fend off an even wider outbreak as it faced the onslaught of cases imported from Italy, which was Europe’s virus epicenter.

“Testing is important in fighting COVID-19. Switzerland is testing more and more”, said Swiss Federal Councillor Alain Berset, in a tweet in late March.

Israel has also ramped up testing capacity recently to one of the highest in Europe – aggressive testing along with precision case tracking and isolation has been viewed by experts there as key to “lockdown exit” strategies – and its army has even taken on a central role, mapping disease incidence house by house in the most heavily infected, ultra-orthodox towns and neighborhoods.

Case Rates Per Capita Across Europe
(HPW/Svĕt Lustig): Sweden, Denmark and Norway have similar case numbers. Based on national data collected by FIND (finddx.org), 20 April, 2020.

Experts have warned that reported cases may not reflect the true picture of disease spread – due to the very different rates in testing that countries have practiced.  Strikingly, Switzerland has one of the highest numbers of reported cases, per capita, in Europe, outpacing even those of neighboring Italy and double those of Sweden. However as one of the countries testing most aggressively, it may be that Switzerland has also simply been more diligent about case tracking and reporting, while cases that passed under the wire elsewhere. In light of its high case rate, the comparatively lower mortality may be a qualified success.

Clearly, however, Switzerland’s proximity to Italy and France, as well as the fact that lockdown measures may have been implemented later in the epidemic surge than in the other countries noted here, may have also played a role in high case incidence.

Czechia Gets The Highest Marks Across The Board – So Far
Homemade mask production for members of the public have become a big part of Czechia’s containment strategy.

At the very other end of the scale, Czechia has reported the lowest number of cases, per capita. And while Czechia’s testing rates are not as high as other countries like Israel or Norway, Czechia also has one of the lowest mortality rates in Europe.

Strikingly, it is also one of the few countries in Europe that has made mask use mandatory in public spaces from the early days. Is it possible that along with the travel restrictions and lockdown measures, widespread and mandatory mask use helped Czechia slash the number of infected people to a minimum, as well as the death rate resulting from the disease?

Given that the Czech public was widely engaged in home-fashioned mask making, it is also likely that priority populations like healthcare workers did not lack access to masks. Last week, Czechia began lifting its lockdown.

Image Credits: Mehr News Agency, Israel Ministry of Health, Pavlina Fojtikova.

United Nations General Assembly hall in New York City

The UN General Assembly approved a resolution Monday night calling for accelerated scientific cooperation and global coordination to hasten the “rapid development, manufacturing and distribution of diagnostics, anti-viral medicines, personal protective equipment and vaccines” needed to fight the COVID-19 pandemic.

The resolution, approved in a virtual poll, also called on countries “to immediately take steps to prevent … speculation and undue stockpiling that may hinder access to safe, effective and affordable essential medicines, vaccines, personal protective equipment and medical equipment.”

Drafted by Mexico and co-sponsored by about 170 countries, the Resolution mandates UN Secretary-General Antonio Guterres to work with the World Health Organization “to identify and recommend options” to ensure timely and equitable access to testing, medical supplies, drugs and future coronavirus vaccines for all in need, especially in developing countries.

The resolution was welcomed by a cross-section of bio-pharma and medical technology industry associations, which banded together to highlight their support for more international collaboration, including between public and private sectors, in the quest for treatments.

“Our organizations believe that coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency,” said the statement by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the International Council of Biotechnology Associations (ICBA), the Global Medical Technology Alliance (GMTA), the Global Diagnostic Imaging, Healthcare IT & Radiation Therapy Trade Association (DITTA), and the Global Self-Care Federation (GSCF).

“COVID-19 is teaching us a crucial lesson: facing any global health challenge, in particular one of such unprecedented scale, requires solidarity, truly inclusive cooperation and even closer
efforts to ensuring health systems’ resiliency. As this Resolution calls for United Nations -wide coordinated efforts, we believe that priority should be placed on critical aspects, including
strengthening the global supply chain to support continuity, ensuring effective surveillance mechanisms, fostering strong and adaptable resource capacity within health systems, and
promoting the establishment of procedures for fast evaluation and approval of new health technologies.”

However one civil society group, which has advocated for removing all patent barriers that might hinder broadbased access to COVID-19 therapies, was not as enthusiastic. “The New York UN resolution avoided the elephant in the room, the issue of IP on tests, drugs and vaccines,”  James Love, head of Knowledge Ecology International (KEI), told Health Policy Watch.

