In the wake of a World Health Organization declaration Thursday of an international public health emergency, there is growing uncertainty among disease control experts over whether even the drastic measures now being taken will be too little too late to contain the outbreak.

The concerns came as the reported case count of 9811 exceeded that of the 2002-03 SARS outbreak, and the fatalities rose to 213 dead. The United States and eight other countries issued stiff advisories against travel to China, while other countries and territories closed or restricted border entries, suspended visa authorizations, and cancelled flights.

However, such measures seemed to pale in the face of reports such as one published Friday by researchers from the University of Hong Kong, in The Lancet, which estimated that up to 75,800 individuals could be infected with the virus in the epicentre of Wuhan, a city of 10 million where the 2019-nCoV coronavirus first emerged in December 2019.

A medical team from Beijing’s Tsinghua (清华) University is sent to Wuhan to help fight the outbreak.

“In a manner of 3-5 weeks, countries around the world are going to be seeing outbreaks not that dissimilar to what we’ve been seeing in China,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch.

He warned that the dynamics of the outbreak were moving into “uncharted territory,” with the virus looking as infectious as the seasonal flu, and the current case-fatality approaching the alarming death rate seen in the 1918 Spanish Flu pandemic, which killed an estimated 50 million people worldwide.

The virus is also spreading silently among people with asymptomatic or mild infections who may not require or seek medical attention, reported the New England Journal of Medicine, in a letter Thursday. The letter, signed by over a dozen doctors from Munich’s University Hospital described the case of a 33-year old German businessman who fell ill with the virus and infected three other co-workers, shortly after meeting a Chinese business partner from Shanghai – who appeared healthy at the time, but became ill on her return flight home.

“The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” said the authors. Osterholm added that although it’s suspected asymptomatic patient are less infectious than those showing symptoms, experts are still determining how often asymptomatic transmission happens.

Although WHO’s Director General Dr Tedros Adhanom Ghebreyesus had said Thursday, during his announcement of the international public health emergency (PHEIC) that WHO did not recommend restrictions in trade or travel – which can cause “more harm than good” by hindering information-sharing and medical supply chains – his advice was being widely ignored.

The United States State Department Thursday issued a level-4 “do not travel” advisory for China – the highest level of travel restriction advisory. Canada, The United Kingdom, France, India, New Zealand, Finland, Australia, and Germany also have recommended against travel to China and particularly Hubei Province.

Egypt, Hong Kong, Russia, Malaysia, and Singapore took even more drastic measures to limit travel to and from China – including cutting flights, temporarily suspending visas, and even closing borders to the mainland – especially targeting travelers to and from Hubei.

On Friday, the Chinese Mission to the United Nations protested the increased travel restrictions in a Twitter post that said: “There is no reason for measures that unnecessarily interfere with international travel and trade. WHO doesn’t recommend limiting trade and movement.”

As for other measures governments should be taking to protect against 2019-nCoV, Osterholm told HPW that countries should be “preparing their health systems as much as they can” with an eye towards “protecting their healthcare workers.”

“Many hospitals in China that are reporting cases in healthcare workers do not have adequate protective equipment because they’ve run out,” said Osterholm.

He added that other countries should prepare for “a major increase in patients with respiratory disease like this who are not only going to need a bed, but some form of isolation so that they don’t transmit the virus to others. And that includes protecting healthcare workers.”

China Blamed For Cracking Down On Medical Reports Of New Virus in Early December

While the WHO Director General repeatedly praised China for its fast and efficient response, other media reports criticized the Chinese government for covering up details of the new virus in its early days in December – and hauling doctors who reported the initial emergence of the novel infections before police for punishment.

“In late Dec a Wuhan doctor said in a WeChat group that there were 7 cases of SARS connected to the seafood market. He was then scolded by the party disciplinary office, and made to sign a “I’m wrong” statement with police. He’s still in critical condition [from the disease],” reported Yaxue Cao, founder and editor of the respected ChinaChange.org website, which reports on Chinese civil society and the rule of law, in a Twitter thread that was circulating widely among Chinese and abroad.

“From the same report, we learned that Wuhan health authorities were having overnight meetings about the new “SARS” at end of Dec. Earlier today the Wuhan mayor said he was not “authorized” to publicize the epidemic until Jan 20. Q[uestion] is, “what went on during the 3 weeks in between?” said Cao.

Li Wenliang, doctor at Central Hospital of Wuhan, was one of the 8 people reprimanded by police for spreading “rumors” about the new viral disease.

