Cover of current edition of Korea Biomedical Review

A sharp decline in new COVID-19 cases was reported by China on Thursday, providing a glimmer of hope about the potential to still contain the epidemic – but only if the steady increase being seen in new cases abroad can now be brought under control.

As of 3 p.m. Central European Time (CET), official Chinese data recorded just 404 new cases of the novel coronavirus over the past 24 hours – for a total of 74,680 confirmed infections. That was in comparison to daily increases of 2,000-3,000 new cases seen over the past two weeks.

However, elsewhere in the world, 68 new cases were reported, for a total of 1,085 reported infections in 26 countries, as of 3 p.m. CET, with yet other cases reported later in the evening.  Most of the international increase was occurring in South Korea where the number of cases had more than doubled from 51 to 104 overnight.

Along with that, there were 8 reported deaths outside of Japan, including two elderly people in Iran, where 3 more coronavirus cases were also confirmed and six were under investigation – in a country that had previously not reported any infections whatsoever.

Two deaths also were reported among the 634 infected passengers of the Diamond Princess Cruise ship that was under a forced quarantine in Japan’s Yokohama harbor until just yesterday, when Japanese authorities began the slow release of the ship’s passengers and crew, which had originally numbered over 3600 people.

In South Korea, a press release by Centers for Disease Control officials said that many of the new Korean cases appeared to be centered around the Shincheonji Church of Jesus, a church with cult-like associations in the city of Daegu. A 61-year old church member had reportedly developed symptoms but refused to be tested, and subsequently infected at least 37 other church members, in what authorities described as a “superspreader” event.  Related to that, there were two clusters of infections within hospitals as well.

Already on Wednesday, the South Korean Ministry of Health and Welfare had put into place a new series of stringent infection control measures nationwide, including screening and limits on  gatherings in schools, leisure venues, and other public places. The Ministry also launched the distribution of hundreds of thousands of masks; stepped up COVID-19 testing in hospitals; issued travel warnings against visit to China’s high-burden COVID-19 provinces; and mandated screening of all inbound travellers, including installation of a self-diagnosis and locational app on their cell phones. Even stricter measures were imposed on Thursday in Daegu, where many public venues were closed and stores and streets remained empty.

COVID-19 cases worldwide, by official China health site as of 3 p.m CET 20 February.

Iranian Deaths May Be Followed By More Cases

The deaths of two elderly Iranians, in the city of Qom, were the first cases to be reported in Iran, making it the third country grappling with the virus spread in WHO’s Eastern Mediterranean Region, outside of Egypt and the United Arab Emirates. Later Thursday Iranian authorities reported, and WHO confirmed, 3 more COVID-19 cases in Qom.  Another six suspected cases in Qom, Tehran and the northern city of Babol were being tested and quarantined, Iranian News Agency IRNA, reported Thursday, for a total of 11.

Iranian authorities did not provide information as to the origins of the various infection clusters, with significant geographic spread. There were some suggestions, however, that the infections may have originated among religious pilgrims arriving to the Shiite holy city from Pakistan or other neighboring countries. IRNA, said that all religious schools in Qom had been closed to head off wider infection spread. Some 60 Iranian students were also evacuated from Wuhan earlier this month, but they were quarantined upon their return to Iran and had not displayed any health problems, authorities said.

Iran had continued to maintain business ties with Chinese companies willing to defy US sanctions. And unlike Saudi Arabia, an important Sunni Muslim pilgrimage destination, the Islamic Republic has not imposed restrictions on travel to our from China, although its national airline reportedly suspended flights several weeks ago, with the exception of humanitarian aid.

WHO Expresses Confidence in South Korean Response; Avoids Japan Criticism 

Speaking at a WHO press briefing on Thursday, WHO’s Director General Dr Tedros Adhanom Ghebreyesus expressed confidence in South Korea’s ability to manage the expanding outbreak there, saying “I think the number of cases are really management and I hope that South Korea will do everything to contain this outbreak at this early stage.”

Added WHO’s Oliver Morgan: “The number of cases in South Korea suggests that they are from several distinct clusters which the Ministry is following quite closely. Although the numbers are quite high, they are mostly linked to known chains, and Korean authorities are following up vigorously on all cases.”

WHO officials, however, sidestepped questions regarding Japan’s handling of the quarantine on the Diamond Princess, which has come under increasing fire as reports of poor disease control conditions aboard the ship seeped out with the gradual release of the 3,700 passengers and crew that had been put under lockdown.  The Diamond Princess COVID-19 cases constitute more than one-half of those reported abroad.

WHO’s Assistant Director General for Emergencies, Jaouad Mahjour, defended the Japanese objectives in the multi-week quarantine which saw infections aboard the ship spiral.

“The objective was to contain it on the ship, and not to prevent infection on the mainland,” he said, “They were heavily following the contacts to detect any case, and if they were detected they were taken it to the hospital for treatment.

“They were practicing drastic measures of quarantine and isolation of the cases to avoid close contacts and transmission… Now they are moving to the second stage,” he said, referring to the gradual release of passengers who have been found to be infection free, along with evacuation of those with mild cases to quarantine locations on land or in their home countries.

WHO Objective “Still Containment” – Repeats Call for More Emergency Funds 

Meaanwhile, Dr Tedros confirmed that members of the United States Centers for Disease Control as well as the US National Institutes of Health were part of the international expert team assembled by WHO and now working alongside Chinese counterparts to support control of the epidemic, as well as means of improving containment, clinical care and cure rates.

He said the team also included experts from national disease control centers or institutes in Singapore, Japan, South Korea, Russia, Germany’s Robert Koch Institute and Nigeria’s Centres for Disease Control.  “Global coordination is key in fighting a dangerous enemy,” said Dr Tedros.

He meanwhile emphasized that donors still have not responded to the WHO call for some $US 675 million to fight the epidemic, which threatens to spill over into a pandemic, saying that money is needed now for “simple public health solutions” that could begin “hammering the outbreak now” while a longer-term quest for a vaccine is pursued.

“Our objective is still containment,” said Dr. Tedros, speaking at the press briefing.  “We believe as WHO there is still a chance to contain this outbreak if we use the window of opportunity that we have now. We need to strike the balance, to finance the simple public health solutions now, but prepare for any eventuality by investing in a vaccine.”

Regarding the most immediate therapeutic solutions, WHO’s Clinical Management Lead, Janet Diaz, said that the results of clinical trials should be completed within three weeks on the two most promising COVID-19 treatments, including Gilead Sciences nvestigational drug remdesivir, as well as a popular HIV combination drug, lopanivir/ritonavir.  The lack of any effective antiviral treatment has plagued clinicians’ efforts to treat the most serious 20% of COVID-19 infections. These cases typically require lengthy hospitilization and often sophisticated mechanical ventilation procedures, with the most critical infections lead to multi-organ failure and death in 2% of cases, risks that increase along with age.

 

 

 

Image Credits: Koreanbiomed.come , Dingxiangyuan, HP Watch .

[WHO Africa Regional Office]

In a strong move for the African state, the Ethiopian Parliament has passed landmark excise tax legislation on tobacco with the express aim of curbing smoking in the country – resulting in some of the strongest taxes on tobacco products on the continent. As a result of the legislation, Ethiopia has now introduced a mixed-excise tax system on cigarettes in line with the recommendations of the World Health Organization (WHO). This involves a 30% tax rate of the cost of producing cigarettes, in addition to a specific excise rate of eight Ethiopian Birr (ETB) (USD$ 0.25) on each individual packet. 

The passing of the legislation demonstrates the commitment of the Government of Ethiopia to addressing one of the leading causes of non-communicable diseases such cancer, cardiovascular diseases and chronic obstructive lung disease.  A considerable number of Ethiopians are at risk: the most recent Global Adult Tobacco Survey estimates the number of smokers in Ethiopia to be around 2.5 million people.

