Men are more likely to suffer ill-health than women. (Photo Credit: Micha Serra for Global Health 50/50 ‘This is Gender’ Competition)

As the governments around the world struggle to control surging COVID-19 outbreaks, health experts highlighted cracks in global health systems that created conditions ripe for the pandemic.

A report titled Power, Privilege & Priorities released Monday by Global Health 50/50 found that an inequality of health benefits and an inequality of opportunities inside organizations have created a system where the priorities of the biggest global health organizations failed to prioritize gender equality and the most common causes of death and ill-health, leading to weak health systems around the world.

“The world’s attention now is on looking after people at immediate risk, and controlling the spread. This is an extreme pressure on an already-ill-equipped global health system. An escalation of the epidemic is inevitable,” Kent Buse, co-founder of Global Health 50/50 and chief of Strategic Policy Direction at UNAIDS told Health Policy Watch.

“If we continue to apply a gender-blind approach to healthcare I am afraid we will see additional global healthcare crises in the future.”

In the context of COVID-19, the stark gender disparity in mortality rates is an example of how a history of “gender-blind” approaches in global health have contributed to the current crisis, according to Sarah Hawkes, co-founder of Global Health 50/50 and director of University College London’s Centre for Gender and Global Health. In the WHO-China Joint Mission on COVID-19 Report, the case fatality rate in men is reported as nearly double that in women – 4.7% compared to 2.8%.

“We have to ask why more men in China are dying from the COVID-19 virus than women. Why are men more at risk?” questioned Hawkes. “Put simply, men are less healthy than women and we know that people with existing ill health are more at risk of dying.”

“While we don’t have the full picture, we know that within the affected regions more men smoke and hence there may be more men with cardiovascular disease and other non-communicable diseases than women.”

According to the WHO report, the case-fatality rate was much higher for people with pre-existing non-communicable diseases (NCDs) – hovering around 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.

Men have higher rates of harmful use of alcohol, tobacco use, and substance abuse, which are all contributing causes of NCDs, said Hawkes.

Yet, the Global Health 50/50 report found that two-thirds of global health funders and philanthropies do not address NCDs, and the vast majority of organizations do not make distinctions between the health-related risks of women and men – particularly for alcohol, tobacco, and substance abuse.

This “gender-blind” approach to health means that “decision making is often focused on politics rather than on people’s need,” said Hawkes.

“We see the consequence of these as contributory factors to the current crisis.”

Inequality in Global Governance as Other “Cracks in the System”

Along with highlighting the systematic neglect of certain health conditions, the Global Health 50/50 report found that a high number of organizations still do not balance gender in senior leadership roles, and people from low- or middle-income countries are barred from the highest echelons of major global health organizations, despite the majority of global health work happening in those countries.

In a review released on the tail of International Women’s Day that covered 200 organizations across 10 different health-related sectors, the report found that more than 70% of the chief executives and chairs of boards are men, while only 5% are women from low- and middle-income countries. Women continued to be barred from higher leadership positions – with the proportion of women board chairs growing only from 20% to 26% in the past two years.

Over 80% of leaders in these global health organizations are nationals of high-income countries, and over 90% among those in leadership roles completed their education in economically rich countries, despite low- and middle-income countries being home to 83% of the global population. Some 90% of all the organizations surveyed were headquartered in the United States, Switzerland, and the United Kingdom.

Other key findings of the report include:

  • Some 75% of global organizations declare a commitment to gender equality, up from 55% in 2018. Some 60% of organizations have gender equality policies in the public domain.
  • However, only 35% define the meaning of “gender” in their policies, only 44% have policies to advance diversity and inclusion beyond gender, and only 14% have policies available on gender equality, diversity and inclusion in their governing bodies
  • Along with the predominance of men in global health CEO roles, 64% of organizations have more men than women on governing boards. Some 54% have more men than women in senior management roles.

“Power asymmetries continue to define the global health architecture. These are rooted in economic power imbalances, global governance structures and also the fact that the global health system has not shaken the vestiges of its colonial past,” said Hawkes.

Image Credits: Micha Serra/Global Health 50/50.

Health System Overload – Italian Civil Protection volunteers install a triage tent for COVID-19 patients in front of the University of Padua Hospital.

“The world is inching towards a pandemic,” admitted WHO Director General Dr Tedros Adhanom Ghebreyesus in a WHO media briefing Monday, which saw COVID-19 cases more than double over the weekend in France, Germany and Spain, as well as the USA.  In an unprecedented move, Italy’s Prime Minister put the entire country under emergency lockdown Monday night after cases soared from 3860 Friday to 9,172 people infected Monday. Over 100 countries around the world were now reporting infections.   

“But it would be the first pandemic we could control,” Dr Tedros added.

“Of all cases reported 93% come from just four countries,” he said, referring to Italy, Iran and South Korea, which have seen exponential increases in recent days, while cases in China decline.

Other countries and regions, were beginning to respond as they saw case numbers spiral in now predictable ways as the outbreak caught hold. Italy’s Prime Minister Guiseppe Conte expanded the lockdown over Lombardy region to the entire country Monday evening as the country reported another 1797 new cases – closing schools until April 3rd, canceling all sporting events and other mass gatherings, and restricting movement across the country.

“Italy’s future is in our hands. We all do our part, giving up something for the good of the community. At stake is the health of our loved ones, our parents, our children, our grandparents,” Conte tweeted just after signing the ministerial decree.

New York State declared a “disaster emergency” on Sunday, following on from the examples of the states of Washington, California and Maryland, the states that have been driving the increases in cases in the United States where 707 cases have now been reported, likely an underestimate since the national rollout of tests had been delayed both by inadequate tests as well as a severe shortage testing kits.

“Countries that continue finding & testing cases & contacts can affect their countries and what happens globally,” Dr. Tedros said, noting that the Republic of Korea now seems to be on the verge of containing the virus.  Singapore and Japan also seem to have turned the corner, following the experience of China, which has managed to beat back the infection, registering only 84 new cases over the past 24 hours.

The WHO Director-General praised examples such as the Korean “drive through” testing model, which allows easy access to tests for people suspecting that they may have been infected, with little risk to them or health care workers.  He said that the “drive-through” model was helping to “widen the net and catch cases that might otherwise be missed.”

At the same time, WHO Emergencies Head Mike Ryan told the press briefing that the world may only be in the early phases of an erupting epidemic, and so the curve of new cases would likely rise further before it starts to decline.

“We are at the beginning or middle of fighting this virus,” Ryan said. “We are very much in the ‘up’ cycle. But it’s up to us to turn this around,” he said, adding that, “the way in which China, Singapore, Korea and Japan are on the verge of turning a corner gives me hope,” he said. He added that there has also been some speculation that warmer weather might potentially help beat back the virus, but that can’t be relied upon since so little is known about the virus behaviour. Comparatively fewer cases have been seen in some parts of the southern hemisphere, which is in its summer seasons, although the pattern has been inconsistent. 

Latest COVID-19 data as of 3:30PM CET (10:30AM EST)- Note numbers are changing rapidly.

People 80+ have 20% Fatality Rate – New Recommendations Likely On Avoiding Travel & Mass Gatherings  

Meanwhile even as case totals and death rise daily, failing to fight for strong containment measures will effectively sacrifice the lives of millions of older people, as well as people with underlying health conditions, the WHO officials stressed.

The most recently available data from China indicates that COVID-19 fatality rates for people over the age of 80 is above 20%, and that data is still not fully up to date, said Maria Van Kherkove, WHO Emergencies Technical Lead.

Similarly, people with underlying conditions have an outsized fatality rates – averaging around 13% for those who fall ill and have cardiovascular disease, for example, and about 7.5% for those with cancer, she said, citing the findings of a recent WHO-Joint Mission Report.

It would be a lapse in “morality” to abandon wholesale such groups, said Dr Tedros. “Not taking the death of the elderly, our senior citizens, is a serious issue, and even a moral decay. Every human being matters – it pains us when some want to move into mitigation [as compared to containment of the epidemic] because the virus kills seniors or elderly only.”

Added Ryan, public health professionals need to be committed to fighting on behalf of the vulnerable. “When people talk about just letting the wave pass, remember that there are many vulnerable people, for whom this won’t go away. Our elderly, people on cancer chemotherapy are precious members of society.. N=1  – every person matters,” he said.

But Ryan conceded that WHO may need to provide more pinpoint advice to countries for guidance about measures that older people should take – so far it has not.

“Maybe we need to push forward our advice to that elderly group about travel, mass gatherings and meetings,” Ryan said.