The resolution also reaffirms the fundamental role of the United Nations system in coordinating the global response to control and contain the spread of COVID-19 and in supporting the 193 U.N. member states, “and in this regard acknowledges the crucial leading role played by the World Health Organization.”

Notably the United States did not block adoption of the text, despite the fact that U.S. President Donald Trump suspended funding to the World Health Organization earlier this month. He accusing WHO of being “China-centric” in its response to the virus, failing to alert member states about potential human-to-human transmission early enough, and opposing travel restrictions – w which were later widely adopted by countries anyway as the outbreak spiraled into a pandemic.

The vote over the resolution was held remotely since the General Assembly is not holding meetings during the pandemic. Under the rules instituted, the draft resolution is circulated to member states and if any single state rejects the resolution, it is not adopted.

General Assembly President Tijjani Muhammad-Bande announced the approval of the resolution in a letter to the 193 U.N. member states Monday night saying there were no objections to the resolution.

The resolution is the second on COVID-19 approved by the General Assembly.

On April 2, the world body approved a resolution on Global solidarity to fight the coronavirus disease recognizing “the unprecedented effects” of the pandemic and calling for “intensified international cooperation to contain, mitigate and defeat” the virus.

Image Credits: Patrick Gruban.

In characteristically soft-spoken tones, World Health Organization Director General Dr Tedros Adhanom Ghebreyesus issued his strongest rebuttal yet to the recent allegations by United States President Donald Trump that the WHO had hidden information in the early days of the COVID-19 pandemic, or failed to inform WHO member states rapidly enough.

Calling upon his own background growing up in Ethiopia where he saw rampant poverty and lost a brother to disease, the WHO Director General declared “we don’t hide information.”

He also warned the world’s leaders saying that they were “playing with fire” by playing politics with the pandemic.

“Don’t use this virus as an opportunity to fight against each other or score political points. It’s dangerous,” he said.

“This is a tragedy which is already affecting many families. So we don’t hide information,” he added, “Because I know what poverty means, I know what war means, I know what killer diseases mean…. This is a devil that everybody should fight, and for that we need global solidarity, cemented in national unity.”

He added that public health experts remain challenged by the lack of knowledge around the virus and this had also contributed to a slow global response: “It’s a virus that many people still don’t understand. Many countries that are very developed, put [out] the wrong conclusions because they didn’t know it, and got into trouble. 

“And we warned even developed countries saying, ‘this virus will even surprise developed countries.’ It did. It will even surprise wealthy nations, we said that, it’s on record.”

WHO has two permanent US government secondees embedded in its operations, added WHO Emergencies Head Mike Ryan, as well as 15 more US experts who have been seconded since the COVID-emergency erupted, acknowledging the “major contribution US government officials embedded in our outbreak have played since the early days of the operation.” Along with those direct scientific links, he said that all G-7 countries have AI-based intelligence systems that pick up signals on new disease threats and outbreaks.

WHO Sees Turbulent Week of Support & Critique

Dr Tedros spoke after a turbulent weekend that saw both strong signs of support for the WHO, in the form of a US$ 500 million emergency contribution from Saudi Arabia, as well as continued backlash from the United States.

The US hand was evident in the squashing of a G-20 statement of support for the beleaguered global health organization at a virtual meeting Sunday of the Group of 20 most industrialized nations. The terse six-paragraph press release that was finally issued  instead made no mention of WHO whatsoever, vaguely referring to “vulnerabilities in the global community’s ability to prevent and respond to pandemic threats.”  A post-meeting press conference was abruptly cancelled by the chair, Saudi Arabia Health Minister Tawfiq Al-Rabiah.

The original 52 paragraph statement had reportedly expressed “concern about the continuity and lack of sustainable funding” of the WHO’s health emergencies programme, according to an unpublished draft obtained by the Guardian. It urged all donors to invest in the fund, saying “it is far more cost effective to invest in sustainable financing for country preparedness than to pay to the costs of responding to outbreaks.” 

Addressing G-20 leaders, the WHO Director-General urged industrialized countries to loosen their lockdown restrictions with caution, while continuing funding and producing needed supplies for the global response.  He noted that even as new cases are stabilizing in many developed, they are escalating in many countries with weaker health systems. 

“We are looking to the G20 countries to continue to support the global response to COVID-19,” said Dr Tedros, in his published statement, “We echo [South African] President Ramaphosa’s appeal on behalf of the African Union to G20 countries to support African countries with stimulus packages and debt relief so they can focus on fighting the pandemic.