“Cancer and other non-communicable diseases are on the rise in Africa,” said Dr Boureima Hama Sambo, WHO Representative for Ethiopia. “This ground-breaking new law will significantly reduce cigarette smoking among Ethiopians and save lives. It is a powerful example of how the government, civil society and WHO can work together to enact meaningful change.”

WHO has estimated that the tax increase would reduce the rate of cigarette smoking among adults by as much as 10%, and reduce the number of deaths attributable to smoking by around 91,000 people.  The increased tax on cigarettes will also increase cigarette tax revenues by as much as 81%, meaning an additional (ETB) 925 million (US$28.7 million) that can be spent on public health or education programmes.

Prior to the approval of this bill, cigarettes in Ethiopia were among the cheapest in the world, even in comparison to other African countries.  The share of total tax on the retail price of cigarettes was also very low in Ethiopia, averaging 33% in recent estimates, compared to the global average of 61%.  WHO estimated that this legislation will increase the tax share of the average retail price of cigarettes to around 54%.

Smoking poses serious health and economic challenges for Ethiopia.  The annual economic costs of smoking in Ethiopia are estimated to be around 1391 million Ethiopian Birr, or US$43.6 million, according to the most recent edition of the Tobacco Atlas.  Buying tobacco also denies families the resources they need to rise out of poverty. A smoker in Ethiopia would have to spend 11.70% of their average income (measured by per capita GDP) to purchase 10 of the most popular brand of cigarettes to smoke daily each year.

Passing this legislation was the result of coordinated advocacy by WHO that involved engaging civil society groups, the media, medical and professional associations, and government partners.  When the bill was first proposed to the Ethiopian Parliament in 2019, the specific additional rate on each packet of cigarettes was just five Ethiopian Birr (US$ 0.16), far below WHO’s recommended rate.  Sustained efforts by WHO and partner organisations during the public hearings that followed the initial adoption of the tax adjustment led to the final legislation reflecting WHO’s recommendations more fully.

WHO has also been working in partnership with the Ethiopian Ministry of Finance since the adoption for the Framework Convention on Tobacco Control in January 2014.  Following the high-level multi-country meeting on tobacco tax policies and tobacco control in Africa, which took place in Geneva in November 2019, a technical workshop on tobacco tax modelling was organised with representatives from Ethiopia.  WHO helped formulate tobacco tax policy options, conducted independent analysis of tobacco consumption and taxation patterns in Ethiopia, and later also helped to increase the capacity of tax experts in the Ministry of Finance through training, workshops and study tours.

 

Image Credits: WHO AFRO.

Ports of entry in the Democratic Republic of the Congo are now using temperature screening systems, created for detecting Ebola to screen travelers for COVID-19.

Experts were closely watching the development of Japan’s COVID-19 outbreak for signs of whether the virus might escape further out of control, moving closer to the tipping point of a pandemic – the worldwide spread of a new disease.

Meanwhile, a new study in The Lancet  found that in Africa, Egypt, Algeria and South Africa are at highest risk of new coronavirus cases. However, these countries also have the most prepared health systems and therefore  less vulnerable.

Countries at moderate risk, include Africa’s most populous nation, Nigeria, as well as Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya. Significantly, they are also less prepared and more vulnerable, and require further support to help them detect and handle imported cases of novel coronavirus disease 2019 (COVID-19).

Algeria, Ethiopia, South Africa, and Nigeria were also among 13 top priority at-risk countries identified by the World Health Organization (WHO), based on their direct links and volume of travel to China. The first case of COVID-19 in Africa was confirmed in Egypt last Friday, on 14 February 2020.

China is Africa’s leading commercial partner with over 200,000 Chinese workers in Africa, and high volumes of travel, through which the novel coronavirus could reach the continent.

Global distribution of COVID-19 cases, as recorded by Chinese national authorities 19 February at 3 p.m. CET.

In Asia, Japan Most Immediate Focus; Korea and Singapore Close Behind

Currently, however, Japan and Singapore remained the most immediate hotspots of concern, with 84 cases each of the novel coronavirus, the most outside of China itself. China had recorded 74,284 cases as of late Wednesday afternoon Central European Time, 1,756 more than the day before, while deaths now reached 2009. Globally, there were 1,017 confirmed cases, a worrisome rise of 220 more over the day before.

Japan has faced a gradual influx of cases brought about by considerable tourism and employment related travel to and from China. But it has also been forced to grapple with the cases of the 621 infected people identified aboard the Diamond Princess cruise ship that was under a strict quarantine in Yokahama harbour until Wednesday, when the first 600 passengers who had been given a clean bill of health, were finally allowed to disembark.  Others of the original 3700 passengers and crew remained aboard because their COVID-19 tests had been positive, though not serious enough for hospitalization. A number of countries, including Canada, Australia and Korea have announced mass evacuations of their stranded citizens, following on the US evacuation of 300 nationals earlier this week.

Rather than containing infection, the quarantined ship may have proved to be an incubator for the spread of the virus, many experts now fear.  A prominent Japanese specialist, Kentaro Iwata, who boarded the ship on Tuesday slammed the infection control measures on board the ship as “completely inadquate.”  In a video posted on You Tube, but later removed, Iwata was quoted describing the ship environment “chaotic” with no distinction between infected and uninfected zones, and no infection control officials in charge, National Public Radio reported.

Former FDA commissioner Scott Gottlieb told CNBC that Japan seems to be “on the cusp of a large outbreak,” while Syra Madad, another public health expert, was quoted, saying “We’re really closing in on the tipping of this being declared a pandemic.”

Meanwhile Korea, which had 51 reported cases as of Wednesday afternoon, the third highest outside of China, announced a host of stringent infection control measures, for schools, businesses and public places following a meeting of top health officials, which was presided by the prime minister.

Those include: mass distribution of masks; as well as stepped up COVID-19 testing in hospitals. It has issued travel warnings against visiting China’s high-burden COVID-19 provinces, and instituted a mandated screening of all inbound travellers, including installation of a self-diagnosis and locational app on their cell phones.

Chinese employees returning from China following the Lunar New Year, will be required to spend two weeks in self-isolation, prior to returning to work as will a group of Koreans evacuated from the Diamond Princess, the announcement by the Korean Ministry of Health and Welfare also noted.

In Cambodia, meanwhile, Cambodian health officials, supported by WHO and the US Centres for Disease Control (CDC), were now scrambling to put in place a series of measures to contain transmission risks, after another cruise ship, the Westerdam, was allowed to dock in Sihanoukville last week and release its 1,455 passengers and 802 crew with far less scrutiny than the Diamond Princess.  However, shortly after disembarking, one 83 year old passenger was found to be infected with the virus upon her arrival in Malaysia.

In a press release late Wednesday evening, WHO said that in response to the confirmed case, the Cambodian Ministry of Health had convened an emergency working group, which decided to undertake COVID-19 laboratory screens for all former passengers still in Cambodia, and “health screening” of passengers still in Phnom Penh or Sihanoukville.   WHO also called on all of the 1455 former cruise passengers, who have now scattered widely, to practice “self-monitoring” and report any possible symptoms to their local health authority along with their travel history.

The WHO announcement reflected a wave of growing concern among global public health experts about the way in which the Westerdam’s passengers disembarked and scattered so quickly, without a rigorous screening for the virus, measures diametrically opposed to the tactics used on the quarantined Diamond Princess, however controversial.