However, recommendations to practice “social distancing” should not just be for the “elderly” said Dr Tedros; it should be for all groups, and particularly for people living in countries and regions that are experiencing widespread community transmission of the virus – from contacts that are difficult or impossible to trace.

The United States Centres for Disease Control is already recommending at national level that older adults and other “high risk” groups stock up on supplies, practice social distancing measures and “stay at home as much as possible,” in light of their greater vulnerability.

Social Distancing – New York State Governor Andrew Cuomo taps elbows with Dr Mark Jarret at Northwell Health Center.

Seattle Hospital Sets Up “Drive-Through” Testing – But Many FDA Testing Barriers Remain

States and cities in US hotspots were finally ramping up diagnostic test capacity, after four state governors declared “states of emergency” in their jurisdictions over the weekend. Overall, the number of US cases more than doubled from 239 on Friday to a total of 566 cases by Monday.

The change came after days of pushing the Federal Drug Administration – the US’s governing body for regulating drugs and diagnostics – to allow local testing and bypass the US CDC’s limited testing capacity. As of March 5, a total of just 1583 patient samples had been tested through the CDC.

The loosening of restrictions saw initial use of successful tools like Korea’s model of “drive-through” testing. The University of Washington’s Hospital – at the center of the US’s first outbreak hotspot in Seattle – followed in South Korea’s footsteps and set up a “drive through” diagnostic center where hospital staff with potential COVID-19 symptoms, or contact with confirmed cases, could pull up and get tested, without leaving their car. The “drive through” testing is so far restricted so far only to healthcare workers. According to an article in Nature, however, the virology lab at the University is now testing hundreds of samples a day from healthcare facilities around the state since the federal government allowed academic centers to test for the virus.

At the other end of the scale, however, Northwell Health Center in the New York City area, was still under an FDA limit to perform manual testing of only 75-80 samples a day as state health officials waited for the FDA to allow Northwell to perform automatic testing in order to scale up to testing 1000-1500 samples a day.

New York’s governor Andrew Cuomo followed in the footsteps of Saturday’s declaration’s by Washington State, California, and Maryland declaring a “disaster emergency” on Sunday. This allows state governments to speed up medical supplies procurement, hiring of medical personnel, transfer of suspected patients to quarantine facilities other than hospitals, and allow medical personnel other than doctors and nurses to test for COVID-19.

The declaration also allows the governor to investigate cases of potential price gouging as prices for cleaning products and hand sanitizer soared last week.

However, an emergency room healthcare worker from a New York City public hospital told Health Policy Watch that there does not yet seem to be a clear protocol for public hospitals that primarily serve underprivileged or uninsured communities – hospitals that are already operating above  capacity.

To order a test for COVID-19 in one particular New York City hospital, for example, the patient must first be cleared of having the flu or any other common respiratory virus – then the test can only be ordered after a consultation with an infectious disease specialist.

Patients often wait to be tested in crowded emergency room waiting areas, where they could expose health care workers or other critically ill people to the virus, said the source. Getting test results still takes a couple days, and the 80% of mild cases of COVID-19 that do not require hospitalization are sent home to self-quarantine, where they might still infect others if the proper precautions aren’t taken.

Another problem faced by hospitals is the lack of systems to test and manage health care workers who may have been exposed to the virus over the past several weeks, when testing was largely unavailable. Healthcare facilities, such as University of California-Davis Medical Center, are asking staff to self-quarantine for two weeks if they have been exposed to the virus. However, experts are concerned that will result in a shortage of healthcare workers during the most critical peaks of the outbreak – particularly if many of those staff ultimately test negative.

“It’s just not sustainable to think that every time a health care worker is exposed they have to be quarantined for 14 days. We’d run out of health care workers,” Jennifer Nuzzo, a senior scholar in Johns Hopkins Health Security Program told National Public Radio.

Africa Region Shifts From “Readiness to Response”

With local transmission confirmed in Algeria, and new cases reported in South Africa, Senegal, and Nigeria, WHO is changing from a “readiness to response” mode in the African Region. Two parallel meetings for Francophone and Anglophone countries were convened to establish a regional partner coordination mechanism, a draft joint work plan, and key action items for governments of WHO’s Africa Region’s Member States and Regional Economic Committees.
“These cases should be a wake-up call for governments across Africa.  Governments must do all they can to prepare for an eventual outbreak: time is critical,”  said Matshidiso Moeti, WHO Regional Director for Africa in a press release. As of 9 March there were 32 confirmed cases in the WHO Africa region.
Experts already in those countries with confirmed cases are now focusing on providing technical support to country health workers, rather than providing generalized preparedness advice. Training on case management and infection prevention has also been provided to health workers from the countries.

See here Open WHO knowledge base with emergency resources for policymakers, professionals and researchers.

Grace Ren contributed to this story.

This story was updated 10 March 2020.

Image Credits: Wikimedia Commons/Amarvudol, John's Hopkins CSSE, Kevin P. Coughlin / Office of Governor Andrew M. Cuomo.

[Medicines for Malaria Venture]

Geneva and Liverpool (8 March 2020) – A new collaboration announced on International Women’s Day 2020 aims to help establish pregnancy registries in malaria-endemic countries in Africa to help fill the data gap on the use of antimalarials in one of the most vulnerable populations to malaria.

The study, led by Medicines for Malaria Venture (MMV) and the Liverpool School of Tropical Medicine (LSTM), will set up pregnancy registers to capture data through a prospective observational study on the real-life use of ACTs during all stages of pregnancy, including the first trimester. The study will be conducted in three countries across Africa with the goal of collecting enough safety and exposure data that, if positive, would allow for policy change on the use of ACTs in the first trimester of pregnancy.

“Pregnant women are disproportionately affected by malaria – 29% of all pregnancies in sub-Saharan Africa were infected in 2018,” said Dr David Reddy, MMV’s CEO. “Yet their needs have not been fully addressed. We are delighted to be collaborating with LSTM to establish a pregnancy registry – a clear first step towards collecting the data necessary to support the medical needs of women suffering from malaria, during every stage of pregnancy.”

Artemisinin-based Combination Therapies (ACTs) are the standard of care for malaria, and are recommended by the World Health Organization (WHO) for children and adults including pregnant women who are in their second and third trimester. Even though they are recommended by the WHO, limited data are available in second and third trimester for the more recently approved ACTs. In addition, ACTs are currently not recommended in the first trimester of pregnancy owing to a historic lack of safety data. However, there is evidence that a significant proportion of women seeking treatment for malaria in early pregnancy are treated with ACTs either because they do not know, or are unable to declare that they are pregnant.

The effort will also contribute to healthcare systems strengthening and capacity building, and encourage a sustainable pharmacovigilance culture in resource-constrained healthcare systems. Furthermore, in partnership with researchers and local regulatory authorities that are responsible for pharmacovigilance, a longer-term goal of the project is to develop a standard protocol and a network of sites that will collect safety data for all antimalarials and medicines for infectious diseases (e.g. HIV, TB) circulating in relevant endemic regions.

Professor Feiko ter Kuile, Head of the Malaria Epidemiology Unit at LSTM, said: “This new collaboration with MMV will give us the opportunity to gather much-needed data and provide a robust framework from which policy makers can make informed decisions that will benefit women when they are at particular risk of malaria, during pregnancy. The work will build on our extensive research and clinical experience in the field, and this pregnancy registry should allow us to gather safety data, not only on anti-malarials, but for drugs for the treatment of other infectious diseases that affect pregnancy.”

For more information, see the press release at MMV.

Image Credits: Elizabeth Poll/MMV.

Iranian women healthcare workers in personal protective equipment

As the world surpassed 100,000 COVID-19 infections, the United Nations announced on Friday that a critical round of climate negotiations among member states in Bonn, Germany will be postponed, while some of the sessions scheduled from 6 March to the end of April would be put on a virtual footing.  Africa Climate Week, a parallel policy event, which was supposed to take place 20-24 April in Kampala, Uganda was also put on hold.

WHO’s Director General Dr Tedros Adhanom Gheyebresus, however, sidestepped the question of whether the World Health Assembly (WHA), which brings thousands of people to Geneva for a week in late May, might be held remotely as well – in light of the COVID-19 crisis and the previously-announced World Bank decision to put its annual Spring Meetings on a virtual platform.

Speaking at Friday’s daily WHO press briefing, Dr Tedros said that WHO would have to do a risk assessment regarding the WHA, adding that he supported a broader approach to “virtual meetings”.

“On the Assembly, we still have time, so we will assess the situation. Based on the risk we will decide and let you know,” Dr Tedros said in response to a question by Health Policy Watch.