“We call on all G20 countries to work together to increase the production and equitable distribution of essential supplies, and to remove trade barriers that put health workers and their patients at risk.”

G20 Health Ministers meet via video conference to discuss the COVID-19 response.
WHO Narrative On Taiwan’s Warnings 

At Monday’s press briefing, meanwhile, Dr Tedros also sought to set the record straight on one key element of the US allegations – the 31 December email from Taiwan’s Centers for Disease Control, that Taiwanese and US authorities said had been ignored. Although Taiwan said the message had suggested that the virus could be transmitted person-to-person, it was not the first alert about the disease, nor did it specifically indicate that the virus was transmitted via human contact. And it was only one of only dozens of emails that were received by countries requesting clarifications about the first news of the virus spread.

“The one thing that has to be clear is the first email [alert about the novel coronavirus] was not from Taiwan,” he said. “The report first came from Wuhan and China itself – that’s number one fact.”

“The email from Taiwan like other entities, was to ask for clarification,”  he added, noting that it was one of many such queries received from countries. “And they didn’t report any human-to-human transmission.  

“So we didn’t receive a report of the existence of human human transmission from Taiwan on December, 31. We have all the documentation, and the emails we received from Taiwan… like other entities, was to ask for clarification. Nothing else. “

On 11 April, the Taiwanese Ministry of Foreign Affairs retweeted its December 31 message to WHO. The tweeted message from Taiwans Centers for Disease Control stated, that “News resources today indicate that at least seven atypical pneumonia cases were reported in Wuhan, China. Their health authorities replied to the media that the cases were believed not SARS; however the samples are still under examination and case have been isolated for treatment. I would greatly appreciate it if you have relevant information to share with us.””

In a follow-up email to media sent 13 April, Chenwei Ku, Assistant Director of the Taiwanese Mission in Geneva said that while the message did not explicitly refer to person-to-person transmission the words “isolated for treatment” suggested that it was a risk.

“Public health professionals could discern from this wording that there was a real possibility of human-to-human transmission of the disease,” she said. “However, because at the time there were as yet no cases of the disease in Taiwan, we could not state directly and conclusively that there had been human-to-human transmission.”

Moving out of Lockdowns 

As many developed countries looked for ways to move out of lockdowns while new case reports stabilized somewhat, Ryan warned that “moving away from a lockdown” means that countries must “move towards something else.”  That includes communities that “understand how to protect themselves and others, and are willing to continue with the physical distancing and personal hygiene measures.”

Testing is another essential element, but along with testing there is a need to train “hundreds of thousands of contact case workers who can isolate cases and do contact tracing,” he added. Effective quarantine accommodations or measures need to be identified for people suspected or found to be ill.

These measures are particularly important, both Ryan and Emergencies Technical lead Maria Van Kerkhove emphasized, because the most recent serological studies continue to show that a relatively low proportion of the population have antibodies to the SARS-CoV-2 virus that causes COVID-19, meaning that “a large proportion of the population is susceptible.” Among those studies is one from Germany, which showed only about 14% of the population carrying the virus antibodies.

Meanwhile, even if the current wave of outbreaks in the pandemic are brought under control effectively, and a vaccine for the disease is finally developed, the world will still face a massive challenge in delivering immunizations to all of the people who need it.

“We are good at delivering vaccines to children,” said Ryan, but for adults, health systems are ill-prepared.  Ensuring equitable delivery “will require one of the greatest scientific, political, financial and public health operations that we have seen in a generation,” he said. “It must be done with proper stewardship and leadership.”

Novartis Receives US FDA Approval on Phase III trial for Hydroxychloroquine

In developments around Europe, the Swiss-based pharmaceutical Novartis received the go-ahead from the US Food and Drug Administration to conduct a 440-patient Phase III randomized trial of the drug used for lupus, hydroxychloroquine, against COVID-19 disease. The trial, one of the largest to consider the drug so far, will take place in about a dozen sites in the USA. The recently announced clinical trials complements a donation of 130 million doses of the drug by Novartis last month.

We recognize the importance of answering the scientific question of whether hydroxychloroquine will be beneficial for patients with COVID-19 disease,” said John Tsai, Head of Global Drug Development and Chief Medical Officer at Novartis in a statement. “We mobilized quickly to address this question in a randomized, double-blind, placebo-controlled study.”  In addition to hydroxychloroquine, Novartis plans to sponsor or co-sponsor clinical trials to study ruxolitiniband canakinumab – both anti-inflammatory drugs – for hospitalized patients with COVID-19 infections.