“WHO’s strategy is still to contain the outbreak in China and try to make sure there is no sustained transmisison in other countries,” Eyal Leshem, head of the Center for Travel and Tropical Medicine at Sheba Medical Center in Israel, and a former medical epidemiologist with US CDC, told Health Policy Watch.  “The strategy mandates contact tracing and quarantine of contacts. Based on traditional public health principles, contact tracing and isolation, if you take 1400 people that have been potentially exposed, and you discharge them without creating a full quarantine, you potentially spread this disease to everywhere they go.”

African preparedness still creates huge risks for continent

In terms of Africa, another major at-risk region, only one case has so far been confirmed in Egypt.  However, weak health systems, combined with the sheer volumes of traffic between the continent and China, leave the continent extremely vulnerable should the virus make a beachhead, the Lancet study notes.

According to the China Africa Research Initiative (CARI), there were 202,689 Chinese workers in Africa by end of 2017, concentrated primarily in Angola, Algeria, Nigeria, Ethiopia and Zambia. Most of the Chinese investments in Africa go to Nigeria and Angola, according to Brooklings.

The Lancet study estimated the risk of African countries importing a COVID-19 case from China using data on the volume of air travel from infected Chinese provinces to Africa and the proportion of COVID-19 cases in the Chinese provinces as of 11 February 2020. Hubei province was not included, given the travel ban introduced by Chinese authorities on travel to and from the province on 23 January.

Maps showing (left) importation risk by country, (top right) country capacity to respond to risk, and (bottom right) Infectious Disease Vulnerability Index

The study notes that some measures to prevent the importation of COVID-19 cases from China, and contain transmission when and if infected people arrive, have already been implemented in many African countries.

However, more technical and operational expertise is required to carry out a full suite of measures that would be  required, including: heightened surveillance, rapid identification of suspected cases, patient transfer and isolation, rapid diagnosis, contact tracing, and follow-up of potential contacts.

“African countries have recently strengthened their preparedness to manage importations of COVID-19 cases, including airport surveillance, temperature screening at ports of entry, recommendations to avoid travel to China, and improved health information provided to health professionals and the general public. However, some countries remain ill-equipped,” said study author Dr Vittoria Colizza, of Inserm, Sorbonne Université, France in a press release.

But, “while almost three-quarters of all African countries have an influenza pandemic preparedness plan, most are outdated and considered inadequate to deal with a global pandemic. In addition, despite efforts to improve diagnostic capacity from WHO, some countries do not have the resources to test for the virus rapidly, meaning that tests would need to be done in other countries,” she added, noting:

“It is essential to train, equip, and strengthen the diagnostic capacities of hospital laboratories close to infectious disease and emergency departments to reduce the time to deliver results, manage confirmed cases and contacts more rapidly, and preserve strict infection control measures. Equally, increasing the number of available beds and supplies in resource-limited countries is crucial in preparation for possible local transmission following importation.”

More Countries Screen but Few Limit Travel Outright

As a result of the risks, pressure has been mounting in some African states to enact stricter limitations on travel to China, as well as on arrivals coming from the Asian nation.

While some countries have indeed issued travel advisories, and some major African airlines have suspended flights to mainland China, most countries have left the doors open.

On Jan. 31, Nigeria – Africa’s most populous nation, sent a powerful signal when Alhaji Lai Mohammed, the Minister for Information and Culture told journalists that Nigeria would not impose travel restrictions.

“We know it’s difficult to ban people from travelling,” Mohammed was quoted in The Guardian, a local Nigerian Daily as saying. “Another thing is that this is not stigmatise people who come from there.”

Despite the inherent risks, open doors policies have been generally supported by Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director General, who has spoken out repeatedly against travel restrictions, both to the media as well as at the outset of the WHO Executive Board meeting in Geneva in early February, saying “there is no reason for measures that unnecessarily interfere with travel or trade.”

His advice clearly echoed among African health policymakers as well, among them Chikwe Ihekweazu, director general of Nigeria’s Centre for Disease Control, who tweeted, “I completely agree with the decision of the #Nigerian Govt. not to ban travel to China. As @DrTedros said, travel restrictions cause more harm than good by hindering info-sharing for public heatlh action, medical supply chains etc & have no obvious benefit.”

Observers have said that with such intertwined economic ties, most African countries simply cannot afford to be more restrictive about travel, regardless of the diverse public health and ethical issues involved.

“What is going on in China clearly shows that it is beyond a health issue. It is an economic threat to china and the world, it’s a security threat to China and the world, and it’s a social threat to China and the world,” said John Nkengasong,  director of the African Centre for Disease Control and Prevention in Addis Ababa, in an African Union news briefing in late January.

Instead of closing borders and limiting travel, countries have focused on ramping up early detection and screening measures at ports of entry, said Michael Yao, head of emergencies for the WHO Africa region, in a press briefing last week.

“What we are emphasizing to all countries is that at least they have early detection because we know how fragile the health system in the African continent is. and these systems are already overwhelmed by many ongoing disease outbreaks,” he said.

It is “critical” for cases to be detected early to “prevent spread within communities” which can trigger an influx of cases that would “easily overwhelm the treatment capacity,” added Yao. Severe cases of the new disease must be treated in intensive care units with respiratory equipment, facilities which are extremely limited in African clinics and hospitals.

 

Image Credits: Twitter: @MoetiTshidi, Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study.

Boys play on a beach in Kiribati, an island nation threatened by rising sea levels.

Ecological degradation, climate change, and exploitative marketing practices are the greatest emerging threats to children’s health, says a new report from a WHO-UNICEF-Lancet Commission on the future of child health.

Despite dramatic improvements in survival, education and nutrition for children over the past five decades, the report, titled A Future for the World’s Children?, found that today’s youth face an “uncertain future.”

“Progress [in child and adolescent health] has stalled, and is set to reverse,” said former prime minister of New Zealand and Co-chair of the Commission, Helen Clark, in a press release.

“It has been estimated that around 250 million children under five years old in low- and middle-income countries are at risk of not reaching their developmental potential, based on proxy measures of stunting and poverty. But of even greater concern, every child worldwide now faces existential threats from climate change and commercial pressures.”

The report finds that economic inequalities persist in countries across the board, affecting the ability of indigenous and marginalized children to thrive. Commercial practices push heavily processed foods, sugary drinks, alcohol and tobacco at youth, contributing to a “double burden” of over and undernutrition. And climate disruption is creating “extreme risks” to children from rising sea levels, extreme weather events, water and food insecurity, heat stress, infectious diseases, and large-scale migration.

According to the report, children are particularly vulnerable because they often lack a voice in policy and health governance, relying instead on parents, governments, and local and global leaders to act in their best interest. Yet a global movement led by youth climate activists such as Sweden’s Greta Thunberg and India’s Licypriya Kangujam has caught the attention of leaders around the world – and allowed children to insert a voice in policymaking. However, global frameworks for promoting and monitoring progress in such matters and in child health are still insufficient.

The Commission compared measures in child education, survival, nutrition, and health across 180 countries to rank countries by “child flourishing”- a concept that aims to represent a holistic view of child health. The report also measured sustainability by using a proxy for greenhouse gas emissions, and equity along with income gaps in order to measure future threats to child health.

Based on the child flourishing index, children in high-income countries such as Norway, South Korea, and the Netherlands had the best chance of surviving and thriving, while children in Sub-Saharan Africa and the Sahel faced the worst odds. However, high-income countries also represented the bulk of the world’s emitters, contributing disproportionately to future threats for children’s health. When ranked by CO2 emissions, Norway fell to 156, South Korea to 166, and the Netherlands to 160. The United States, Australia, and Saudi Arabia represented the highest emitters by volume.

“We all know from the science that the carbon budget is giving us at most ten years before we exceed 1.5 degrees of warming and that was a target agreed by all countries at the Paris Agreement five years ago. We’re way off track, emissions are going up and the future for children we can see all around us already,” Anthony Costello, professor of Global Health and Sustainability at the University College London and lead co-author of the study, said at a press briefing.