“Virtual meetings should actually be considered, not because of COVID now, but when there is no COVID,” he added, “We have to challenge all of our meetings, whether we really need to meet in person. In the middle of the COVID-9, now, we [also] have to do the risk assessment.”

Meanwhile, WHO is making contingency plans for how to continue its own operations at its Headquarters in Geneva, Switzerland, should the local outbreak accelerate.

Switzerland is now reporting 214 cases of COVID-19, largely as a spillover effect from the epidemic in Italy. That leaves the tiny mountain country of only 8.79 people among the top ten nations with the greatest burden of COVID-19 infections outside of China, in both absolute and per capita terms.

Said Emergency’s Head Mike Ryan, a key WHO concern will be how to maintain its Geneva global operations, which are badly needed now for COVID-19 emergency response:

“There is a big international community here in Geneva and we have been working with them (Swiss authorities) on how we deal with business continuity going forward. We have our own concerns about how to continue to run our operations in WHO, not only for our normal health programs but to be able to continue running our global operation here, our global nerve center.”

Ryan added that the Swiss were implementing national “preparedness plans” as well as trying to coordinate with other European authorities, but added, “I think that one of the challenges in Europe right now is coordinating across all of the nations of Europe with such open borders, and many having slightly different policies regarding mass gatherings, slightly different criteria regarding testing, and I think that’s caused a lot of people to question why there isn’t one standard approach in every country?

“But that is impossible to achieve,” he added, saying that: “What we need is each country is making its own risk assessment based on the risks it perceives, its openness, its exposure and its own vulnerabilities.”

As for the UN climate talks, the Bonn negotiating sessions were to be the lead-up for the planned COP26 Conference of Parties in Glasgow in November, a critical moment for the world to agree on a more aggressive plan of climate action. The Bonn sessions are important venues for countries to hammer out agreement on a wide range of technical issues that would underpin a stronger climate agreement on issues ranging from reductions pledges to carbon emissions counting and the financing of mitigation and adaptation measures.

Now these talks will be suspended indefiniely, or held virtually.

“I would like to inform Parties, observer States and Observer Organizations that after careful consideration and with considerable regret, the UNFCCC secretariat will not hold any physical meetings in Bonn and elsewhere between 6 March and end of April. This decision is in response to the Coronavirus disease (COVID-19) outbreak, and the evolving situation in Germany,” said the statement by the UN Framework Convention on Climate Change Secretariat (UNFCCC).

“This exceptional measure aims to contain the spread of COVID-19 and safeguard the health and safety of participants attending UNFCCC meetings in Bonn and elsewhere, as well as address the requisite duty of care of and by the secretariat in such circumstances. At the same time, it seeks to ensure that all mandated UNFCCC meetings and events have the necessary transparency and inclusiveness that our process requires.

“The secretariat is now working with the elected officials, members and registered observers of constituted bodies and other mandated events to find suitable alternative arrangements to meetings scheduled during March and April, such as virtual meetings, or postponement.”

Woman On Front Lines of COVID19 Battle – As World Marks International Women’s Day  

Although women health workers are on the front-lines of the battle to contain the infection — far fewer hold senior roles in the policy fora where key decisions on how to do that will be made.

Dr. Tedros made the remark ahead of International Women’s Day, which will be commemorated on Sunday, March 8. WHO also has declared 2020 to be the International year of the Nurse and the Midwife.

“International Women’s Day highlights the role women play in protecting and promoting the health of all people, noted Dr Tedros in his daily COVID-19 briefing, adding that. “Some 70% of the global health workforce are women, but women only hold 25% of senior roles.”

“We are on the verge of reaching 100,000 confirmed cases of COVID 19,” he added, speaking in the afternoon, shortly before that milestone was in fact reached. Still, he repeated his earlier calls for countries to “continue make containment” their key strategy, and to “detect, isolate, test and care for every case.

“Every day we slow the epidemic is another day hospitals can prepare for cases, governments can prepare, and every day we come closer to having vaccines and therapeutics available,” Dr Tedros said.

Around the world, 3793 new cases of COVID-19 were reported in the past 24 hours. The total number of global cases early Friday evening stood at 100,685. About a third of all new cases were reported in Iran, which saw an increase of 1234 new cases in the past 24 hours. There are now 4747 cases in Iran.  In South Korea, the total number of COVID-19 cases increased by 505 cases in the past 24 hours to 6593 total cases. Italy saw a 24-hr increase of 769 cases for a total of 3858 cases.

Latest COVID-19 data as of 5:43PM. CET (11:43AM EST)- Note numbers are changing rapidly.

Case Fatality Rates Assessed From Multiple Perspectives

Among the global hotspots, South Korea has so far confirmed only 42 deaths – suggesting a below-average case-fatality of about 0.6%. That contrasts sharply with the updated global average mortality cited this week by WHO of 3.4%.

Experts quoted by Business Insider suggested that Korea’s low case-fatality may be driven by the country’s quick roll out of “drive through” diagnostic clinics. The diagnostic dragnet has greatly increased the country’s ability to quickly screen a large number of people, both swelling the numbers of reported infections, including mild cases, but also insuring that people get early treatment.

Another modelling study, released Friday, estimated that the true case-fatality for COVID-19 stood at 1.4%.  That would still be about 14 times higher than mortality for seasonal flu, but half as much as the curent WHO estimate.

Gabriel Leung, head of the University of Hong Kong’s School of Medicine and lead author of the study conducted in collaboration with Harvard University, told the South China Morning Press that the model was created based on data from China’s experience, but considers numbers of people with very mild symptomatic infections.

Still, Leung told reporters at a press briefing Friday that COVID-19 could still claim many lives, particularly among older people as well as those with preexisting conditions.

“We must not let [the virus] enter elderly care homes and centres, else the impact would be huge,” he said.

WHO’s Emergencies Head Mike Ryan echoed that, noting that even if average fatality rates prove to be somewhat lower, due to the identification of more mild cases, mortality rates could very well prove to be much higher than the average among older people and those with pre-existing conditions.

“Yes we could add in a whole bunch of younger people and children who may be getting infected but not getting sick and that’s important and the overall CFR (case fatality rate) may drop,” he said. “But that may not affect the experience of older people, and remember within this when you look at the data from China baed on the numbers reported, the actual age specific or condition specific mortality goes up with age and for those with underlyin conditions. So the actual age-specific or condition-specific mortality could be much higher than those numbers..

“Equally, we have the assumption that children may be getting infected or having milder symptoms. IN influenza outbreaks,  for children with low nutrition, in compromised refugee camp -type situations, the mortality rate in children is much higher, their mortality from many common diseases can be much higher, anyone who has worked in refugee camps we know how devasting viral disease can be in those situations. Of course we hope there is a lower overall case fatality…. But We have to look to those around you who are most vulnerable. ,look to people who are older, or have underlying conditions, look to our refugee populations look to those who are undernourished, look to those with long term infectious conditions, and that’s what we need to do  in order to put together the necessary approached to protect and save their lives,

WHO officials have also underlined that the rapidly changing dynamics of the outbreak mean that the case-fatality estimate will change over time – and the most accurate case-fatility rate will only be able to recorded after the outbreak is over.

Among COVID19 Therapies Under Review – Antibody Treatments Hold Most Immediate Promise 

Meanwhile, more than 200 different clinical trials are now underway in China and abroad, according to WHO. They run the gamut from vaccines, testing existing and new drugs, and traditional Chinese medicine as well.

But the first COVID-19 medications to reach patients are likely to be antibody treatments, many experts believe.

Antibodies are naturally produced by people’s immune systems to combat viruses, usually by blocking the binding of the virus to host cells. They can be an effective treatment for infected patients,  as well as helping in prevention – although they cannot be described as a vaccine.

According to SixthTone, a Chinese media review of trending topics, WuXi Biologics, a Shanghai-based biotech company, is collaborating with Vir Biotechnology in California to produce such a  treatment. The two firms expect to begin clinical trials in about three to four months, according to Chris Chen, CEO of WuXi Biologics.

“Using neutralizing antibodies for viral infections is quite safe, because they bind to very specific targets that only exist on the intended viruses,” says Chen.

Another company working on a COVID-19 antibody treatment is Regeneron Pharmaceuticals, which previously developed and tested Ebola antibiodies at very short notice in respone to the 2013-2015 outbreak in West Africa. The New York-based firm is now trying to harvest antibodies by injecting the SARS-CoV-2 virus that causes COVID-19 into mice that are genetically modified to have human immune systems.