Meanwhile, Chinese officials announced they were moving forward with trials for two more vaccine candidates, produced by the Wuhan Institute of Biological Products Co. Ltd., and the Sinovac Research and Development Co – bringing up the total number of vaccine candidates under investigation by China up to 5. In Europe, immunologist Martin Bachmann told Medical News that he hoped his lab at the University of Bern could mass produce enough of a viable vaccine in 6 – 8 months.

Across some 10,000 sequences of the SARS-CoV-2 genome that have been released, the virus appears fairly stable and has not mutated significantly. Thus, researchers can use existing strains of SARS-CoV-2 to develop a vaccine, according to WHO experts.

“The development of a vaccine on current viruses that are available is good,” said Van Kerkhove. “We welcome all work on the development of the vaccine and the as rapidly as safely as possible.”

Switzerland’s top technical universities Swiss Federal Institute of Technology, Lausanne (EPFL), and the Swiss Federal Institute of Technology, Zurich (ETH-Zurich) pulled  out of an European coronavirus tracing App project due to privacy concerns last Friday, Radio Television Switzerland, reported, quoting EPFL president Martin Vetterli. Switzerland plans to lift its lockdown next week.

France plans to triple its testing capacity to 500 000 tests a week by mid-May, said French Health Minister Olivier Véran in a press conference on Sunday. Although France plans to lift its two-month lockdown in mid-May, a complete return to normalcy was far away, French leaders cautioned. Members of the public will ‘probably’ have to wear mask to prevent infections and not all schools will re-open, said French Prime Minister Édouard Philippe. A group of French activists called for an “efficient reorganization” of French trade union Les Entreprises du Medicament (LEEM), which defends the interests of the pharmaceutical industry, in an attempt to improve French medicines production capacity.

In Africa, Chinese billionaire Jack Ma’s foundation sent a third batch of personal protective gear (PPE) for health care workers on the continent,  including 4.6 million masks, 500 000 swabs and test kit, 300 ventilators, 200 000 clothing sets, 200 000 face shields, 2000 thermal sensors, and 500 000 pairs of gloves. The African-based Ecobank said it would contribute some US$ 3 million to governments, the WHO and the private sector to help fight COVID-19.  

Total cases of COVID-19 as of 6:38PM CET 20 April 2020, with active case distribution globally. Numbers change rapidly.
White House Supports Reopening Country After Weekend Protests Over Lockdowns

The White House called for the reopening of sports venues, restaurants, gyms and places of worship, “With federal guidelines in place to protect – not control- American people, it’s time to work together towards it’s time to work together toward reopening America,” said the Tweet. 

Since US President Donald Trump gave initial support to lifting stay-at-home orders, protests erupted in at least six states of the USA over lockdown restrictions, including California, Texas, Ohio, Kentucky, Pennsylvania. Michigan was the first to create a massive traffic standstill around the state capitol building, with many protesters carrying firearms with them. “We want to work. We have paychecks to issue”, said one Michigan protester .  

Speaking on Fox News, Kellyanne Conway, counselor to US President Donald Trump, said, Americans were saying: “I want to get back to work. The governors have the last word on that, but some have been more concerned about controlling the population rather than protecting them,” she said, adding.  “Some of these governors have physically distanced from common sense.  In Michigan, you can basically smoke your grass, but not cut your grass.”

Surge in Singapore 

In the Western Pacific region, however, Singapore was experiencing the biggest surge in cases in a day since the beginning of the outbreak, with 1426 new cases reported today in a press release from the Ministry of Health. Some 99% of confirmed cases are foreigners with work permit residing in foreign worker dormitories, many of which have been declared “isolation areas”. On Saturday, all work permit and S pass holders in construction sector were given stay-home notice.

A nurse in Tehran reported that Iran’s Ministry of Health gave instructions to report coronavirus-related deaths as ‘severe lung infection’ in an attempt to reduce case numbers. US President Trump also cast doubt on Iran’s and China’s numbers.

Indian Prime Minister Narendra Modi has formed a high level task force to develop a vaccine for COVID-19. It will further enable and speed up international efforts in this direction, announced the Bharatiya Janata Party (BJP) today.

Tsering Llamo and Svet Lustig Vijay contributed to this story.

Image Credits: Twitter: @g20org, Johns Hopkins CSSE.

Lady Gaga, the American singer-songwriter, will be curating a massive benefit concert with Global Citizen to fundraise for the global coronavirus crisis. The virtual concert titled, One World Together at Home, will be streamed live on the Global Citizen website and a number of other platforms on 18 April, from 2 – 10PM Eastern Standard Time.