Most urgently, the report finds that countries ranked lowest for child flourishing are contributing the least directly to the existential threat caused by climate change, but will likely be most susceptible to the impending ecological damage.

“While some of the poorest countries have among the lowest CO2 emissions, many are exposed to the harshest impacts of a rapidly changing climate,” said Awa Coll-Seck, health minister of Senegal and co-chair of the Commission. “More than 2 billion people live in countries where development is hampered by humanitarian crises, conflicts, and natural disasters, problems increasingly linked with climate change.”

A handful of small countries, however, seem to be on track for both child flourishing and sustainability – Albania, Armenia, Grenada, Jordan, Moldova, Sri Lanka, Tunisia, Uruguay, and Viet Nam all ranked within the top 70 for child flourishing, and are on track to beat their CO2 emission per capita targets by 2030.

“This report shows that the world’s decision makers are, too often, failing today’s children and youth: failing to protect their health, failing to protect their rights, and failing to protect their planet,” Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization said.

“This must be a wakeup call for countries to invest in child health and development, ensure their voices are heard, protect their rights, and build a future that is fit for children.”

Harmful Advertising Pushing Products Towards Children

Children are also vulnerable to increasing commercial marketing of highly processed junk food, sugary beverages, and alcohol and tobacco, the report stated.

According to the findings, children are “frequently” targets of advertisements for addictive and unhealthy foods – which can contribute to childhood obesity and poor nutrition. The report cited a review of 23 studies in Latin America that found advertising exposure was associated with a preference for and purchase of unhealthy and low-nutritional value foods by families and children who were overweight or obese.

Additionally, children are often exposed to advertising for products for adult use, such as alcohol, tobacco, and e-cigarettes. E-cigarette advertising is of specific concern to high-income countries such as the United States, where youth exposure to television e-cigarette advertisements increased by 256% between 2011 to 2013. There is even evidence of inequities in exposure to harmful marketing – one study cited by the report found that African-American and Hispanic youth in Los Angeles were exposed to twice as many alcohol advertisements per day as non-Hispanic white youth.

Advertisers are increasingly targeting children through social media marketing via smartphones and computers.

Another unknown threat is “the trend in social media advertising and algorithm targeting,” said Costello, who added he was “rather horrified” to learn that many search engines and social media websites operate by selling consumer data, including data generated by children’s profiles, according to a report released by the Norwegian Consumer Council in 2019.

“This is totally unregulated, unlike TV and the other forms of media. And we know that self-regulation doesn’t work.”

Solutions for the Future: Opportunities to Protect Child Health  

The report concludes with a series of recommendations for the global community to mitigate the threats to child health, including:

  1. Stopping CO2emissions with the utmost urgency, to ensure children have a future on this planet;
  2. Placing children and adolescents at the centre of efforts to achieve sustainable development;
  3. Promoting new policies and multisectoral action towards child health and rights;
  4. Incorporating children’s voices into policy decisions;
  5. Tighten national regulation of harmful commercial marketing, supported by a new Optional Protocol to the UN Convention on the Rights of the Child.

“Children are already advocating for the need for a shift in the governance structure and that they should be playing a greater role in driving the agenda,” said Jennifer Requejo, senior technical officer for the Partnership for Maternal, Newborn & Child Health.

“The opportunity is great. The evidence is available. The tools are at hand…It will take courage and commitment to deliver,” added Richard Horton, editor-in-chief of The Lancet family of journals. “It is the supreme test of our generation.”

Image Credits: WHO, A future for the world’s children? A WHO-UNICEF-Lancet Commission.

Checking temperatures at a Chinese supermarket in Wuhan in late January. Measures since have tightened even further.

Amidst reports of an even tougher crackdown in China, including door to door visits by Wuhan public health authorities to identify people infected with the novel COVID-19 coronavirus and place them in mass quarantine facilities, WHO’s Emergencies Head Mike Ryan defended the tough government measures at a press briefing on Tuesday.

“Door to door surveillance, going around and doing active surveillance, this is a very good public health measure,” Ryan said. “Right now, the strategic and the tactical approach in China is the correct one.”

He noted that a slow reduction in the number of cases in China had created space for public health authorities to take more active measures in the Wuhan, Hubei epicentre of the epidemic, as well as in other cities such as Beijing, where new rules require residents returning to the city to isolate themselves for 14 days.

“While they are getting the success in putting out one fire, they don’t want the first to start somewhere else,” he said. “Now, you can argue whether those measures are excessive or restrictive on people, but there is an awful lot at stake here in terms of public health, and in terms of not only the public health of China, but all of the peple in the world.”

As of 5 p.m. Tuesday Central European Time, China was reporting a total of 72,532 cases in China, and 1872 deaths, 1,888 more than the day before. Abroad, there were 897 cases and 3 deaths reported across 25 countries. Of the more than 200 new cases outside of China, 99 of them were concentrated on the Princess Diamond cruise ship moored in Japan’s Yokohama harbour, where a total of 542 of the ship’s original 3,600 passengers and crew have tested positive for the virus.

House To House Surveillance in Wuhan, China

In Wuhan, authorities tightened their grip even further on residents that have been under lockdown already for several weeks, seeking to round up and quarantine anyone with the infection, including people with mild cases.

The Wuhan Health Commission announced a system of “closed management” of all apartment blocks and neighborhoods in the city of 11 million people, with 24/7 surveillance, and even stricter controls on those allowed to exit than had been in place previously.

Chutian Daily, a Wuhan newspaper was cited saying that 10 new quarantine centres with 11,400 beds were being set up across the city for people showing mild symptoms of infection, identified through house to house surveillance. Anyone suspected of having the virus would face mandatory testing.

Outside of Wuhan, other communities in Hubei province were also being sealed off. placed under around-the-clock “closed-off” management, in effect putting them under lockdowns.  The actions came as a prominent Wuhan doctor, Liu Zhiming, had reportedly died from the virus on Tuesday at the age of 51.

While COVID-19 can be very mild for younger people, deaths such as that of Zhiming, illustrate the way that the virus can hit much harder at older people, even when they are presumably in good health.

“Clearly there has been an apparent drop in the fatality rate,” said Ryan, pointing to results from a newly published paper by China CDC reviewing some 44,672 cases in China.  The findings indicate a case fatality rate of about 2%, somewhat lower than the 3% fatality rate of the very first patients who fell ill in Wuhan in January.  About 80% of those infected have only mild symptoms and quickly recover, the paper also found, although others become severely ill.

“We need to be careful that sometimes this is projected as a mild disease,” Ryan said. “That is true, but there is a significant number of people, 20 percent of people, who get this are severely or critically ill.”

Notably, average hospitalization time for the severely ill has been about 20 days. “If you have lots and lots of people in hospital for a very long time, requiring intensive care, it requires takes a huge effort from the health system,” Ryan observed. “We must remember that there is an at-risk group which is 40-79 years and older, and they can have a very severe course of disease, and we must be aware of that, if the disease is imported to a third country….”

Strengthening Weaker Health Systems

To that end, WHO has continued its efforts to bolster the preparedness of weaker health systems for the potential arrival of the virus, said WHO Director General Dr Tedros Adhanom Ghebreyesus, also speaking at the press briefing. “By the end of this week, some 40 African countries and 29 countries in the Americas will have the ability to detect COVID-19,” he said.

“Many of these countries have been sending samples to other countries for testing, waiting several days for results. Now they can do it themselves, within 24 to 48 hours.

“DRC is leveraging the capacity they have built to test for Ebola to test for COVID 19,” he said, noting it as a “great example” of how health system strengthening generates knock-on benefits. “Namibia, Timor Leste and Nigeria are running workshops and workshops with the media.”