Once the right drugs are identified or developed, the next challenge will be making them available to the people who need them the most, said Ryan.

“We have to look beyond the issue of efficacy, of having an effective drug,” Ryan said. “We have to ensure that those who most need the drugs can get them. We have to absolutely focus now on equity and access – we cannot have a situation where people who need the drug don’t get it, and people who don’t need the drug do. We must find ways where we can ensure that, where we can scale up production of drugs that are effective, and that those drugs are distributed on the basis of need and on the basis of benefit. WHO is already working on this with our partners in the north and south.”

 

Image Credits: Twitter: @WHOEMRO, John's Hopkins CSSE.

A young woman vapes an e-cigarette – a type of nicotine delivery device recently labeled by WHO as “undoubtedly harmful.”

As the World Health Organization and WHO member states celebrate 15 years since the signing of the the Framework Convention for Tobacco Control (FCTC), the global uptake in e-cigarettes, as well as targeted advertising aimed at children and adolescents, threatens the worldwide gains that have been achieved in reducing tobacco use.

The convention is the only legally binding international treaty to have been led and negotiated by WHO. Since coming into force in 2005, some 181 UN member states, accounting for over 90% of the global population, have committed to the treaty to rollback tobacco use, which WHO has described as the “only legal drug”  that kills so many users when “used exactly as intended by manufacturers.”

“Tobacco kills more than 8 million people every year, costs the world economy over a trillion dollars annually in medical expenses and lost productivity,” said the Head of the FCTC Secretariat Adriana Blanco Marquizo in an opening statement, at WHO’s 15th anniversary celebration of the FCTC Thursday in Geneva. 

“The case is clear: implementing the WHO FCTC is a powerful means for Parties to improve the lives of their citizens and ensure a better future of their countries.”

Tobacco use has declined by some 60 million users since 2000, driven by more stringent national tobacco control policy measures, stimulated by Convention provisions, as well as sharp declines in use by women. For the first time in 20 years, WHO also released findings in 2019 indicating that tobacco use in men had plateaued, and is now projected to decline by more than 1 million users in 2020.

Since 2005, 90% of all countries that have signed the Convention have implemented bans on tobacco smoking in indoor workplaces, on public transportation, and in other public places. Some 60% of countries have facilitated more accessible and affordable pharmaceutical products for the treatment of tobacco dependence and 64% have prohibited or restricted imports of tax and duty free tobacco products by international travelers. A total of 34 countries have earmarked a proportion of their tobacco tax income for funding tobacco control measures, said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a keynote address at the celebration, which laid out the record of accomplishments. .

However, the progress in tobacco control does not mean that countries can “take their foot off the accelerator,” the Director-General said.

Notably, the unknown effects of long-term e-cigarette use is emerging as one potential threat to global tobacco control efforts. While there has been much debate about the benefits of electronic nicotine delivery systems (ENDS) for adults looking to quite combustible cigarettes, early this month, a WHO  statement released on 5 February stressed that such devices are “undoubtedly harmful, should be strictly regulated, and most importantly, must be kept away from children.”  

“Progress towards reducing tobacco use remains uneven…We’re increasingly concerned by the growing popularity of new products such as e-cigarettes, particularly for children and adolescents,” said Tedros. “Nobody can be left behind if we are to achieve a 30% reduction in tobacco use by 2025.” 

Challenges to FCTC Implementation: Targeting Children & E-cigarette Use

There are still 15 countries that have not committed to the Convention at all.  And many parties to the treaty have not yet fulfilled all of policy commitments made in the treaty. For example, one third of all parties to the Convention have yet to enact a comprehensive ban on all tobacco advertising, promotion and sponsorship.

The tobacco industry remains the “single greatest barrier” to full implementation of the FCTC, Sandra Mullin, senior vice president of Policy, Advocacy and Communication at Vital Strategies, a global health non-profit that works in tobacco control, remarked to Health Policy Watch. 

Industry tactics to counter tobacco control efforts include: lobbying governments through third-party organizations; creating and funding front groups; hiring retired policy-makers and bribing governments; influencing upstream trade policies that create barriers to integrating public health concerns into tobacco trade policies; and producing and disseminating misleading research about tobacco use, according to a report published by Vital Strategies and STOP (Stopping Tobacco Organizations and Products).

Among the greatest concerns is predatory tobacco advertising for “novel and emerging products flooding the markets” – such as flavored e-cigarettes that are often targeted at children and adolescents, said Blanco Marquizo.

Notably, the Convention has defined a specific set of obligations that countries must fulfill to protect minors from tobacco use, including text prohibiting “the manufacture and sale…of tobacco products which appeal to minors.”

Youth tobacco consumption will be the focus of the ninth session of the Conference of the Parties to the WHO FCTC in November 2020, to be held in The Hague, Netherlands. 

According to Dr Tedros, tobacco companies often use “threats of litigation to intimidate governments trying to implement tobacco control policies.”

However, as an international treaty, the FCTC has been used successfully to support legal defense arguments against industry challenges to tobacco control policies. Along with its sister Protocol to Eliminate Illicit Trade in Tobacco Products which came into force in 2018, the FCTC remains the strongest tool to “take on the tobacco industry,” said Dr Tedros.

“We have to keep up the momentum…Together we can reverse the global tobacco epidemic and save millions of lives,” he added.

Image Credits: WHO.

WHO Director General Dr Tedros Adhanom Ghebreyesus urged countries to redouble their efforts on COVID-19 containment, saying that China’s stunning success shows that goal still may be attainable – even as 16,470 new cases of the fatal virus mushroomed elsewhere across the globe in the past 24 hours.

“This not a drill. This is not the time to give up. This is a time for pulling out all the stops….. We need to fight, we need to fight now,” said the WHO Director General. “Our predictions will come true, if we do nothing.”

“This is not a one way street,” he said, “The epidemic can be pushed back.”

While “some countries are stepping forward to face the fire,” others, however, were reacting too little and too late, he warned, adding, “We’re concerned that some countries have either not taken this seriously enough, or have decided there’s nothing they can do. We are concerned that in some countries the level of political commitment and the actions that demonstrate that commitment do not match the level of the threat we all face.”

Against the almost dizzying spiral of cases abroad, China saw only 143 new cases over the last 24 hours, and only 4 new cases outside of Hubei Province, Dr Tedros noted, citing it as proof that containment actions can work.

Three quarters of the new cases seen abroad, meanwhile, were linked just three countries that have become the world’s three largest hotspots, the Republic of Korea, which saw 467 new infections overnight for a total of 6088 cases; Iran, which saw 691 new cases overnight, for a total of 3513; and Italy, which saw 587 cases overnight, for a total of 3089.

Latest data as of 6 p.m. CET – Note numbers are changing rapidly.

Don’t Abandon Containment – Says WHO 

In remarks that alternated between a plea and a call to battle, the WHO Director General appealed to the global community to “not give up on a containment strategy,” saying that not only China but also other countries that seemed to be beseiged by the virus threat, had pushed back aggressively and demonstrated that it could be contained.

Korea, for instance, was seeing fewer new cases in the past 24 hours than either Italy or Iran, which have only about half as many reported infections. While both Italy and Iran have reported 107 deaths each, Korea, with nearly twice as many cases, has reported only 35 fatalities.  While many factors can explain such a variable, it also points to the likelihood that Korea is identifying cases sooner and getting those infected to treatment more rapidly.

“We see encouraging signs from the Republic of Korea,” said Dr. Tedros. “The number of newly-reported cases appears to be declining, and the cases that are being reported are being identified primarily from known clusters.”

Singapore is another such example he cited.  It was one of the first countries outside of China to discover cluster of local infection transmission  But careful contact tracing and other measures seem to be containing further spread to 117 cases so far, with only 12 new cases were reported over the past week.

A total of 115 countries have not reported any cases, Dr Tedros added, 21 countries have reported only one case, and 5 countries that had reported cases have not reported new cases in the past 14 days.

“The experience of these countries and of China continues to demonstrate that this is not a one-way street. This epidemic can be pushed back, but only with a collective, coordinated and comprehensive approach that engages the entire machinery of government. We are calling on every country to act with speed, scale and clear-minded determination.

“If countries act aggressively to find, isolate and treat cases, and to trace every contact, they can change the trajectory of this epidemic,” the WHO Director General said. “If we take the approach that there’s nothing we can do, that will quickly become a self-fulfilling prophecy. It’s in our hands.

“The worst thing that can happen to any country or any individual is to give up,” he added. “Don’t give up, don’t surrender. Do everything we can do to contain it.”