“It is a love letter to our doctors, a love letter to our nurses and other health care professionals who are risking their own lives,” said Gaga in a World Health Organization press briefing on Friday. “This is for the sake of the delivery drivers, grocery store workers, factory workers, public transportation workers, postal workers and restaurant workers doing the same. We celebrate your bravery and your heroism.”

Representing the entertainment industry, Gaga, donning an unusually simple make-up and a crisp white collared shirt in contrast to her usual flamboyant style, extended the community’s commitment towards raising funds for the COVID-19 Solidarity Response Fund while thanking the medical community globally and acknowledging those financially burdened by the Covid-19 pandemic.

Lady Gaga calls into WHO’s 17 April COVID-19 press briefing

Since announcing the concert just two weeks ago, the event has already raised over $50 million for the Solidarity Response Fund, Gaga said on Friday.

Echoing Gaga’s sentiments, Global Citizen CEO Hugh Evans expressed gratitude to all essential workers in the frontline of the pandemic globally and announced the organization’s partnership with the World Health Organization and the United Nations in its proactive commitment and action towards preventing future pandemics by strengthening the global health system and ensuring the equitable access of resources. 

The massive line-up features over 60 major artists and celebrities from around the world. It will include acts and appearances from Sir Paul McCartney, Sir Elton John, Alanis Morriset, Andrea Bocelli, Billie Eilish, Billie Joe Armstrong, Burna Boy, Chris Martin, Sir David Beckham, Sir John Elton, J Balvin, John Legend, Keith Urban, Lang Lang, Lizzo, Maluma, Philip Collins, Priyanka Chopra Jones, Shahrukh Khan, and Stevie Wonder.

The concert will begin livestreaming at 2PM EST (8PM CET) on 18 April at the Global Citizen website, and will be broadcast live on CBS, ABC, Univision. BBC One+ and Viacom stations will broadcast the concert on 19 April and 20 April. Some stations will only be broadcasting certain hours of the event – more details can be found on the Global Citizen website. 

 

Microbiologist Kerry Pollard performs a manual extraction of the coronavirus inside the extraction lab at the Pennsylvania Department of Health Bureau of Laboratories on Friday, March 6, 2020.

World Health Organization experts are urging countries to use caution when determining whether to use large scale serological testing as part of their exit strategies from lockdowns.

Serological testing identifies whether a person’s blood has antibodies for SARS-CoV-2, the virus that causes COVID-19,  indicating that they were exposed to the virus at some point and recovered – if they are not carrying the virus itself at that point. 

However, “nobody is sure whether someone with antibodies is fully protected against having the disease or being exposed [again],” Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis told reporters in a Friday WHO briefing.

In addition, only a comparatively low proportion of the population may have so far acquired the antibodies. And that means the potential of  “herd immunity” to purportedly provide a crude shield of protection for others who have not been exposed, may be weak or non-existent, the WHO experts warned.

“There’s been an expectation, maybe that herd immunity may have been achieved and that the majority of people in society may already have developed antibodies,” said WHO’s Emergencies Head, Mike Ryan.  “[But] a lot of the preliminary information that’s coming to us right now, will suggest a quite a low proportion of the population have actually sero-converted [with antibodies that can fight the virus]. 

“I think the general evidence is pointing towards a much lower prevalence so may not solve the problem that governments are trying to solve. And then thirdly, there are serious ethical issues around the use of such an approach, and we need to address it very carefully,” Ryan added. 

The ethical issues arise because herd immunity is a crude protective tool, which is generally only effective if a large majority of a country’s population has lived through the disease, experts say. And in the case of COVID-19, that would mean accepting the very high death rates that are occurring among older people and those with chronic conditions who fall ill.  

Added Van Kerkhove, “We also need to look at the length of protection that antibodies might give. Nobody is sure whether someone with antibodies is fully protected against having the disease or being exposed.” 

Some of the tests also are not sensitive enough and may yield false positives she said, giving people the impression that “they’re sero-positive and protected,” where in fact they may be susceptible to disease, added Van Kerkhove. 

But the rapid development of serological tests just a few months into the pandemic is “a good thing,”  added Van Kerkhove. However with the number of new tests flooding the market, “we need to ensure that they are validated,” she said.

New guidance from WHO on the use of serological tests will be released this weekend, according to Van Kerkhove, speaking at WHO’s Friday briefing on the COVID-19 emergency.