A number of Asian and African countries have also stepped up their monitoring at ports of entry, including Bangladesh, Cambodia, Ethiopia, Pakistan, and South Sudan, Dr Tedros added.

And WHO has recently released new guidance related to management of ill travellers at international points of entry as well as interim guidance on planning and preparing for mass gatherings, in the context of the COVID-19 emergency.

Ryan confirmed that WHO was also in the process of shuttling supplies to test for the virus to DPR Korea, as well as meeting with North Korean officials in Geneva’s mission on risks the country might face due to its close ties with China. So far no cases have been reported in the country, however, he added.

China API Shortages May Boost Indian Drug Prices

Meanwhile pharma observers were nervously eying the crisis in terms of potential interruptions it might create in the Chinese supply of active principle ingredients (APIs), to the global drug market.

Reportedly, Chinese firms supply some 80-90% of the world’s APIs for basic drugs such as antibiotics, which undergo final manufacture as patented or generic drugs elsewhere.

While India’s pharma industry may be able to ramp up capacity to cover some of the shortfalls, India also procures almost 70% of its APIs from China, including for many generic drug formulations which help keep the world’s drug prices low.

Many suppliers had stocked up on API’s ahead of the Chinese Lunar New Year, so the shortages may not be felt immediately.

However, Daara Patel, secretary general of the Indian Drug Manufacturers Association, which represents over 900 of the country’s drug producers,  told Reuters that he could project supply disruptions beginning in April, if the crisis continues.   He said that antibiotics would likely be among the hardest hit as India is a major global generics producer.

Other international pharma companies are also watching the situation with concern.

However,  Thomas Cueni, head of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which represents most of the large patent drug producers said that currently the epidemic was not expected to create the same level of  interruptions in the patent drug market.

“Generic companies operate on tight margins, with often with procurement based on the lowest price, this does put pressure on companies for treatments such as antibiotics,” Cueni said.

“As a rule, the innovative pharmaceutical industry have tried and tested business continuity plans with alternative suppliers.…At this moment, the novel coronavirus outbreak isn’t causing problems for innovative medicines supply.

“The companies are continuously monitoring and proactively handling the situation as it’s developing and do not expect any long-term impact on the availability of medicines and vaccines, unless disruption due to the novel coronavirus outbreak is sustained over the next several months.  That being said, we (IFPMA and its innovative pharma member companies) are far from complacent and are monitoring the coronavirus situation in China closely.

“R&D biopharmaceutical companies are working to prevent and mitigate potential shortages through close coordination with national regulatory authorities and other global stakeholders, including the World Health Organization.”

 

Image Credits: Wikimedia Commons: Painjet.

Rush hour traffic in Ho Chi Minh City, one of the cities supported by Bloomberg Philanthropy’s Global Road Safety Partnership

Bloomberg Philanthropies announced a six-year US $240 million commitment to prevent road traffic injuries in low- and middle-income countries on Tuesday, just a day ahead of the Global Ministerial Conference on Road Safety in Stockholm, Sweden. The new commitment aims to fund efforts to prevent 22 million injuries and save 600,000 lives from road traffic accidents.

“The price we are paying for our mobility is unacceptable. We need to do much more to save lives on our roads. This new investment is excellent news that comes at a critical time when world leaders convene to decide on achieving a 50% reduction in road traffic deaths by 2030,” said Etienne Krug, director of the Department of Social Determinants of Health at the World Health Organization in a press release.

The announcement comes just a day before 1700 delegates – including over 80 country delegations led by Ministers of Transport and Health – plan to meet in Stockholm for a two-day forum co-sponsored by WHO on road traffic safety. The attendees will set global priorities for road traffic safety for the next decade and review lessons learned from the Global Plan for the Decade of Action for Road Safety 2011–2020.

Road traffic injuries are the number one killer of people ages 5-29. More than 1.35 million people die and up to 50 million are seriously injured in road traffic crashes each year. Some 15 countries account for 60% of all road traffic deaths globally.

“We should keep in mind that these deaths and injuries are completely preventable. After more than a decade of working with our international and in-country partners, we know which policies and interventions are saving lives,” said Kelly Henning, director of Public Health at Bloomberg Philanthropies.

The investment will help support implementation and enforcement of a package of “best-practice” interventions in up to 30 cities and 15 countries most impacted by the global road safety crisis:

  • Help governments regulate vehicle safety standards and raise consumer awareness to demand safer cars that meet the UN safety recommendations;
  • Reduce deaths on high-mortality roads such as interstate highways, through reduced speed limits, wider use of helmets and seatbelts, and reducing speeding and drunk driving;
  • Improve and enhance the collection of road crash data to more accurately capture fatalities and injuries, monitor the impact of policies, and prioritize interventions;
  • Launch the “Awards for Outstanding Excellence in Road Safety” to highlight countries and cities that have made progress in road traffic safety.

The new commitment builds on 12 years of previous investments by the foundation, which have resulted in at least 10 countries changing laws or policies to improve road safety.

Image Credits: Flickr/ M M.

The Diamond Princess, docked in Yokohama, Japan, now has a total of 454 cases, the largest case load outside of mainland China.

The rise in new cases of COVID-19 seemed to be slowing in mainland China, but concerns remain about local transmission in cities abroad such as Hong Kong, Singapore, and Japan, and on cruise ships.

China has confirmed 70644 cases and 1772 deaths as of 5 p.m. Central European Time, representing an increase of 2060 cases in the last 24 hours, according to the latest Chinese data. This comes even after the Chinese health authorities expanded diagnostic criteria to count “clinically confirmed” cases on top of lab-confirmed cases, the rate of new infections appears to have slowed.

However, “this trend must be interpreted very cautiously,” WHO Director General Dr Tedros Adhanom Ghebreyesus told reporters at a press briefing Monday. “It is too early to tell if this reported decline will continue.”

The slow, but steady growth in cases outside of China, however, particularly in Singapore and Japan, has also been a cause for concern among public health experts closely watching the epidemic unfold.  A total of 694 cases in 25 countries have been reported, along with three deaths.

Of particular note is yet another huge spike in the number of infections on the quarantined cruise ship, the Diamond Princess, to 454 confirmed cases as of Monday evening, which now represents the largest cluster of cases outside China. Some 189 passengers were classified as “asymptomatic carriers,” according to a statement from Japan’s Ministry of Health. The ship has been docked in Japan’s Yokohama port since 3 February.  Many of the original 3,600 passengers remain under a two-week quarantine while the Japanese government tests every one on the ship.  Some 1,723 have been tested so far. Those found to be infected with the virus, elderly people and those with other medical conditions have been allowed to disembark and complete their quarantine period in special facilities on shore.  Most of the 400 Americans on board the ship were evacuated earlier this morning, although they will they will have to undergo another two weeks of quarantine in the United States.

The strict measures being enacted for passengers on the Diamond Princess were not repeated for the Westerdam, a cruise ship that was finally allowed to dock in Cambodia last week after being stranded at sea for two weeks. Once clearing temperature and health checks, passengers were allowed to continue on their travel itineraries. However, one COVID-19 case was confirmed in a passenger after she had already disembarked and traveled to Malaysia.

Two more former Westerdam passengers, were, however, suspected of being ill are awaiting lab results for the virus after traveling to Singapore. Some 255 guests and 747 crew members are still waiting aboard the ship to complete further health checks.

Holland America, the owner of the Westerdam, said in a statement that no passengers had elevated temperatures upon disembarking. The 20 individuals who reported to the ship’s medical center also later tested negative for COVID-19.