“The first known coronavirus infections in the city of Wuhan presented symptoms beginning on December 1 and by 8 December, there was alarm in Wuhan’s medical circles. That would have been the moment for the authorities to act decisively. And act decisively they did – not against the virus but against whistle-blowers who were trying to call attention to the public health threat,” said New York Times journalist Nicholas Kristof, in an 30 January Op-Ed that related the authorities’ detention of a group of Wuhan medical doctors’ who had reported the emergence of an unidentified SARS-like virus on WeChat social media. One doctor who was among the group detained in January later posted his story and photo online, and is currently recovering from the disease himself.

Other reports have also confirmed that China was busy cracking down on journalists and social media about the virus in early and mid-January – at a time when more information might have strengthened the early response effort.  A Hong Kong news station said its reporters were approached by police during an interview in a Wuhan hospital in mid-January, and forced to delete their interviews and photographs.

Shanghai sources reached by Health Policy Watch also confirmed that the “government told Chinese citizens not to talk about the outbreak on social media” a couple of weeks ago.

Virus May Have Spread Too Far To Be Squashed Like SARS – Africa At Risk

Speculation was now growing over whether the virus could in fact be contained and effectively eliminated, as was the case with SARS in the 2002-2003 outbreak, or if it might enter permanently into the global chain of viral transmission – at least until a vaccine could be developed.

Already, the number of reported cases has outnumbered those of SARS, which reached 8,000, and also appears to be more insidiously infectious – although SARS still had a higher fatality rate.

And that is not including the asymptomatic cases, which may number as high as 75,000 in Wuhan alone, according to a study published Friday in The Lancet.

African countries, which have a deep and embedded network of links with China may be particularly at risk. Even though so far, no cases had been reported on the continent, several individuals suspected of infections had been quarantined. And asymptomatic cases could be slipping through borders undetected, experts feared.

It was the need to bolster response in low-income countries with weaker health systems and fewer resources was a key consideration in the WHO declaration of a PHEIC on Thursday, Dr Tedros repeatedly emphasized.

Already earlier this week, senior officials from African Union (AU) said screening and surveillance was being enhanced across the continent.

John Nkengasong, the director of African Centre for Diseases Control and Prevention warned that the continent stood at “risk” given its existing links with China at the moment.

“It is very possible that we have cases, but not recognised,” Nkengasong told reporters at the African Union (AU) headquarters in Addis Ababa.

Airports across the continent have increased screening for passengers, even as carriers announced flight cancellations. Kenya Airways halted flights to Guangzhou, backtracking on earlier statements that it would continue to monitor the situation. Ethiopian Airlines has also suspended its flights.

Some African countries were considering evacuating their citizens from the Chinese province – although only Morocco said it would actually evacuate 100 nationals. An estimated 4,600 African students are residing in Hubei Province, ground zero for the rapidly spreading virus.

As the virus struck just before the Chinese Lunar New Year, some students had already travelled back home to Africa before Wuhan and the Hubei region were placed under lockdown. But a large number of students still remain trapped in Hubei.

However so far, no cases have been reported among the returning students. Kenya’s Health Cabinet Secretary, Cecily Kariuki, Ministry of Health confirmed that a student who had been quarantined at Kenyatta National Hospital in Nairobi after returning to Kenya from Wuhan on 28 January was virus-free. Zweli Mkhize, South Africa’s Minister for Health said the country had screened 55 frequent travelers to China at points of entry, all who were found to be virus-free.

“We have remained vigilant on the development regarding the movement and behaviour of the viral infection across the world and we continue to engage with the international academic fraternity to better understand how the virus behaves,” Mkhize told News24.

However, with the climbing reports of confirmed cases, models suggesting tens of thousands more in China, and reports of asymptomatic carriers able to infect others within days, the chances of any country remaining virus-free for much longer were rapidly diminishing.

“Trying to control transmission of a virus like this, an influenza-like virus, is virtually impossible. So you can try to keep it out or minimize its arrival into your area into a very limited degree, but generally it’s going to make its way,” Osterholm told Health Policy Watch.

“In terms of what actions countries and governments can take right now, it’s really preparing their health systems as much as they can. And one of the things to prepare in fact is protection for their healthcare workers.”

Further Actions To Speed Vaccine Trials Announced

Meanwhile, as public health experts looked towards a new vaccine as a potential solution, the Oslo-based Coalition for Epidemic Preparedness (CEPI), announced its fifth collaboration in just a few weeks – to accelerate development of a vaccine against the new coronavirus.