“I think what we do have is advice for countries to be very prudent at this point,” said Ryan. “And number one, we need to be sure that tests would be used to establish the status of an individual, and there’s lots of uncertainty around what sort of what such a test would be and how effective and how well performing that test would need to be.” 

Many countries and companies are already looking towards the emergency use of serological tests, including Switzerland, the United Kingdom, Chile, and the US. Roche, the Swiss pharma giant, was the latest biomedical powerhouse to announce they were developing a COVID-19 antibody test, with the aim to roll it out in May.

(left-right) Mike Ryan, Dr Tedros, and Maria Van Kerkhove sitting 2 metres apart at the regular WHO COVID-19 Press Briefing
UN AIDS Calls For Dramatic Scale-Up of Healthcare Spending As COVID-19 Response

Meanwhile, the Executive Director of UNAIDS called for governments to “invest in universal social protection,” and dramatically scale up healthcare spending in response to the COVID-19 emergency. It was the first major statement by the organization on the health emergency. 

“COVID-19 is killing people. However, the scale and the consequences of the pandemic are man-made,” said Winnie Byanyima, UNAIDS Executive Director, speaking at an event Thursday cosponsored by the Global Development Policy Center and the UN Conference on Trade and Development.

Winnie Byanyima

 

Byanyima also drew attention to the economic fallout of the COVID-19 crisis, warning that the poorest populations, facing a triple threat of COVID-19, loss of livelihoods, and climate crises, are those likely to be hardest hit by the crisis.

“COVID-19 is expected to wipe out the equivalent of 195 million full-time jobs,” said Byanyima. 

In a related development,  Gavi- The Vaccine Alliance, was awarded a US$ 30 million grant by Netflix magnate Reed Hastings to support the organization’s ongoing vaccine work, in the shadow of  COVID-19.

“Global immunisation is vital to ending this terrible pandemic and Gavi’s hard-fought gains in this area will help prevent more lost lives and livelihoods,” said Hastings in a press release, about the donation by the Reed Hastings and Patty Quillin Foundation, named after him and his wife. “We hope that our contribution will help those most in need, but also to inspire other businesses, entrepreneurs and organizations to join in this urgent effort.”

The support comes at a particularly significant moment, since over the past week, humanitarian aid groups as well as African health leaders have expressed concerns that other vital disease control activities, including  immunizations could be harmed, by the recent suspension of funds by US President Donald Trump to the World Health Organization.  The donation is the first private sector contribution towards Gavi’s Sixth Replenishment drive, which aims to raise at least US$ 7.4 billion in 2020 to immunise 300 million children and save 8 million lives over the coming five years.

European Union Submits WHA Draft Resolution Supporting COVID-19 Intellectual Property Pool

While so far no vaccine exists for COVID-19, the debate over how to ensure equitable access to any new therapy continued to accelerate, following the European Union’s publication Wednesday of a Draft World Health Assembly Resolution calling for a global intellectual property pool of COVID-19 drugs, vaccines and diagnostics. 

The European Union proposal calls on WHA member states to explicitly support the creation of a voluntary pool of intellectual property rights for COVID-19 technologies.  If adopted, the proposal would pave the way for WHO to actively coordinate such an activity along with the UN-supported Medicines Patent Pool. The 74th WHA is scheduled to meet May 17-23, although there has been no announcement so far of whether the meeting might be held virtually or be delayed, due to the continuing lockdown measures in Switzerland, which has had some 25,000 reported cases so far. 

In an op-ed published this week in The Lancet, two lead negotiators of last year’s landmark World Health Assembly resolution to increase drug and R&D cost transparency, Luca Li Bassi and Lenias Hwenda, came out in support of the EU call. The call was first launched by the Costa Rica government in an open letter to WHO Director General Dr Tedros Adhanom Ghebreyesus in late March. 

“We urge Member States who adopted the World Health Assembly 72 Resolution on “Improving the transparency of markets for medicines, vaccines, and other health products” to formally support the request from Costa Rica’s Government,” wrote Li Bassi, former director of the Italian Pharma Agency and lead negotiator of the 73rd World Health Assembly “transparency resolution”, and Hwenda, chief executive officer of Medicines for Africa, in their comment. 

The EU draft resolution called for international actors, NGOs, and private industry, to “work collaboratively at international level to develop, test and produce safe, effective, quality diagnostics,  medicines and vaccines for the COVID-19 response, and to facilitate the equitable and affordable access of people to them, including through voluntarily pooling their intellectual property for all COVID-19-related medical interventions.” 