The drastically different treatment of the passengers on the Westerdam and Diamond Princess highlight the very different national policies governing public health responses to contain the spread of the virus, as well as the different circumstances involving each ship. WHO’s Director General Dr Tedros Adhanom Ghebreyesus last week strenuously urged the government of Cambodia to allow the cruise ship to dock.  In the aftermath, he has not commented on the discovery of cases aboard the second ship, or on the very different procedures undertaken by Cambodia to screen and disembark passengers, as compared to Japan.  The Westerdam, which departed Hong Kong on 1 February had not identified any cases aboard while at sea, although the incubation period of the virus is believed to average 14 days.

“Measures should be taken proportional to the situation… Blanket measures may not help,” said Dr Tedros, in a press briefing today. “”There is no zero risk…[every action] has to be proportional to the situation.”

Number of COVID-19 cases worldwide, collected by Dingxiangyuan, which tracks national and sub-national press releases from health authorities.

Will COVID-19 Become a Pandemic?

Experts are worried that, despite the decline in new cases on mainland China, there may be potential for further spread, leading to some questioning whether it was time to label the outbreak a “pandemic” – or a global outbreak where every citizen could be infected.

The media frenzy around the outbreak has also been whipped up by published and pre-print studies estimating that the current number of infections is much higher than reported due to a high number of asymptomatic and mild cases, with some estimates in the range of 75,000 thousand infections in Wuhan alone. A WHO advisor, Ira Longini from the University of Florida, was quoted by Bloomberg News as projecting that up to two-thirds of the world’s population could be afflicted by COVID-19 if current measures to contain the virus’ spread are unsuccessful.

However, WHO scientists are cautious about using the “p” word, for fear of inducing widespread panic.

“For the general public, I think [pandemic] means the worst-case scenario. We need to be cautious… because it can create panic unnecessarily,” said WHO’s Sylvie Briand in Monday’s press briefing.

Added Mike Ryan, WHO’s head of Emergencies, “We have said that the risk for regional and global spread is high – that is not high of a pandemic, it’s high for further spread.

“We need to be careful not to drive fear in the world right now.”

On the WHO advisor’s prediction that the majority of the world could get infected by COVID-19, Ryan added that, “all predictions are important. But most predictions are wrong.”

Image Credits: Flickr/ Yoshikazu TAKADA, ncov.dxy.cn.

Nina Renshaw, Saman Zia-Zarifi, Luisa Cabal, Mariangela Simão, and Gian Luca Burci speak at Health and Law panel, moderated by Lawrence Gostin.

The International Health Regulations are in need of reform, experts say – to create a more nuanced system of alerting the public about international health emergencies that goes beyond the existing yes-no decision, and to improve compliance to IHR laws by member states during such outbreaks.

A high level panel of experts reviewed key concerns and possible solutions last week at the Geneva launch of the Legal Determinants of Health – The Lancet Commission, Global Health & the Law Report – hosted by UNAIDS on the margins of WHO’s Executive Board meeting.

The report, first published in 2019 at the height of the Democratic Republic of Congo’s Ebola outbreak, noted that implementation of the IHR, which is a binding legal convention between WHO member states, has been “plagued by incomplete state compliance”.

The issues surrounding the IHR’s use and compliance have received further attention within the public health community during the present coronavirus emergency (COVID-19)– where declaration of a Public Health Emergency of International Concern (PHEIC) was delayed because the dimensions of the crisis were initially unclear.

When an Emergency was finally declared on 30 January WHO Director General Dr Tedros Adhanom Ghebreyesus said at the time that “along with a red and a green light” the system needed a “yellow light” so that health systems could begin to prepare even before a full-blown international crisis had emerged.

The Lancet report on “harnessing law for global health and sustainable development” lays out a broader framework for why global health law is relevant to public health professionals.

The report shines light on certain systemic weaknesses of existing legal instruments, and argues that non-state actors could potentially drive change in reforming and ensuring stronger legal frameworks. The authors describe four legal “determinants of health” that they argue most fundamentally influence health and equity. And they recommend a slew of strategies that could make legal frameworks a more central imperative in the governance of global public health.

The “Legal Determinants of Health” & Recommendations for Action

The report lists four “legal determinants” of health that can “demonstrate the power of law to address the underlying social and economic causes of injury and disease.” These determinants also highlight areas of law where lawmakers can successfully intervene to improve health as follows:

  • SDG vision to action – Law can translate vision into action with respect to Sustainable Development Goals, in particular in laying the foundations for Universal Health Coverage. International institutions can set standards and support implementation and for national governments to create rights-based legal frameworks.
  • Strengthened governance – Law can strengthen the governance of national and global health institutions. These institutions, both at international and national levels, can used law to improve governance and safeguard public health and safety. (The report also notes that “domestic and international law are inter-related and bidirectional in their impact on health and justice)
  • Evidence-based health interventions – Law can be used to implement fair and evidence-based health interventions, drawing from examples of cases from communicable and non-communicable diseases and injuries. The report suggests WHO can increase legal capacity to spearhead the development of a global evidence-base for public health.
  • National legal capacity  – National governments must build legal capacities to enact and effectively implement public health laws. On a global level, the report recommends that WHO create  an independent standing commission on global health law.

On Reforming the IHR

The panel in Geneva largely agreed that the IHR, which has its origins in the International Sanitary Regulations first adopted in 1851 to standardize quarantine measures for cholera, plague and yellow fever, needs another revision, especially in the light of the COVID-19 outbreak.

On the other side of the WHO campus, meanwhile, senior officials had just informed the Executive Board that WHO would convene experts to work on an intermediate level of alert, to integrate more nuance into the current binary system that governs “yes or no” declarations of a Public Health Emergency of International Concern (PHEIC).

Speaking at the event, Gian Luca Burci, adjunct professor at the Graduate Institute, former WHO legal counsel, and one of the co-authors of the Lancet report, said that in exploring the gaps and weaknesses in the IHR, there is a need to look at the “design and politics” behind the law, not only how the existing law is being implemented.

The latest version of the IHR, adopted by WHO member states in 2005, served to codify much of what was already existing WHO practice for emergency response and management. However, a number of political compromises as well as assumptions were built into the design of the instrument, including the “assumptions that governments will act transparently, in good faith and in a spirit of solidarity. “Now these assumptions are getting tested. We do see instances of excesses and stigmatizing that result during outbreaks,” he said.

He recounted that the last version of the IHR, adopted in 2005, was also revised within a very short period of time between January 2004 to May 2005, in the aftermath of the outbreak of Severe Acute Respiratory Syndrome (SARS).

“This may explain some of the flaws we are witnessing, and perhaps there is a need to take a step back and rethink the design of the IHR with an open mind,” said Burci.

There are two approaches on reforming the IHR, Burci said. “One is to say that let’s not touch the text and try to improve its implementation. As a result we have seen the emergence of the global health security agenda and efforts at voluntary evaluations conducted outside the IHR framework.

“The second approach, which I consider more useful, is that we have a binding legal instrument, and if there is a flaw, may be there should a good faith attempt to sit back and find out how to change it. Sometimes, there is a need to amend the law, changing the assumptions, especially if proposals for new measures are inconsistent with the clear letter of the instrument as in the case of the binary approach to alert,” he explained.

However, Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University and a lead author on the report, expressed concerns that in light of current global trends, reopening the IHR’s formal texts could risk weakening the text, giving greater leeway for decisions driven by populist governments and sentiments rather than evidence.

For instance, the IHR was meant to be seen as an instrument to balance human rights and public health objectives, he said. At the same time, in the current COVID-19 crisis, WHO has been “looking the other way,” even as China had restricted movement in affected areas.

On the politics of dealing with an outbreak, Burci said, “There are a number of variables that explain how states respond to a crisis of this magnitude. There are cultural, political, domestic and other factors that shape responses.