CEPI said that it had signed a collaboration with CureVac AG, a biopharmaceutical company pioneering the field of mRNA-based drugs, aims to “safely advance vaccine candidates into clinical testing as quickly as possible, and would include US $8.3 million from CEPI to fund accelerated vaccine development, manufacturing and clinical tests,” according to a press release.

Rendering of the novel coronavirus, 2019-nCoV, created by the US CDC.

The coronavirus is made up of a single RNA chain enclosed in a spiky, spherical envelope.

Yesterday CEPI also launched a new call for proposals to rapidly develop and manufacture already proven vaccine technology that can be used against the new coronavirus. The call is rolling and open for two weeks.

CEPI also has three other collaborations underway with the Pharma company Inovio, The University of Queensland (Australia) as well as a third partnership involving Moderna, Inc. and the US National Institute of Allergy and Infectious diseases.

Grace Ren and Fredrick Nzwili contributed to this story

Image Credits: Twitter: @Tsinghua_Uni, Nandu News, US Centers for Disease Control and Prevention.

In the face of an escalating crisis over the spread of a novel coronavirus in China, WHO declared an international public health emergency Thursday evening, signalling a new stage in global efforts to contain and control the escalating outbreak.

The announcement came after a week of waiting and debating, which saw the case load of the new virus (2019-nCoV), first discovered in Wuhan, escalate to 7834 victims by Thursday evening, according to numbers released at an evening press conference, including 7736 cases in China and other cases scattered across 18 more countries.  Some 170 of those infected have died and about 20 percent are seriously ill, according to other WHO reports.

WHO Director General Dr Tedros Adhanom Gehebreyesus (left) and Didier Houssin, (right) chair of the WHO Emergency Committee.

In announcing the move, WHO Director General Dr Tedros Adhanom Ghebreyesus, said that China has “already done incredible things to limit the spread of the virus to other countries.” But he said that in countries with “weaker health systems” more support was needed, which a formal WHO declaration of a “public health emergency of international concern” (PHEIC), would help unlock.

“In the past few weeks we have witnessed the emergence of a previously unknown pathogen, which has escalated into an unprecedented outbreak and has been met by an unprecedented response,” said the WHO Director General told journalists.

Dr Tedros commended China for its “extraordinary measures” it has taken to contain the outbreak, saying, “we would have seen many more cases outside of China by now, if it were not for the government efforts, and the progress that they have made to protect their own people and the people of the world.”

“However, we don’t know what sort of damage this virus could do if it were to spread to a country with a weaker health system,” he cautioned. “We must act now to help countries prepare for that possibility.

“The main reason for this declaration is not what is happening in China, but what is happening in other countries; our greatest concern is the potential of the virus to spread to countries with weaker health systems, which are ill prepared to deal with it.”

The WHO Director-General spoke shortly after Finland, India and The Philippines reported their first cases as the virus continued its relentless march across borders – defiant of the draconian lockdown measures imposed by China over 50 million people in the Wuhan epicentre and the wider Hubei province.

Signs of mounting international concern were also evident in moves by countries such as Russia, which closed its eastern border with China, as announced by Prime Minister Mikhail Mishustin, over government-controlled media. A cruise ship with 7,000 people aboard was being held off the shore of Italy after one woman from the autonomous Chinese region of Macao, came down with a suspected case, ABC News reported.  And the US Centres for Disease Control announced the first US case of human-to-human transmission in Chicago.

Despite such moves, as well as the widening array of airlines canceling flights in and out of China, Dr Tedros said that WHO was not recommending further international travel and trade restrictions as a response to the outbreak. “WHO doesn’t recommending trade and movement,” he said.

Didier Houssin, head of the Emergency Committee of expert advisors, said that the expert committee “almost unanimously” recommended that WHO declare a Public Health Emergency of International Concern (PHEIC) over the novel coronavirus under provisions of the WHO International Health Regulations (IHR) at Thursday’s meeting, the third one in a week.

Houssin said that the PHEIC was deemed justified due to the increased number of cases seen in China; the increase in the numbers of countries affected with cases; as well as the fact that “some countries have taken questionable measures against travellers.”

“Thanks to the IHR, our main international health treaty, declaring a Public Health Emergency of International Concern is likely to facilitate a WHO leadership role for public health measures; holding countries to account concerning additional measures they may take regarding travel, trade, quarantine or screening; research efforts; global coordination; anticipation of economic impacts, support to vulnerable states,” said Houssin.