The EU move came just a week after World Health Organization Director General Dr Tedros Adhanom Ghebreyesus himself welcomed the initiative to pool IP rights for COVID-19 diagnostics, vaccines, treatments, and data, along with the Medicines Patent Pool. Rights holders would submit patents and other rights voluntarily to the new COVID-19 pool, which can then license those rights to other manufacturers to increase access to research, data, and blueprints needed to ramp up production of COVID-19 technologies.

Still, more steps must be taken to “make sure that the resolution adequately reflects the Costa Rica proposal, which has already been endorsed by a number of Member States, including the Netherlands,”  Jaume Vidal, senior policy advisor at Health Action International told Health Policy Watch. “That means a COVID-19 technology pool hosted and managed by WHO based on non-exclusive – and not geographically limited – licensing.”

Still, the move is “a welcome first step by the European Union to achieve a collective solution, within a multilateral framework, to a global pandemic,”  said Vidal.

World’s Largest COVID-19 Drug Trial Set To Begin in the UK 

Meanwhile, the UK was set to launch the largest ever randomized controlled trial that aims to systematically compare several of the leading COVID-19 therapies to see how well they perform. Those therapies will include a hydroxychloroquine + azithromycin combination that showed initial results in a French trial; a combination of two antiretroviral drugs used in HIV treatment, lopinavir-ritonavir; and low-dose dexamethasone, a type of steroid used in a range of conditions, typically to reduce inflammation. 

The so-called RECOVERY trial, which has been set up in the United Kingdom at unprecedented speed, has recruited over 5,000 patients from 165 National Health Service hospitals in a month, and is hoping to have initial results as early as June. However, Peter Horby, professor of emerging infectious diseases and global health at Oxford University, who is leading the trial, warned that there is “no magic bullet” for COVID-19. 

As for hydroxycholoroquine, which has even been touted by political leaders such as Trump, Hornby stressed, “There is in-vitro evidence that it is inhibitory against the virus [in the lab]. But I haven’t seen any sound clinical data.”  Other drugs will be added to the trial later. 

Enrollment in the trial has been offered to adult in-patients who have tested positive for COVID-19 in NHS hospitals, and who have not been excluded for medical reasons. Patients joining the trial will be allocated at random by computer to receive either lopinavir-ritonavir or dexamethasone, or no additional medication. This will enable researchers to see whether any of the possible new treatments are more or less effective than those currently used for patients with COVID-19.

Global COVID-19 Death Toll Increases as China Revises Figures For Wuhan – Has Implications for Mortality Rate Estimates Globally 

In China, officials announced a revised death toll from COVID-19 in the original virus epicenter of Wuhan, adding 1290 more deaths to the tally – for a total of 3,689 in Wuhan and 4,636 in China as a whole.

The revisions have implications for COVID-19 death toll estimates more broadly, insofar as worldwide baseline mortality estimates, which have hovered around 3.4%, according to WHO, were largely based on Chinese data, which had the largest proportion of cases so far, where the disease also ran its term. More recently, however, death rates in some countries, such as Italy, soared as high as about 10%, while they have been below .02% in other countries that took measures early, such as Norway, New Zealand, Iceland, and Israel. Experts have underlined that death rates are influenced not only by population age, but also quality of hospital care that seriously ill people receive, and reporting patterns. 

The changing figures are likely to further fuel the fires of criticism over China’s reporting on the pandemic. While US President Donald Trump has been the most outspoken, lashing into the WHO in particular over being “China-centric” other western leaders have also now chimed in with criticism leveled directly against China for downplaying or covering up the virus emergence in the early stages, losing valuable time and laying the groundwork for its widespread circulation in China and ultimately globally. On Thursday, Dominic Raab, the foreign secretary of the United Kingdom said that there would be “hard questions” for China on handling the crisis, as did French president Emmanuel Macron, who criticised the lack of transparency in data. 

Their comments came after a damning Associated Press report that stated China sat on important information about the virus spread for six days between January 14-20. According to notices on Chinese University websites, schools have received instructions that “papers related to virus tracing should be managed strictly,” and must be reviewed by the college’s own academic committee, and submitted to the National Academy of Sciences before submitting for publication in formal academic journals. Scientists largely believe that the virus first originated in bats, then passed to humans through an intermediate host, potentially through a pangolin, an animal that may have been illegally traded at a Wuhan wet market. As China clamps down on research over the virus origins, debate is growing around the theory that it may have first infected humans in a Wuhan virology lab situated close to the wet market.