“Major crises are political events and governments do not simply respond by looking at epidemiological evidence”. Locking down an area, for example, may slow down the spread of the disease but may also create hardship for the affected population which encourages people to escape – the exact opposite of what is needed, he added.

A number of speakers underscored the importance of considering the principle of ‘proportionality’ based on rational evidence while evaluating states’ responses during an outbreak. The panel referred to the non-binding Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights (ICCPR) 1985 that asks states to strike a balance between protecting liberties and securing population health.

Lessons from Tobacco Control for Alcohol

Along with a consideration of the IHR’s legal frameworks, the Geneva panel discussion also discussed the potential role of law in responding to other public health challenges, including: tobacco control; the harmful use of alcohol; access to medicines; and the discrimination of marginalised people.

Despite uneven compliance with WHO’s Framework Convention on Tobacco Control (FCTC), the Lancet report credits the FCTC as having had a substantial impact in the uptake by many countries of legal measures that advance: smoking bans and marketing restrictions, such as pictorial warnings on packages, among others. Experts believe that lessons from tobacco control could be applied to other public health challenges.

Nina Renshaw, director of Policy and Advocacy at the NCD Alliance, said that political leaders were nonetheless reluctant to go beyond tobacco and craft laws that might curb the harmful use of alcohol and unhealthy foods that are the cause of many noncommunicable diseases, and were pushing instead for voluntary commitments. However, ultimately fighting NCDs requires legislation upstream of food and beverage industries, she asserted. “There need to be legal underpinnings to follow up on this,” she said.

“There is a desperate need for legally binding measures to address alcohol related death,”, she said, speaking even as countries attending the WHO Executive Board huddled not far away, to reach agreement on a new global action plan to address the harmful use of alcohol. Renshaw also advocated greater use of fiscal measures, e.g. excise duties or taxation, to both reduce harmful alcohol consumption and to increase public revenues to promote health.

Legal and regulatory interventions to prevent non-communicable diseases can promote “small changes across entire populations for a mass impact”, observes the Lancet report, noting that “law has the power to facilitate profound changes in behaviour.”

ACCESS TO MEDICINES

Speaking on the use of law for improving the access to medicines, Mariângela Simão, assistant director-general of Access to Medicines and Health Products at WHO, said, affordability is partly patent-related, but also emphasized on the importance of a legal framework to govern transparent procurement and pricing negotiations.

Simão said, “access to medicines is an excellent proxy for the right to health.” The situation in China also shows that in a globalised world no country is alone, she said referring to the current outbreak. The access to safe, quality drugs is important, including access to active pharmaceutical ingredients, she added.

To improve access to medicines and technologies, the Lancet report suggests “regulatory frameworks need to be reformed, or made more flexible to support development, deployment of effective therapeutic countermeasures. Legal obstacles to the effective deployment of counter-measures should be addressed and resolved in advance of future pandemics.”

Improving Legal Capacities

Overall, the Lancet report calls for building disciplinary bridges in order to build legal capacities by getting legal and medical professionals together. It also noted the contribution of effective health diplomacy in complex negotiations that resulted in the FCTC, the IHR or the PIP Framework.

But experts at the event, also noted that in reality, member states are not often keen on doing the hard legal work implicit in promulgating new laws, partly due to uneven their legal capacity. “We cannot cut and paste legal solutions from one country to another,” a senior WHO official present at the event cautioned.

The IHR, and its application, is to be the focus of another public lunchtime session this Wednesday, at the Geneva Graduate Institute – The global governance of outbreaks: from Ebola to the novel Coronavirus.

 

Priti Patnaik is an independent Geneva-based journalist and researcher.

[Press Information Bureau, Government of India]

In light of the threats to human health and biodiversity due to climate

and pollution, India marks the beginning of the “super year of Biodiversity” with the hosting of the 13th Conference of Parties (COP) of the Convention on the Conservation of Migratory Species of Wild Animals (CMS), an environmental treaty under the aegis of United Nations Environment Programme, from 17th to 22nd February 2020 at Gandhinagar in Gujarat.

Shri Prakash Javadekar (left) and Sveinung Rotevan (right)

Addressing a press conference, Union Environment Minister Shri Prakash Javadekar said that the year 2020 is a super year of Environment and will set the tone and tenor for the decade ahead. Highlighting the urgent nature of global environment issues including marine plastic litter, plastic pollution and microplastics, the Union minister said the issues cannot be solved by any one country alone.

On the side-lines of the COP, the Union Minister met a delegation led by Norwegian Minister of Climate and Environment, H.E. Mr. Sveinung Rotevan. India and Norway today agreed to jointly tackle concerns related to oceans, environment and climate matters.

The text of the Joint statement is as follows:

India – Norway Joint Statement on Climate and Environment

  1. Meeting at the beginning of the ‘2020 Super Year’ for the environment, the Ministers stressed that they will do their share to ensure that the 2020s will be a decade of rapid action on climate and environment.
  2. The two sides expressed interest to continue and strengthen the mutually beneficial cooperation on environment and climate between the two countries, including on ocean affairs.
  3. Actions that target climate change and air pollution at the same time pose a win-win situation. The two sides recognized that such actions should be stepped up, and agreed to work together to raise this agenda.
  4. The Ministers recognized that the Kigali Amendment to the Montreal Protocol for phasing down use of Hydrofluorocarbons (HFCs) could prevent up to 0.40C of warming by end of the century, Further, noting that universal ratification of Kigali Amendment to the Montreal Protocol shall allow realization of its full potential.
  5. The Ministers noted the results of the projects supported by Norway on issues / aspects related with phase down of HFCs. It was agreed to continue such projects for facilitating a smooth transition towards energy efficient solutions and technologies while phasing down HFCs.
  6. If managed properly, the ocean holds the key to meeting many of the Sustainable Development Goals. Integrated ocean management is central to achieving a sustainable blue economy. In 2019 Prime Minister Modi and Prime Minister Solberg welcomed the signing of the MoU on India-Norway Ocean Dialogue and the establishment of the Joint Task Force on Blue Economy for Sustainable Development. The two Ministers were pleased with the progress that has been made under this MoU, including the establishment of the Marine Pollution Initiative. They were particularly satisfied that Norway and India will sign a Letter of Intent on integrated ocean management including sustainable Blue Economy initiatives.
  7. The Ministers also noted the importance of delivering concrete, scalable solutions for ocean health and wealth at the UN Ocean Conference in Lisbon on June 2020.
  8. The Ministers further noted the importance of sustainable management of chemicals and waste and welcomed the cooperation between India and Norway on the implementation of the Stockholm Convention on Persistent Organic Pollutants and on the minimisation of discharge of marine litter.
  9. The Ministers emphasized a shared understanding of the global and urgent nature of marine plastic litter and microplastics and underlined that this issue cannot be solved by any one country alone. They are committed to supporting global action to address plastic pollution and exploring the feasibility of establishing a new global agreement on plastic pollution.
  10. The Ministers agreed to support and work together with other political leaders to prompt a global and effective response to curb the direct and indirect drivers of biodiversity loss. They agreed to work together to deliver an ambitious, strong, practical and effective global biodiversity framework at COP15 of CBD to be held in Kunming, China, in 2020.
  11. The Ministers further discussed the conservation of migratory species of wild animals. The Ministers recognized the importance of integrating ecological connectivity into the post-2020 global biodiversity framework.
  12. The Ministers stressed that international supply chains and finance must de-invest from deforestation and destruction of nature and invest in companies and projects that improve smallholder livelihoods while promoting sustainable production and consumption. They agreed to continue the discussion on forests and deforestation free supply chains.
  13. The Ministers stressed that the fifth United Nations Environment Assembly of the United Nations Environment Programme offers a good opportunity to call for greater international action on several environmental issues, in particular strengthening action for nature to achieve the Sustainable Development Goals.
  14. Minister Rotevan thanked Minister Javadekar for the great hospitality extended to him and his delegation during the visit. He invited Minister Javadekar to visit Norway and the Arctic, to further strengthen the collaboration between India and Norway on climate and environment.
  15. Norway and India will explore areas of cooperation in forestry and linking the same with climate change

The Opening Ceremony and Plenary session of the COP will take place on 17th February followed by Side Events and Working Group meetings till the Closing Ceremony on 22nd February. Prime Minister Narendra Modi will inaugurate the COP 13 via video conferencing. Numerous national and international organizations will showcase best practices in wildlife conservation during the course of the conference.