He added that a “whole of government approach” should be used, involving every branch of government, from security and diplomacy to finance, commerce, transport, trade and information sectors:  “Activate your emergency plans through that whole-government approach.

“Educate your public, so that people know what the symptoms are and know how to protect themselves and others. Increase your testing capacity. Get your hospitals ready. Ensure essential supplies are available. Train your health workers to identify cases, provide careful and compassionate treatment, and protect themselves from infection.

“If countries act aggressively to find, isolate and treat cases, and to trace every contact, they can change the trajectory of this epidemic.”

US House Overwhelmingly Approves $US 8.3 billion for Emergency  COVID-19 Response – In Rare Bipartisan Display  

In a rare bipartisan display of support for funding on a health issue, the US House of Representatives approved an US$ 8.3 billion package of funding to support emergency coronavirus response, by a 415-2 vote. That should ensure ready approval in the US Senate as well.

The US is so far only reporting 129 COVID-19 cases officially. But some US experts have warned that significant numbers of cases could have passed under the radar during the past three weeks when testing services were inadequate, and protocols too strict to include tests for people with, and who later proved to be infected.  That has led to patterns of surreptitious community transmission in Washington State, with new clusters also emerging in California and now, the New York metropolitan area.

Notably, New York City reported 9 new cases  overnight that were linked to the city’s first COVID-19 case in a health worker recently returned from Iran. And Los Angeles County, California, declared a state of emergency after identifying 6 new cases.

The draft funding bill, now to go before the Senate, includes about $US 7.7 billion in funds to boost vaccine development, R&D on vaccines and drug therapies, build critical stockpiles of hospital devices and health worker protective gear, and provisions that every state would receive at least US$ 4 million in funding.  The package would also liberalize Medicare rules on telehealth, so that people with chronic conditions or minor illness other than COVID-19 could consult health care professionals remotely, removing risks of exposure to the virus at health clinic and hospital waiting rooms.

After intense debate, congressional leaders also agreed to a provision of $US 300 milllion that would be used to reduce the costs of new vaccines along with language in the draft bill stating that, “the Secretary [of Health and Human Services] may take such measures authorized under current law to ensure that vaccines, therapeutics, and diagnostics developed from funds povided in this Act will be affordable in the commercial market.”

The language was supposed to allay fears that any new COVID-19 treatments and vaccines developed with public funds would be affordable to the millions of Americans who lack even the most basic health care insurance to cover drug and vaccine costs.

However, Knowledge Ecology International’s James Love, described the draft language in the billl as “worse than weak”, and said the fine print could even undermine existing authority that the federal government has to intervene in drug markets.

“The use of ‘may’ rather than ‘shall,’ adds no new authority and no new mandate to protect the public from unreasonable, excessive or unaffordability prices,” Love said, in a blog.

He stressed that another sentence, is even more worrisome. It states that: “in carrying out the previous provision the Secretary shall not take actions that delay the development of such products.”

That clause, Love contends, could in fact undermine existing legal authority that the federal government has to use any patent or have any product manufactured “by and for” the federal government in cases of public need. It could also undermine existing government authority to issue so-called “compulsory licenses” to third parties for production of a patented drug or vaccine, even if federal funds supported the drug development.

“The proposed legislation can blow all of these measures up, by preventing the federal government from undertaking any measure that would ‘delay the development of such products,’ ” said Love.  “Companies can claim that ANYTHING that reduces the price reduces incentives to invest in more rapid development, and under this act, and litigate that issue.”

 

 

Image Credits: Johns Hopkins CSSE.

Workers in full personal protective gowns help unload 7.5 metric tons of medical supplies to support the COVID-19 response in Iran

As the COVID-19 continued its march across the planet, shortages of some key drug ingredients were beginning to be felt in some markets, and iconic events such as the World Bank’s annual spring meeting were to be moved to a virtual platform.

In Geneva, parallel sessions and side events involving the ongoing annual meetings of the Human Rights Council were cancelled. The Geneva Health Forum, Switzerland’s own premier global health event, originally planned for the end of the month, was postponed until mid-November.  This followed a Swiss ban of gatherings of more than 1,000 people.

India Surprise Announcement Restricting Exports of Key Drug Ingredients

India’s surprise announcement on Wednesday of restrictions on exports of two dozen pharmaceutical ingredients (APIs) and products, including such common drugs as paracetamol, acyclovir, and the anti-parasitic agent metronidazole, seemed to catch drug agencies and pharmaceutical industry observers by surprise.

The FDA also announced shortages of pindolol, a drug commonly used for the treatment of hypertension and cardiovascular disease. That followed an FDA announcement last week of a pending shortage of “one human drug” on US markets, without referring to the compound by name.

About 40% of APIs for the US generic drug market come from India.

Some observers, however, cautioned that it was too soon to assess how significant supply interruptions in China and India were, or how they would affect markets elsewhere.

“We have heard reports of export restrictions in China and India…Whether it’s there is a real supply shortage or there is a certain amount being set aside for domestic use, and they are cutting exports…We need to learn a little bit more about that,” Outi Kuivasniemi, of Finland’s Ministry of Social Affairs and Health, at a seminar on the COVID-19 crisis at the Geneva Graduate Institute.

Until now, it had been widely thought that India’s generics industry could hopefully make up for the shortfalls in China’s manufacturing of key APIs, or drug ingredients, which is still reeling from a month of COVID-19 shutdowns.

“China’s manufacturing of APIs still trying to come back online,” Paul Mollinaro, WHO’s head of logistics told reporters at a WHO press briefing on Tuesday, noting the fear that the “ripple effects will create shortages in medicines as well.”

Global Cases of COVID-19 as of 4:30PM CET 4 March 2020.

More Cases in Europe; Rising Concerns About Iranian Epidemic 

Around the world, there were now 94,250 cases of COVID-19 and 3,214 deaths as of 4:15 pm Central European Time.   More than 800 new cases were reported in the European Union and the United Kingdom overnight, according to the European CDC, reporting the acceleration of the epidemic across the continent.  Italy continued to be the epicentre with 2502 cases and 79 deaths in total.  But more cases were being reported in France, Spain, Switzerland, Germany and the United Kingdom as well.

In contrast, China had reported only 119 new cases in the past 24 hours, another record low since the outbreak began accelerating in the country in late January. In Asia, South Korea now was facing the biggest battle to control the disease, with a cumulative total of 5,621 cases and 28 deaths, while Iran was reporting 2922 cases and 92 deaths. WHO has rushed a team of medical advisors as well as a shipment of supplies to Tehran, including 100,000 testing kits, which arrived earler this week.

There were, however, concerns that numbers of those affected by the outbreak in Iran had been under-reported, as media accounts of bungled COVID-19 control measures and a slow reaction by health authorities came to light.

In a blistering op-ed, the Washington Post’s Editorial Board described Iran as: “a worrying scenario: a government in denial, a people cynical and distrustful, and a burgeoning infection. Strictly from a health point of view, Iran has become a dangerous epicenter for COVID-19, a hazard not only for its population but also the world.”

As many as three top Iranian officials, including an advisor to Iran’s Supreme Leader Ali Khamenei Mohammad Mirmohammadi, have died from the disease, noted Suerie Moon, co-director of the Geneva Graduate Institute’s Global Health Centre, in a seminar Wednesday on government and public responses to the crisis. According to VOX news, Iranian Vice President Masoumeh Ebtekar tested positive for COVID-19 just a day after attending a high-level cabinet meeting with the Supreme leader himself. Already last week, Iran’s deputy health minister announced that he had tested positive for COVID-19.

Reports of a growing COVID-19 outbreak in Iranian prisons have also emerged, leading to the reported furloughing of some prisoners. In one account, the law firm Perseus Strategies, described the case of an Iranian-US executive Siamak Namazi held in Evin Prison since 2015, where prisoners continued to be housed in crowded cells of 10-20 people each, even after one prisoner tested positive for the coronavirus. Family membes of the Iranian-British woman, Nazanin Zaghari-Ratcliffe, a project manager with the Thomson Reuters Foundation detained in Evin Prison since 2016, have also stepped up their diplomatic battle to have her released, saying that she lacked access to basic hygiene and also had symptoms of COVID-19 infection, something that Iranian authorities have denied.

Southeast Asia Reporting More Cases – US Fears of Community Transmission

WHO’s Regional Director for South-East Asia, meanwhile warned that for India along with the rest of South-East Asia “more cases can be expected” of the coronavirus which is now slowly appearing across the sub-continent too. On Wednesday, densely populated India was now reporting 28 cases, along with 43 cases in Thailand, 2 in Indonesia and 1 each in Sri Lanka and Nepal.