Researchers Race to Develop Vaccine

Meanwhile, researchers were racing to develop a vaccine against the novel virus, dubbed 2019-nCoV – whose spread will soon outpace the 8,000 cases seen in the 2002-03 SARS epidemic.  While less deadly than SARS, so far, the virus had still claimed 170 victims as of Thursday evening, according to a WHO disease outbreak news.

Researchers are racing to find a vaccine for the novel coronavirus, 2019-nCoV; this rendering was created by the US CDC.

At the frontlines of the research effort was the new Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) – an initiative founded in 2016 in Davos by the governments of Norway and India, the Bill & Melinda Gates Foundation, the Wellcome Trust, and the World Economic Forum.

CEPI had announced last week during the 2020 World Economic Forum that it was funding three different initiatives to develop vaccines against the novel coronavirus. The programmes are in partnership with the Pharma company Inovio, The University of Queensland (Australia) as well as a third partnership involving Moderna, Inc. and the US National Institute of Allergy and Infectious diseases.

A joint WHO-World Bank statement thrust the CEPI efforts once more into the spotlight Thursday. The statement by the Global Preparedness Monitoring Board called upon CEPI and private sector pharma to “use the vaccine research they are supporting for other coronaviruses, such a MERS-CoV, for exploring the development of vaccines against 2019-nCoV.”

Dr. Tedros said Thursday evening that WHO had “invited partners” to discuss the vaccine further and there had already been “progress” that would be discussed further.

Observers say that the novel coronavirus will be the first real-time test case for the Norwegian-based international non-profit initiative, which has recruited US $750 million to prepare vaccines that can counter the threat of new disease outbreaks and pandemics.

CEPI’s CEO Richard Hatchett told the Financial Times that he aims to begin clinical trials on a vaccine for the 2019-nCoV virus within 16 weeks. Hatchett, a former director of the U.S. Biomedical Advanced Research and Development Authority (BARDA), served on the White House Homeland Security Council under President George W. Bush and was a member of the White House National Security Staff under President Barack Obama.

Image Credits: Twitter: @WHO, US Centers for Disease Control and Prevention.

Funding to develop new drugs for some of the world’s leading infectious disease killers, such as HIV/AIDS, TB and malaria, reached a record high of US $4 billion in 2018, with private sector investment driving much of the increase, according to the 2019 G-FINDER Report, which tracks such investments globally.

However, investments in neglected tropical diseases (NTDs) – a subset of debilitating but lesser-known parasitic, viral and bacterial infections – have plateaued in the past two years, and even declined by US $34 million over the last decade, according to the findings in the report, launched today by Australian Policy Cures Research group.

That was sobering news as the global health community celebrated the first-ever World NTD Day, to mark the need for more attention to 20 of the world’s most neglected diseases that affect over 1.5 billion of the world’s poorest and most vulnerable people.

Mixed Signals In Global Trends  

The G-FINDER report is the most comprehensive annual review of trends in investments in neglected disease research, and it is used widely by national governments, industry, civil society, and the World Health Organization to identify gaps in progress and areas where investments need to be increased.

Reactions to the news were mixed, in line with the good and bad news that the report contains.

“Great to see continued donor commitment to malaria R&D—critical, if we are to accelerate progress,” said David Reddy, CEO of Medicines for Malaria Venture (MMV). Malaria along with tuberculosis and HIV/AIDS are among the biggest so-called “neglected diseases.”

But the report also reflects the comparatively low priority that NTDs are receiving, said Nathalie Strub-Wourgaft, director of NTDs at the Drugs for Neglected Diseases Initiative (DNDi). This is despite the fact that such NTDs include some major global health threats such as dengue disease, transmitted by mosquitoes, as well as infections such as leishmaniasis and Chagas that are a cause of debilitating chronic illness and death among the world’s poorest.

“Flatlined funding for NTDs is proof that the world is not paying enough attention to the biomedical needs of the most vulnerable,” Strub-Wourgaft said. “It will be impossible to alleviate poverty, or achieve gender equity, quality universal health coverage, or any of the other Sustainable Development Goals (SDGs) without urgent course correction, and increased, sustained investment in R&D for NTDs.”

A man with symptoms of the deadly NTD, African trypanosomiasis (sleeping sickness), is examined by Dr Victor Kande in the Democratic Republic of Congo (DRC). Kande was principle investigator for clinical trials of fexinidazole, the first oral treatment approved by the European Medicines Agency (EMA) in 2018. Developed by DNDi,  it is being rolled out in  DRC.