As the host, India shall be designated as the Presidency during the intersessional period following the meeting. The COP Presidency is tasked to provide political leadership and facilitate positive outcomes that further advance the objectives of the Convention, including steering efforts towards implementing the Resolutions and Decisions adopted by the Conference of Parties.

Migratory species of wild animals move from one habitat to another during different times of the year, due to various factors such as food, sunlight, temperature, climate, etc. The movement between habitats, can sometimes exceed thousands of kilometers/miles for some migratory birds and mammals. A migratory route will typically have nesting sites, breeding sites, availability of preferred food and requires the availability of suitable habitat before and after each migration.

India is home to several migratory species of wildlife including snow leopard, Amur falcons, bar headed Geese, black necked cranes, marine turtles, dugongs, humpbacked whales, etc.

Image Credits: Press Information Bureau Government of India.

Subway riders in Singapore, some do and some don’t wear masks.

SINGAPORE – Last Saturday, a day after Singapore raised its disease outbreak response alert for COVID-19 from yellow to orange as the first cases of local transmission of the virus were confirmed, supermarkets found themselves besieged by customers piling carts full of instant noodles, rice and toilet paper, among other essentials.

“As there are now a few local cases without any links to previous cases or travel history to China, we have stepped up our risk assessment from DORSCON Yellow to DORSCON Orange,” stated the Ministry of Health announcement, referring to its sophisticated disease outbreak alert system, which includes four public health preparedness levels – from green to the highest level of red.

“What if it gets worse?” said the more fearful, a succinct verbal summary of the Singaporean concept of “kiasi”— a self-deprecatory, half-joking, self-assigned, stereotypical response that literally translates to “scared to die”.

But, as suddenly as panic buying spiked, it vanished almost overnight.

“Was at the largest NTUC Fairprice [supermarket chain] in my estate – and happy to report that the ‘zombie-apocalypse’ crowd is gone,” observed one Singaporean cheerily on her Facebook page, on Sunday afternoon.

Local memes poking fun at the panic buyers and the more creatively-masked commuters and consumers made their rounds on social media, even as hand sanitiser and surgical masks flew off shelves and hours-long queues formed at retailers that still had items in stock.

In all available communication outlets, government ministers repeatedly assured the public that the country had more than sufficient “national stockpiles” of essential items, one of many responses in a steady stream of public announcements about both emerging details of the virus and appropriate behaviour.

The government has also had to reckon with rampant misinformation spreading by social media in one of the most connected, device-loving nations in the world, this week having to dispel rumours of emerging evidence that COVID-19 was “”airborne”.  In fact it is transmitted by droplets, which can be transmitted to others by coughing, sneezing or heavy breathing, or by touching a contaminated surface, but not merely as viruses hurtling through the air on their own.

Yellow is the same DORSCON level the the Ministry announced 17 years ago when the SARS outbreak gripped the small, densely-populated island state, but much has changed since then— among the new developments, almost everyone has an unverified theory gleaned off social media about the virus, its spread, its epidemiology, its origins, its development, and how to protect oneself.

But while social media can fuel darker knee-jerk reactions driven by peer pressure, it also means public scrutiny can be equally swift.

Just this week, unsettling echoes of the SARS outbreak sounded.  There were firsthand accounts of nurses working at Tan Tock Seng Hospital – the main hospital treating infectious diseases – being shunned emerged on social media. People reportedly gave a uniformed nurse a wide berth on public transport and refused to share an elevator with another, snapping at her to take the stairs. Another nurse posted a screenshot showing that her rideshare driver cancelled her trip because her destination was the hospital.

But in the same breath, these posts attracted tens of thousands of outraged messages directed at the bad behaviour, and expressing support for healthcare workers.

Some shoppers wear masks at a plaza near Paya Lebar MRT station in Singapore, on the outskirts of the city centre

The quality of the fear now is a faint shadow of what SARS evoked in 2003, an epidemic in which some 238 Singaporeans became ill and 33 Singaporeans died, many of them health care workers. Back then, among other things, taxis refused to pick up nurses outside that same hospital and buses wouldn’t stop for them to alight or board at bus stops in the area – which people avoided like the plague. The public scrambled to avoid nurses on trains,  buses, shopping plazas, food courts, and lifts.

This time, it’s just about business-as-usual, and one gets the sense of a well-oiled machine borne of the SARS experience: at peak hour for appointments at Tan Tock Seng Hospital, patients and visitors, wearing a motley of masks, are funneled via long but reasonably fast-moving queues at a number of selected entrances.

The entrances are teeming with masked, triaging staff, who direct the public to QR codes stuck on walls on the way in. These lead to a declaration page in a browser, with the usual questions (travel history, flulike symptoms) and a requirement to leave contact details. The queue fans out to a number of temperature-taking stations. If you pass, you get a sticker dot, a process repeated at the door of the specialist centres where normal medical appointments still continue.  Or, you can go online with a question regarding COVID-19, and a Ministry of Health bot will pop up to give you some answers.

Schools so far remained open this time around. They closed for a fortnight during SARS, and upon reopening, every schoolchild was given a thermometer and temperature-taking was scheduled each morning at school assembly.

To date, Singapore has 67 confirmed cases of the virus, with 764 having tested negative for COVID-19, and 91 cases still awaiting test results.

Contract tracing has uncovered links between previously announced and new cases— a process the Ministry of Health says was made possible with the assistance of the Singapore Police Force.

Five main clusters have emerged: two churches, a Chinese health product shop, a private business meeting held at a major hotel in the city centre, and a construction site.

But not all chains of transmission have been charted— contact tracing is still in progress for nine locally transmitted cases. And even a few such uncharted cases pose concerns to public health officials who aim to prevent the wider “community-based transmission” of the virus where containment of individual cases and the outbreak would become impossible.

Nonetheless, even as Singapore steps up measures to contain the virus, including increased cleaning in public places, Health Minister Gan Kim Yong stated at a press conference that there were no plans to further raise the current alert level.

“I want to say categorically that we have no plans to go to DORSCON red,” said Mr Gan, who co-chairs a multi-ministry task force with National Development Minister Lawrence Wong.

The government expects that the economy is likely to take a significant hit, but is trying to minimise retrenchments, if any, due to the virus.

The tourism industry, taxis and rideshare drivers are all feeling the pinch of government-imposed travel and visa restrictions which have severely limited incoming visitors from China, who make up a large proportion of the market. The local population remains cautious; crowds at some malls in the city last weekend were noticeably thin, after the orange alert. But the spectre of COVID-19, so far significantly less deadly than SARS (though more contagious), has not held Singaporeans in the same thrall.

And on Valentine’s Day evening in a busy mall hub on the city fringe, life went on—with long queues outside restaurants. The only clue that anything has changed was the fact that some of the faces of friends, families and couples standing in line were covered by masks.

Couples undeterred by COVID-19 form long queues outside restaurants on Valentine’s Day.

Jade Lee is a Singaporean journalist, living and working in the city. 

Image Credits: Jade Lee, Jade Lee , Singapore Ministry of Health, HP-Watch/Jade Lee.