“Rapidly identifying these cases, isolating them and following their contacts are important initiatives to help limit person to person transmission. The speed of our response is critical, which is only possible if we are prepared,” said the Regional Director, Dr Poonam Khetrapal Singh.

Port of entry temperature screening in Bhutan, part of WHO’s Southeast Asia Region

Community transmission seemed to be a rising problem in the United States, which was reporting 128 cases including a growing cluster of community transmission in Washington State, which has seen 27 cases and 9 deaths, and the first confirmed cases in the country’s most densely populated urban hub, New York City.

But as with emerging clusters elsewhere, those numbers may only be the tip of the iceberg, experts said.

Trevor Bedford, head of the Seattle-based Bedford Lab estimated that the real number of cases Washington State’s Snohomish County was more likely around 570 with an 90% uncertainty interval of between 80 and 1500 infections.”

His modelling estimates, published in the Laboratory’s blog, are based on the fact that due to delays in testing, the first people infected may have quietly exposed others else to the virus between Jan 15 and Jan 19 before they were isolated.

“If this second case was mild or asymptomatic, contact tracing efforts by public health would have had difficulty detecting it,” Bedford said, adding, “After this point, community spread occurred and was undetected due to the CDC narrow case definition that required direct travel to China or direct contact with a known case to even be considered for testing.”

He called this delay in testing a “critical error” that allowed an outbreak in Snohomish County to grow to a “sizeable problem” before it was detected.

In another development, a leading group of US public health experts called upon the US Government to make COVID-19 testing and treatment free – so that costs would not pose a barrier to disease containment.

In an open letter to Mike Pence, US Vice President, and designated head of the nation’s COVID-19 response, 489 public health, law, human rights, and medical experts and 14 organizatios published called on the government to “make sure that the burdens of COVID-19, and our response measures, do not fall unfairly on people in society who are vulnerable because of their economic, social, or health status.”

While the high cost of health care in the US, leaving tens of millions of uninsured, has been a longtime domesitc political football, the issue has now also become critical to COVID-19 containment as reports began to proliferate in media about Americans saddled with large medical bills after they submitted to quarantine or treatment.

On Tuesday, New York State Governor Andrew Cuomo became the first issue a directive requiring state health insurers as well as state supported Medicaid to wave co-pay costs associatd with testing and medical care for anyone infected. Ruben Gallego, Arizona’s democratic representative for the US House of Representatives announced that he plans to introduce a bill to cover medical testing and treatment costs associated COVID-19.

“Coronavirus could spread even more quickly if people avoid testing and treatment due to astronomical medical costs,” Gallego said. “Nobody should be forced to put their own health and lives – and the health and lives of those around them – at risk because they can’t afford critical medical care.

Global Fund Says Countries can Repurpose Some Grants for COVID-19 Response

In Geneva, The Global Fund to Fight AIDS, Tuberculosis and Malaria, said it would allow countries to “reprogramme” unused funds from existing grants and “redeploy” underused resources to bolster overall health system response to COVID-19 in low- and middle-income countries.

“COVID-19 could derail progress on HIV, TB and malaria, through disruption to treatment or other interventions or supply chains of critical medicines and medical supplies,” a press release from the Global Fund stated.

“As was the case with Ebola, the Global Fund is committed to a pragmatic and flexible approach in supporting countries in the fight against COVID-19,” said Peter Sands, Executive Director of the Global Fund, in a press release. “Our priority is to ensure continuity of lifesaving programs to end HIV, TB and malaria. However, COVID-19 could knock us off track. People infected with HIV, TB and malaria could prove more vulnerable to the new virus given that their immune systems are already under strain.”

Additional activities under the new COVID-19 guidelines include, but are not limited to, epidemic preparedness assessment, laboratory testing, sample transportation, use of surveillance infrastructure, infection control in health facilities, and information campaigns.

The news follows announcement on Tuesday of an immediate US$12 billion grant by the World Bank to support COVID-19 response activities.

World Bank Plans “Virtual” Spring Meeting; But Iraq Continues Plans For Mass Pilgrimage Event 

While the Bank announced that it would be holding its annual Spring Meeting, virtually, to avoid risks of infection among the tens of thousands who usually attend, plans were going ahead in Iraq for a major series of Shi’ite pilgrimage events set to occur this month – bolstered by technical support from WHO on infection prevention measures.

“As millions are expected to visit Iraq in the coming month for religious events, WHO is working with religious leaders and health officials to discuss necessary preventive measures to improve planning for mass gathering events during visits to holy sites to protect visitors from possible coronavirus disease (COVID-19) infections,” a press release from WHO’s Eastern Mediterrenean Region Office, stated.

“So far, the measures taken by the Government of Iraq to limit the spread of COVID-19 comply with WHO recommendations. Other urgent preparations, however, are critically needed, such as designating proper isolation facilities,” WHO Representative in Iraq Dr Adham Ismail, was quoted as saying. “Iraq has conducted a risk assessment and health authorities are calling on clerics to support Iraq’s decision to avoid gatherings as much as possible to prevent the spread of this disease. WHO supports that position,” he added.

The Islamic month of Rajab, which this year extends from 25 February-23 March, is marked by an important series of days of celebration, remembrance and mourning in the Shi’ite Islamic calendar, when Shi’a pilgrims from around the world typically visit religious centres such as the Al Kadhimiya Mosque in Baghdad.

“Strict measures have been taken by religious authorities at Al-Kadhimain Holy Shrine to preserve the safety of workers and visitors alike. These measures include the use of personal protective equipment, such as masks and gloves, by all shrine workers, in addition to closing the site for sterilization,” the Secretary-General of Kadhimain Holy Shrine, Dr Haider Hussain Al-Shammari, was quoted in the WHO press release as saying.

“WHO is providing technical advice and recommendations on visits to holy sites to prevent the spread of disease, including COVID-19. This includes best methods for sterilizing surfaces and equipment, the use of thermal detection devices at entrances and checkpoints, and proper referral and isolation measures for suspected cases.”

Iraq announced the first COVID-19 infection on 25 February 2020. This number has since increased to 26 cases on 3 March, all among nationals coming from Islamic Republic of Iran.

Asked by Health Policy Watch if WHO was in fact recommending that the Shi’a mass gatherings still proceed – even after Saudi Arabia has suspended foreign visits to its year-round “umrah” pilgrimage over fears of the virus, a WHO spokeswoman didn’t respond.

Meanwhile, across Europe, conferences and meetings, both large and small continued to be cancelled in the face of the burgeoning COVID-19 epidemic on the continent.

While France has banned mass gatherings of 5,000 or more, Switzerland has banned gatherings of more than 1,000 people.

In Geneva’s international health and development hub, Geneva Cantonal health authorities told the many non-profit groups operating in the city that they are free to meetings involving fewer participants.

But they should undertake a risk assessment to determine if the event is really necessary at this moment in time.  NGOs or their participants also need to be prepared to bear the costs of state-mandated treatment, should someone develop symptoms during their time in the city, as well as costs of quarantine for any close contacts of identified COVID-19 cases,” officials have said.

It is not yet clear how the Swiss directive might affect one of the next really big UN gatherings in the city, the World Health Assembly, which usually takes places in late May and draws thousands of participants from around the world.

On the other side of the Atlantic, however, the World Bank was setting a carefully-watched precedent, in its announcement that virtual channels would be used for its Spring Meeting, which covers a wide range of health and development topics:

“Like everyone else around the world, we have been deeply concerned by the evolving situation of the Coronavirus and the human tragedy surrounding it. Given growing health concerns related to the virus, the Management of the IMF and World Bank Group and their Executive Boards have agreed to implement a joint plan to adapt the 2020 IMF-World Bank Spring Meetings to a virtual format.”

The decision was hailed on some social media channels as a milestone move that could save on high travel costs and related carbon emissions that are often associated with big global gatherings.

“This *could* be the moment when we collectively finally crack videoconferencing on a mass scale, for good,” said The Wellcome Trust’s Director of Strategy, Ed Whiting in a Tweet filled with emojis of airplanes and then trees, “Bring it. Interested how tech steps up.”

 

 

 

 

 

 

 

 

 

 

Image Credits: Twitter: @WHOEMRO, John's Hopkins CSSE, WHO Bhutan.

Babies are particularly vulnerable to complications from malaria.