The G-FINDER report tracks investments across 36 diseases including HIV/AIDS, tuberculosis, and malaria – which together represent the world’s biggest infectious disease killers. The so-called “big three” received a whopping US $2.7 billion in R&D investments in 2018, representing more than two-thirds of the total investments in neglected diseases.

The latter third of R&D investment was split between the remaining 33 diseases. Funding for the 20 diseases categorized by the World Health Organization as NTDs plateaued or even fell. Investment in disfiguring and painful skin diseases such as leprosy, cryptococcal meningitis, and Buruli ulcer dropped “across-the-board.” Trachoma, the leading cause of blindness caused by the common bacteria Chlamydia trachomatis, also saw decreases in R&D funding, along with cryptococcal meningitis, leptospirosis, and rheumatic fever.

Dengue, a WHO-categorized NTD listed as one of the top ten threats to global health in 2019, saw a funding drop of $3.6 million in 2018 – once again the largest decrease in funding for a single disease for at least two years in a row.

Overall, the report notes “the extremely small quantum of funding these diseases receive” overall. It states that “there is little chance of meaningful progress in developing missing tools – especially drugs and vaccines – when total global investment in some of these diseases is just $2 million annually.”

On a brighter note, while NTD research financing remains dominated by public sector sources, industry investments seem to be slowly increasing. According to the report, some US $57 million of the growth in multinational pharma companies’ investments went to diseases outside of the “big three.”

“I am pleased to see that investment by multinational pharmaceutical companies reached its highest-ever level last year. However, we are far from having all the tools we need to control and eliminate NTDs,” said Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a press release.

“‘Collaboration” is the watchword: cross-sectoral cooperation and public-private partnerships are more important than ever if we want to further catalyze innovation, harness the power of science and technology, and help unlock new ways of reaching a world free of NTDs,” Cueni said.

Funding trends for neglected diseases and NTDs, as reported by G-Finder

Late Stage R&D Also Gets More Funding   

Investment by public and philanthropic, as well as the private sector, all reached record highs in 2018, according to the report, although contributions varied by country and organization.

Particularly significant was the positive trend in investments for critical late-stage drug development, including clinical trials and post-registration studies, filling a historical gap in the last steps that are usually required to bring novel treatments to patients.

Funding for clinical development and post-registration studies reached a record high of US $1.4 billion in 2018, increasing by US $198 million. Much of the progress was driven by industry investment, which reached a record high of US $694 million in 2018.

High-income countries represented the lion’s share of the US $2.6 billion in funding reported by the public sector, with all three of the largest public donors moderately increasing their investments. The United States made the biggest investment in R&D at US $1.78 billion, although the recorded increase in funding was also partly attributable to improved reporting by the US National Institutes of Health. The second largest donors were, once again, the United Kingdom and the European Commission, providing some US $230 million and US $134 million respectively.

Japan, Australia, and Brazil also upped their financing for neglected diseases, although France and The Netherlands both reduced funding by about US $9.1 million. Two of the largest lower-middle income donors – India and South Africa – also reduced their contributions by US $9.4 million and US $1.9 million respectively.

Philanthropic funding for neglected disease R&D totaled US $760 million in 2018, an increase of US $43 million, reaching its highest level in a decade. The two historically largest donors – The Bill and Melinda Gates Foundation and The Wellcome Trust – jointly accounted for 93% of such contributions. Both organizations also increased their funding in 2018: the Gates Foundation by US $36 million and the Wellcome Trust by US $11 million.

World NTD Day 

Meanwhile, more than 250 public and private sector groups marked 30 January as the first World NTD Day, devoted to raising awareness of the world’s most neglected diseases.

While important new treatments have recently come on line for some NTDs, such as sleeping sickness, as well as Chagas disease and leishmaniasis, NTDs continue to be responsible for thousands of preventable deaths each year.

NTDs also cause physical impairments that perpetuate the cycle of poverty by keeping millions of adults out of work and children out of school, costing developing economies billions of dollars each year, organizers of NTD events, led by Abu Dhabi, noted in a press release. Despite their prevalence, NTDs have not always been at the top of public health priorities, advocates say. World NTD Day aims to engage the general public in the effort to ensure people at risk for NTDs no longer remain “neglected”.

“World NTD Day will raise awareness and rally the general public behind the urgent need to end NTDs, helping to keep the issue high on the global agenda. Our commitment to ending NTDs is not just about disease elimination. By removing the barrier of disease, we can help alleviate poverty and uplift entire generations,” said Mohamed Mubarak Al Mazrouei, Undersecretary of the Crown Prince Court of Abu Dhabi, which sponsored the first-ever World NTD events, in the press release.