To a certain extent, these previously unaccounted-for deaths can also be attributed to a focus on treating cases rather than reporting deaths during the early stages of the pandemic, as well as many people dying at home and delays in data collection from various sources. In addition, authorities have also bounced back and forth in terms of how they counted  confirmed cases.

Total cases of COVID-19 as of 17 April 2020, with active case distribution globally. Numbers change rapidly.
Nordic Countries and New Zealand Join Chorus Decrying US Move to Suspend Aid To WHO 

Despite the new criticisms being leveled against China, international opinion continued to run strong against the recent US decision to suspend aid to the WHO ostensibly for being too pro-Beijing. 

The latest statements came from a group of five Nordic countries and New Zealand’s former prime minister, Helen Clark.  

“We as Nordic ministers for development cooperation are convinced that the work of WHO is essential during these critical times. Evaluation of their work will come later. Now is time for more international cooperation and solidarity – not less,” said the statement on behalf of Finland, Denmark, Sweden, Norway and Iceland, in a tweet posted by Norweigian Minister of International Development, Dag Inge Ulstein.

“The decision of the US government to defund WHO is disastrous,” Clark tweeted. “WHO is working to turn the tide on COVID-19; it is not responsible for a President ignoring advice which could have seen a fast USA response & saved thousands of lives. This is no time for a blame game.”

The decision has already been roundly criticized by other global leaders and heads of state including: UN Secretary General Antonio Guterres, European Commission Vice-President Josep Fontelles, and billionaire health philanthropist Bill Gates. 

US President Donald Trump announced on Tuesday the country was putting a halt on funding while the administration conducted an investigation into WHO’s handling of the coronavirus crisis, criticising the organization for alleged missteps in the early days of the pandemic. 

The WHO Staff Association released a letter to Dr Tedros on Thursday supporting the WHO’s pandemic response in light of the suspension of US funding to the organization.

“We regret that our Organization has been the target of unhelpful verbal attacks and threats, while we are in the midst of this health crisis,” said WHO headquarters personnel in a heartfelt letter. “WHO HQ’s personnel wish to join with individuals and other organizations around the world, in expressing our full support to our colleagues working tirelessly on the frontlines of this pandemic, and to you, Dr Tedros. 

“This pandemic has shown us that rapid transformational change and remarkable international collaboration are possible… We stand by your statements that this is the moment for all of us to rise to the challenge of collaborative leadership.”

Trump Unveils Plan For Phased Reopening Amidst Concerns About Insufficient Federal Support For Critical Testing; Bolsonaro Replaces Health Minister

President Donald Trump issued broad federal guidelines outlining the reopening of the country on Thursday April 16. The 18-page document, titled “Opening Up America Again” lays out a three-phase approach to relaxing social distancing measures, depending on the trends in new cases and new deaths.

The Trump guidance comes even as states such as New York extend the shutdown of non-essential businesses to 15 May, and issue rules for wearing masks in public. Ultimately, the power to reopen rests in state governors’ hands. 

Health officials have stressed the need for increased testing before Americans can safely return to work — following reports that the federal government will curtail funding for coronavirus testing sites. State officials have expressed that states will not be able to ramp up testing without federal support. Democratic House and Senate members have also urged him to wait for testing to become more widespread before announcing measures for reopening the economy, as has the Infectious Diseases Society of America. The United States has the highest number of confirmed COVID-19 cases and deaths globally, with over 650,000 confirmed cases and 33,288 deaths. 

Brazilian president Jair Bolsonaro removed health minister Luiz Henrique Mandetta from his position on Thursday. The President has received widespread criticism for repeatedly dismissing the severity of the coronavirus pandemic, calling it “just a little cold” and making highly publicized visits to crowded public spaces without protective gear, 

Mandetta, who has been at odds with the president’s views, has advocated for large-scale social distancing measures and quarantines. On the day he stated that the worst of the pandemic was yet to hit Brazil, Bolsonaro told religious leaders, “this issue seems to be going away”, thus creating confusion for people over who to listen to. However in a recent survey, some 76% of respondents were in favour of the health minister’s response to the pandemic, and less than 30% trusted the president’s approach. 

Mandetta’s replacement Nelson Teich, an oncologist and healthcare executive, shares similar views in recently published articles, where he too endorses scientific social-distancing and isolation measures.Brazil currently records more than 30,000 confirmed cases with almost 2,000 deaths although Edmar Santos, Health Secretary for Rio de Janeiro, estimated that the real case count was much higher due to under-testing.

Gauri Saxena and Grace Ren contributed to this story

Image Credits: Twitter: @WHO.