[Medicines for Malaria Venture]

  • EDCTP grants the PAMAfrica research consortium €21.9 million over a 5 year period; MMV, Novartis and other partners will provide an additional €22 million.
  • The PAMAfrica consortium brings together a global medicines company, a not-for-profit product development partnership and leading academic institutions in Africa and Europe. PAMAfrica aims to develop new medicines for both severe and uncomplicated malaria, designed to combat emerging artemisinin resistance.
  • The projects will include development of the first new malaria treatment for babies under 5kg, a new fast-acting medicine for the treatment of severe malaria, and new combinations to treat drug-resistant uncomplicated malaria. 

The Hague, the Netherlands; Geneva and Basel, Switzerland (3 March 2020) – The European & Developing Countries Clinical Trials Partnership (EDCTP) awarded a new grant to the new PAMAfrica research consortium led by Medicines for Malaria Venture (MMV). The consortium will support the development of new treatments for malaria in the most-at-risk populations, including babies, patients with severe malaria, and those with drug-resistant infections. The EDCTP grant of €21.9 million is to be matched by funding from MMV, Novartis and partners. Over a period of 5 years, the grant will support the development of a portfolio of projects executed under the umbrella of the PAMAfrica research consortium. Clinical trial capabilities in Africa will also be strengthened to ensure each site involved can effectively operate to ICH-GCP regulatory standards. The consortium includes seven research organizations from Burkina Faso, Gabon, Germany, Mozambique, Spain and Uganda. In addition to Novartis, other pharmaceutical company partners may join the consortium.

The PAMAfrica research consortium will conduct three clinical trials, supporting efforts to build clinical capacity and train scientists across Africa. One trial will explore new combinations of compounds, including new chemical classes, for the treatment of uncomplicated malaria in adults and children. These compounds are all known to be fully active against all drug-resistant strains, including the artemisinin-resistant Kelch13 strains. The second trial will evaluate a new generation, rapid-acting treatment for severe malaria, cipargamin, also known as KAE609, which is being developed by Novartis, supported by a grant from the Wellcome Trust. In the third study, a novel formulation/ratio from Novartis of the current gold standard treatment artemether-lumefantrine will be tested in newborn infants weighing less than 5 kg or who are malnourished.

Dr Timothy Wells, Chief Scientific Officer of MMV and the coordinator of the PAMAfrica group, said: “All three of these research projects address areas of urgent need in malaria treatment. Antimalarial drug resistance, originally seen in Southeast Asia, is being reported in Africa and may threaten current treatments. It is important to have new therapies that are active against this emerging threat of resistance. The work on newborn infants and in severe malaria is groundbreaking in bringing medicines to this neglected group. Thanks to this critical support from EDCTP we are not only able to bring together the necessary African and European expertise to conduct these projects to address unmet needs, but in doing so, we are also able to support the training and development of the next-generation of leaders in clinical malaria research in Africa.”

Dr Michael Makanga, Executive Director of EDCTP, said: “Malaria continues needlessly to take 405,000 lives a year and must remain a global and national priority in endemic countries. We hope our funding for PAMAfrica will contribute to the development of successful new treatments that will support malaria eradication, while supporting the development of African research capacity.”

Caroline Boulton, Global Program Head, Malaria, Novartis, said: “Despite advances in malaria control, we still have a long way to go. New antimalarials are urgently needed to tackle rising parasite resistance to current therapies. In response, Novartis has committed to advance research and development of a number of next-generation antimalarial treatments. Partnerships play a critical role in helping to bring these novel agents forward and we sincerely appreciate the crucial support of EDCTP to this process.”

Image Credits: Jaya Banerji/MMV.

UNFPA distributes clean baby delivery kits to women in Kasaï province, Democratic Republic of the Congo.

[UN News]

(3 March 2020) – In an emotional ceremony on Tuesday, the last Ebola patient in the DRC – a woman called Masiko – was discharged from the treatment centre in Beni, the World Health Organization reported.

“There are currently zero cases of Ebola in DRC after over a year of fighting this outbreak”, WHO Regional Director Dr. Matshidiso Moeti said in Tweet sharing a video of Masiko leaving the facility to the cheers of a waiting crowd.

“So proud of all involved in the response. We are hopeful, yet cautiously optimistic that we will soon bring this outbreak to an end”.

Dr Tedros in a daily briefing on Ebola added that no new Ebola cases had been reported in the past two weeks.”

The milestone comes as countries increasingly report cases of respiratory disease caused by a new strain of the coronavirus, which first appeared in the Chinese city of Wuhan late last year.  To date, more than 60 additional countries have been affected.

Africa Prepares for COVID-19

Following the virus’s spread to the continent, the African Union and the Africa Centres for Disease Control and Prevention organized an emergency ministerial meeting last month where the DRC was identified among 13 countries most at risk of coronavirus disease 2019 (COVID-19) due to their direct travel links with China.

“Some countries in Africa, including DRC, are leveraging the capacity they have built up to test for Ebola, to test for COVID-19”, WHO Director-General Tedros Adhanom Ghebreyesus told the meeting. “This is a great example of how investing in health systems can pay dividends for health security.”

WHO’s Africa office this week held an emergency partnership meeting on coronavirus , aimed at boosting engagement and developing an effective preparedness and response plan for countries in the region.

Organizations in attendance included fellow UN agency the UN Population Fund (UNFPA), which believes that compared to countries with little experience in large-scale infection prevention and control, the DRC may be better positioned to prevent the spread of the coronavirus because of the Ebola measures already implemented.

Lessons :earned from the Ebola outbreak

UNFPA health workers have been supporting Ebola response in the DRC: the tenth such outbreak in the country’s history. It has occurred against the backdrop of one of the world’s most protracted crises and in a region of the country that has been scarred by deadly armed group attacks. Overall, nearly 16 million Congolese citizens require support, including 3.5 million women and girls of reproductive age: that is between 15-49 years old.

Workers disposing of Ebola-contaminated materials

While all people living in affected areas are at risk of contracting Ebola, UNFPA explained that  health workers face increased risk due to frequent contact with infected persons, their biological fluids and contaminated objects. They also risk spreading the disease to other patients and practitioners during care. More than five per cent of Ebola victims in DRC were health workers who contracted the disease through contact with an infected patient’s bodily fluids, according to the agency.

Midwife Rachelle Mbavindi was infected with Ebola while working in the Mangina Referral Health Centre, which was renovated by UNFPA. Located in North Kivu province, it is at the epicentre of the humanitarian crisis and Ebola outbreak.

Rachelle and nine colleagues spent 90 days in quarantine and treatment after contracting the disease. Despite the difficulty of her experience, Rachelle returned to work following her release.

“After my experience with Ebola, I felt born again,” she said, “and I carry out my work with great caution and attention.”

UNFPA expanding interventions

As a midwifery supervisor, Rachelle trains her colleagues in the proper implementation of practices that can make the difference between life and death in the prevention of fatal diseases. These steps include proper hand hygiene, face protection and clothing, prevention of injuries causing open wounds, respiratory hygiene: that is, preventing viral spread through coughing, systematic cleaning of rooms and linens, and appropriate management of biological wastes.

Rachelle is applying her personal and professional experience with Ebola to prepare for the potential spread of coronavirus.

“Thanks to the Ebola training provided by UNFPA, I feel reassured that my maternity ward can prevent and control a new epidemic, including the coronavirus”, she said.

“In addition to the training and related supervision, UNFPA provides maternity wards with essential equipment to ensure full implementation of the infection prevention and control measures”, said Dr. Polycarpe Takou, UNFPA humanitarian coordinator for Ebola response.

UNFPA regional and country offices are now working to expand such interventions in preparation for the potential spread of COVID-19.

Image Credits: UNFPA DRC, UN News.

Temperature check at Hartsfield-Jackson Atlanta International Airport, USA. In the face of worldwide shortages, WHO recommends masks only in health care and border control settings, and for people experiencing flu-like symptoms.

The World Bank on Tuesday announced the immediate release of US$12 billion to support countries struggling to respond to the COVID-19 crisis.

That followed news that the global death rate from the novel coronavirus was now averaging around 3.4% as compared to around 2% of cases previously reported by WHO.

In comparison, estimated fatality rates for seasonal flu are just a fraction of that – ranging between an average mortality of about  .1% based on historical records of the United States Centers for Disease Control data to .4% in other settings, depending on the country, year and population vaccine status.

The new data was released at the WHO daily press briefing, where WHO Director General Dr Tedros Adhanom Ghebreyesus also highlighted the severe worldwide shortage of personal protective equipment (PPE) for health care workers – equipment that will be critical in containing the now running tap of new cases abroad from becoming a larger flood.