The date of January 30th was chosen for the first-ever global event, as it is also the anniversary of a landmark 2012 London Declaration on NTDs, which unified partners, countries and disease communities to push for greater action on ten of the highest-priority NTDs. Organizers say that 2020 will be a decisive year for the advancement of NTD eradication. This year, the World Health Organisation is expected to launch a new NTD strategy, including roadmap and goals for 2030.

 

Image Credits: DNDi, G-Finder .

With some 4.2 million deaths worldwide from outdoor air pollution, and many or most cities in low- and middle-income countries failing to meet World Health Organization air quality guidelines, it’s clear that reducing air pollution’s huge death toll needs rapid action by urban centers. But officials and administrators of fast-growing municipalities often lack the right tools for tackling air pollution.

A new guide, “Accelerating City Progress on Clean Air: Innovation and Action Guide,” aims to fill that gap – fast-tracking strategies and solutions. The guide was launched Wednesday at the World Sustainable Development Summit in New Delhi, by the Delhi-based Energy and Resources Institute (TERI), Bloomberg Philanthropies and Vital Strategies.

The publication provides a step-by-step approach for city governments to take action on air quality beginning with effectively monitoring air quality, assessing emissions and sources; expanding data access and use; and engaging governments and partners to develop and implement action plans.

Smog over the city of Delhi

The launch of the report in Delhi was particularly significant, in light of the air pollution emergency experienced in the city last month, said Dr Sarath Guttikunda, a lead contributor to the guide and head of the Indian-based non-profit group, urbanemissions.info, a leading repository of air quality information in India and the region.

He was referring to the period when the city was covered with haze created by a combination of emissions from regional crop burning, industry, transport and waste-burning, which became trapped in the city due to seasonal weather conditions. At times, the city’s air pollution levels exceeded what monitoring equipment could record.

“Unless India urgently adopts long-term strategies to address air pollution effectively, we are doomed to repeat the associated health crisis of this past season year after year,” Guttikunda said. “This guide identifies recent data and resources that each city can use to address their challenges, both shared and unique, and make rapid progress. Poor air quality shouldn’t drive us indoors, depriving us of a full life of opportunity, productivity and health. This is a solvable problem, and I urge cities to use this guide to commit to action today.”

The guide is focused around four stages of activity deemed critical to identifying air pollution sources and addressing them. These include:

  • Monitoring air quality, including with the use innovative low-cost approaches;
  • Assessing emissions and leading sources – which typically include transport, power production, industry, waste and biomass burning – but may vary in priority from city to city;
  • Creating and using open data sources about air pollution emissions;
  • Catalyzing action by government and other stakeholders.

The guide draws on lessons learned from successful urban clean air initiatives including New York City, Beijing, Bangkok and Hong Kong. For example, interventions by New York City and the New York state government saw a 70% reduction in sulphur dioxide levels in just five years.

Best practices and progress from cities in early phases of developing air quality management plans, such as Battambang, Cambodia and Accra, Ghana are also highlighted. In addition, the guide addresses the roles of cities in regional, state and national policy and implementation.

Ambient PM2.5 concentrations (left) and mortality attributable to ambient PM2.5 (right) by region

“Cities, centers of creative governance, intellectual and civic life, are also home to growing civil society movements pressing for clean air and other environmental improvements,” said Daniel Kass, Senior Vice President for Environmental Health at Vital Strategies, which has a growing programme on air pollution and health. “The guide can help local governments respond to these demands with good science, logical planning and inclusive and transparent action. Each year, air pollution takes a huge public health toll and more children experience harm that can affect their future health and productivity. City governments can be powerful agents of change that speeds progress towards clean and healthy air for all.”

“Air pollution has constant, adverse repercussions on communities around the globe, and we must act now to mitigate its effects,” said Ailun Yang, head of global air pollution programs at Bloomberg Philanthropies. “By helping cities identify feasible, near-term solutions, this guide will empower governments to quickly build more sustainable, comprehensive clean air management plans at the local, national and regional level. Cities are hubs of innovation and ingenuity, and by making faster progress on clean air goals, they can lead the way in improving lives.”

 

 

Image Credits: Flickr/Jean-Etienne Minh-Duy Poirrier, Accelerating City Progress on Clean Air: Innovation and Action Guide/Vital Strategies.

The World Health Organization is set to reconsider a declaration of an international public health emergency over the novel coronavirus discovered in Wuhan – as the number of confirmed cases soared to 6086, the death toll to 132, and infections were reported in 15 other countries.

WHO announced that it would reconvene its Emergency Committee on Thursday to reconsider an announcement of a “Public Health Emergency of International Concern” (PHEIC) over the outbreak– just a few days after experts had deferred such a move saying “it was too soon.”

Momentum was clearly building towards a PHEIC announcement now, as the case load approached that of the 2002-2003 SARS epidemic. While not as deadly as SARS, the new coronavirus, dubbed 2019-nCoV, appears capable of being transmitted between people even before symptoms appear.

Citizens of Wuhan lining up outside a drugstore to buy masks

“Not sure what @WHO is waiting for….not acting now will not age well,” tweeted Florian Krammer, a professor of microbiology at Mount Sinai School of Medicine in New York City. “This is a PHEIC. We are all China at this moment.”

“It’s PHEIC time,” tweeted Ian Mackay, another respected infectious disease researcher.

“@WHO is monitoring the new #coronavirus outbreak every moment of every day…. We will have more news following tomorrow’s Emergency Committee meeting,” tweeted Dr Tedros Adhanom Ghebreyesus after returning from Beijing today with the head of WHO’s Emergencies Department, Mike Ryan.

“The decision to reconvene the committee is based on the evidence of the increasing number of cases, [and] human to human transmission that has occurred outside of China,” said Ryan,  in a press conference convened Wednesday evening. Ryan described the outbreak as one “of grave concern”  but also praised China for “doing the right things” and said that the outbreak has “spurred countries to action.”

“The whole world must be on alert right now,” said Ryan.

Dr Tedros, however, added that the Emergency Committee was also considering a new “traffic-light” approach for declaring a PHEIC in the wake of the advisory committee’s 50-50 stalemate last week over whether to declare an emergency over the outbreak at that point.

“Right now the PHEIC declaration is either ‘yes’ or ‘no’ – green or red,” Dr Tedros told journalists. “It would be good to have the green, the yellow, or the red. We need to have something in between; we are considering that. I think the traffic light approach will help, so the yellow would be a warning, something that shows that it is quite serious, but not totally red.”

There has also been speculation, however, that WHO has been reluctant to declare an emergency as long as Chinese authorities, who want to be seen as in control of the emergency response, were opposed to such a move.

Latest Developments

However, while the case load remains heavily concentrated in China, the novel virus was also increasingly spilling over international borders. According to confirmed reports, the new virus, believed to have jumped from an infected wild animal to people visiting, or working in, a Wuhan market, has now spread to 15 countries in Asia, Europe, North America and the Middle East. Most of those infected, however, had recently returned from Wuhan, and no deaths have been reported among the victims abroad.

Confirmed cases were highest in Thailand (14), Singapore (10), Malaysia, Japan and Australia (7 each); followed by the United States (5); France, Korea and Germany (4 each); and including Japan Korea, Thailand and Singapore in Asia; Canada (3) Vietnam (2) and Nepal, Cambodia, Sri Lanka and the United Arab Emirates (1 each).

Novel Coronavirus (2019-nCoV) Global Cases as of 28 January 2020 at 11pm EST, collected by Johns Hopkins Center for Systems Science and Engineering

While exacting a lower fatality rate than the infamous SARS epidemic of 2002-2003,  the coronavirus appeared to be leaving about 17% of peple with confirmed cases seriously ill, according to the latest official Chinese government case data.

Unlike SARS, however, the virus may be infectious even before people began showing symptoms – and thus with great potential to spread silently to unknowing contacts. But it is too early to determine whether so-called “asymptomatic transmission” is a large risk in this outbreak, Ryan told reporters at Wednesday’s press conference.

Maria Van Kerkhove, WHO’s head of Emerging Diseases, said that there was evidence of so-called “fourth generation” infections inside Wuhan, a city of 10 million people, where the outbreak first began around the beginning of January. This means that a person originally infected by an animal source transmitted the virus to another person, who passed it on to another person, who then infected someone else.

Van Kerkhove added that second generation infections had been seen elsewhere in China, and in limited cases outside of the country as well.

Approximately 99% of the cases remain concentrated in China, along with all 132 deaths, with the majority  majority concentrated in Hubei Province.

Dr Tedros said disease control efforts thus need to focus “on the epicentre” in Wuhan and the province of Hubei – as the “most effective” way to quash an outbreak.

Like Ryan, he praised the response of Chinese authorities so far, saying, “the fact that we have only seen 68 cases outside of China has shown… its actions have helped prevent it from spreading to the rest of the world.”