“We are concerned that countries’ abilities to respond are being compromised by the severe and increasing disruption to the global supply of personal protective equipment – caused by rising demand, hoarding and misuse,”  said Dr Tedros, noting that worldwide PPE supplies need to increase by 40%.

He spoke as China again set a record low of only 129 new cases, the fewest since 20 January.  But abroad there were record highs, once more, with 1,848 new cases reported in 48 countries overnight Monday. The reports included 12 new countries reporting infections for the first time. Korea, Iran and Italy continued to be the hotspots with 80% of the new cases outside China occurring in those three countries. Total cases worldwide now total 92,314 in 79 countries as of Tuesday evening Central European Time.

Even China is now at risk of re-importing the outbreak. Caixin news reported that officials in the eastern Chinese province of Zhejiang confirmed eight new cases of COVID-19 in people recently returned from Italy, where they had worked in a restaurant in Bergamo – a town near the epicentre of Italy’s outbreak.

Global Cases of COVID-19 as of 6:30PM CET 3 March 2020.

COVID-19: Much More Severe than Flu – Not Many Asymptomatic Cases

Along with being more fatal, COVID-19 causes more severe disease than seasonal influenza, the WHO Director-General also noted, in remarks that appeared intended to dispel some of the myths surrounding the new disease.

“While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection, and some will suffer severe disease,” he said.

“Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected,” added the WHO Director General. In fact USCDC data shows ten-year flu mortality averages .1% – or roughly 34 times fewer deaths in relation to the number of people infected.

Dr Tedros’ remarks came just a day after the US Acting Secretary of Homeland Security, Chad Wolf, told the Senate Appropriations Committee that the death rate from the COVID-19 virus was comparable to that of seasonal flu: “Worldwide… I believe it is under 2%.. it’s between 1.5 and 2%,” Wolf said in televised remarks, adding [incorrectly] that the mortality rate for seasonal flu was “right around that percentage as well. I don’t have it offhand, but it’s right around 2%.”

Previous data published by China CDC have also highlighted how COVID-19 death rates also vary sharply by age.  An analysis of 44,672 cases reported as of 11 February in China found that the average mortality rate for people aged 10-49 was only about .2-.4%, while death rates for people aged 60-79 ranged from 3.6-8% and nearly 15% of people age 80 or older who were infected with COVID-19 had died.

Significantly, those numbers were based on the now out-of-date estimate of a 2.3% average mortality rate. So far, a revised age and gender-related breakdown of the new mortality 3.4% mortality rate has not been published by WHO, China, or institutions elsewhere. But based on trends to date, it would likely reflect even higher average mortality rates across older age groups.

In another important new finding, few COVID-19 cases are turning out to be entirely asymptomatic, the WHO Director-General also added. While more large scale studies of immunity have to be done, that is the evidence so far from one large scale Chinese study in Guandong province, as well as from very wide-scale testing of cases and contacts in China, Singapore and elsewhere.

“Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days,” said Dr Tedros.

“Some countries are looking for cases of COVID-19 using surveillance systems for influenza and other respiratory diseases.  Countries such as China, Ghana, Singapore and elsewhere have found very few cases of COVID-19 among such samples – or no cases at all.

“The only way to be sure is by looking for COVID-19 antibodies in large numbers of people, and several countries are now doing those studies. This will give us further insight into the extent of infection in populations over time,” he added, noting that WHO has developed protocols available on its public COVID-19 platform, for how such studies should be done.

WHO Calls on Manufacturers to Boost Production of Personal Protective Equipment by 40%

In terms of the personal protective equipment, that is critical to prevent the spread of disease in health facilities, the world is facing both supply shortages and soaring costs, the Director General said.

“Prices of surgical masks have increased six-fold, N95 respirators have more than tripled, and gowns cost double their previous price, said Dr. Tedros. “Worldwide shortages are leaving doctors, nurses and other frontline healthcare workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons,” he observed.”Supplies can take months to deliver, market manipulation is widespread, and stocks are often sold to the highest bidder.”

He noted that WHO has shipped nearly half a million sets of personal protective equipment to 27 countries, but supplies are rapidly depleting.

And yet in the coming months, projections are that 89 million more medical masks will be required for the COVID-19 response along with 76 million examination gloves and 1.6 million goggles.

“Globally, it is estimated that PPE supplies need to be increased by 40 per cent.”

Dr. Tedros said that WHO was working with governments, manufacturers and its Pandemic Supply Chain Network to “boost production and secure supplies for critically affected and at-risk countries. “We continue to call on manufacturers to urgently increase production to meet this demand and guarantee supplies.”

“And we have called on governments to develop incentives for manufacturers to ramp up production. This includes easing restrictions on the export and distribution of personal protective equipment and other medical supplies.

“We can’t stop COVID-19 without protecting our health workers.”

US CDC Updates Testing Guidelines Amidst Continuing Brouhaha over Lack of Tests

Meanwhile, in the United States, controversy continued to rumble over reports of delayed testing of suspected COVID-19 cases, due to overly restrictive USCDC guidelines and a shortage of testing kits.

In one report, the New York Times quoted the story of a woman who had reported for testing with a high fever and breathing difficulties on 19 February, but was refused a test because her fever was not high enough, and she hadn’t recently travelled to China. The woman was later found to be positive with the disease, after a contact was reported ill.

In the wake of such incidents, the US CDC said on Friday that it had changed its criteria for testing suspected cases on Friday to allow cases of respiratory illness with no known contact with COVID-19 cases to be tested. WHO also updated its case definition for suspected cases Friday to account for links with growing hotspots of the outbreak in Italy, Iran, and South Korea; with the definition now being cases of serious respiratory illness in those with recent travel history to any place with local transmission.

As of 27 Feb, the US CDC now encourages COVID-19 testing at clinicians’ discretion, for people reporting “fever with severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza)” …. even if “no sources of exposure has been identified.”

The first case of community transmission of COVID-19 in the US was confirmed in a California woman last Thursday – days after she had reportedly presented with severe respiratory illness at the University of California Davis Medical Center. In a press release the UC Davis hospital reported that an initial request for COVID-19 testing was “not immediately administered” because the woman did not “fit the existing CDC criteria for COVID-19.”

However, when questioned by reporters Nancy Messonier, the US Centers for Disease Control’s designated COVID-19 spokesperson, said that the CDC team handling testing requests has “not said no to any request” and that according to their records, a test for COVID-19 was recommended for the California case on Sunday 23 February, the same day the case was first reported to the CDC.

World Bank Makes US$ 12 Billion “initial” commitment  

In a press release, the World Bank Group said “an initial package of up to $12 billion” was being made available in immeidate support to assist countries coping with the health and economic impacts of the epidemic.   Calling it a “fast-track” package, a press releaase said that the money, “will help developing countries strengthen health systems, including better access to health services to safeguard people from the epidemic, strengthen disease surveillance, bolster public health interventions, and work with the private sector to reduce the impact on economies.”

“We are working to provide a fast, flexible response based on developing country needs in dealing with the spread of COVID-19,” said World Bank Group President David Malpass. “This includes emergency financing, policy advice, and technical assistance, building on the World Bank Group’s existing instruments and expertise to help countries respond to the crisis.”

The health aspects of the package will include support for: strengthening health services and primary health care; bolstering disease monitoring and reporting; training front line health workers; encouraging community engagement to maintain public trust; and improving access to treatment for the poorest patients, the announcement stated.

The Bank will also provide policy and technical advice to ensure countries can access global expertise. The financial package will include grants and low-interest loans for low-income countries as well as loans for middle-income countries, financed by the Banks various branches.

The announcement was welcomed by Jeremy Farrar, Director of Wellcome Trust, who just days ago had publicly challenged top World Bank officials to immediately come forward with at least US$ 10 billion dollars in immediate aid.

“This is a remarkable and unprecedented move by the World Bank – and one which will make a huge difference to the global response to this already immensely challenging epidemic,” Farrar said.

“This support will be critical to enabling efforts globally to get ahead of the rapid spread of COVID-19. This is not simply a health crisis – it is a global crisis which is already impacting every sector of society.

“This commitment from the World Bank is needed if we are to have a chance of averting long-term catastrophe worldwide. It will be vital to supporting the ongoing global response, co-ordinated by the WHO, and to support health systems and societies around the world, particularly in vulnerable regions. It will also facilitate accelerated research and development of vaccines, diagnostics and treatments, ensuring equitable access to advances made. The World Bank deserves great credit for the speed and scale of its response.”

This story was updated 4 March 2020

Image Credits: US CDC, Johns Hopkins CSSE.