Still, the few reports of human-to-human transmission in other countries including in Germany and Japan, clearly have disease control experts worried.

The greatest fear is that human to human transmission of the virus might be sustained in a country with a “weaker” health system, with less capacity to enact strict public health and infection prevention measures, the WHO officials said.

Ryan emphasized the importance of reinforcing countries’ “preparedness” efforts, saying those with “fragile” health systems, may also need help containing the transmission of the virus.

“We don’t see many media coming to press conferences about preparedness,” Ryan quipped. “Maybe that’s part of the problem.”

Countries Evacuate Ex-Pats & Airlines Suspend Flights as Wuhan Digs in for Seige

Multiple airlines had, meanwhile, suspended flights in and out of mainland China; foreign nationals evacuated from the epidemic’s epicentre were being placed in isolation, and Wuhan was laying down the foundations of two new hospitals to deal with the overwhelming influx of coronavirus patients.

Three carriers, British Air, Lufthansa and United, announced Wednesday that they were temporarily suspending flights into the mainland, although flights in and out of Hong Kong continued. American Airlines canceled some flights to mainland China.

Multiple countries were in the process of evacuating their foreign nationals. California-bound American passengers were being rerouted to Anchorage, Alaska for health checks, before landing at an air base in California, ABC News reported. British officials said that evacuated nations should be “safely isolated” for 14 days, The Guardian reported.

Australia is taking precautions one step further, quarantining evacuees offshore on Christmas Island for 14 days before allowing Australian ex-pats to return to the mainland. Japan, South Korea, the Philippines are among the other countries planning to evacuate expats.

In Wuhan, meanwhile, social media reports from citizens were lamenting the overwhelmed hospital systems. One Wuhan reporter tweeted that patients were waiting hours in the hospital for diagnosis due to a shortage of testing kits.

Two makeshift hospitals with a total capacity about 2,600 beds were frantically under construction. Some 1905 are reported ill in the capital of Hubei province, with more infections expected to be reported daily. The first, the Huoshenshan hospital, with an area of 25,000 square meters and capacity for 700 to 1,000 beds, is expected to be put into use by next Monday.  The second hospital, Leishenshan is expected to be operating by next Wednesday. Chinese social media was rife with livestream reports of the rapid hospital construction, which Chinese authorities see as a test of their capacity to combat the disease.

US Secretary of Health and Human Services Alex Azar told journalists that the US had offered to send a group of experts to China to support the response, although China had not so far responded. “We’re urging China: More cooperation and transparency are the most important steps you can take for a more effective response,” Azar told the press conference.

Meanwhile, WHO will assemble an international team of “the best minds in the world” to explore different dimensions of the response effort along with Chinese experts, Dr Tedros told journalists Wednesday evening.  And that is apparently an offer that Beijing will not refuse.

 

Grace Ren contributed to this story

Image Credits: China News Service／中国新闻网, John's Hopkins CSSE.

Cases of the novel coronavirus first discovered in Wuhan, China nearly doubled again in a day jumping from 2585 confirmed cases Monday to 4515 cases and 106 deaths as of Tuesday morning. As the numbers climbed, countries around the world planned to evacuate citizens in the quarantined city of Wuhan – the epicentre of the outbreak.

The alarming surge in numbers reported by the Chinese National Health Commission (NHC) echoed Chinese Minister of the NHC Ma Xiaowei’s warning in a press conference Sunday that the world had likely “not yet seen the peak of the epidemic,” just days after the World Health Organization’s Emergency Committee decided not to declare the outbreak a “public health emergency of international concern.”

Dr Tedros (left) and Xi Jinping

Following a meeting with Chinese President Xi Jinping Monday, the World Health Organization’s Director-General Dr Tedros Adhanom Ghebreyesus said that “stopping the spread of this virus both in China and globally is WHO’s highest priority.”

WHO praised China’s swift public health response and agreed on further collaboration, but did mention whether the Emergency Committee will reconvene in the near future in the press release.

Meanwhile, as China expanded its travel restrictions and the Lunar New Year holiday in an effort to contain the outbreak, a number of countries have mobilized to evacuate expats stuck in Wuhan. The European Commission is sending two planes to repatriate citizens from the Wuhan area to Europe, following a request from France that activated the EU Civil Protection Mechanism. Other countries such as the United States, Japan, and South Korea, have also announced plans to evacuate citizens from Wuhan in the coming days.

Most of the countries that have announced intentions to evacuate citizens from Wuhan will also be requesting evacuees to then quarantine themselves at home for up to 14 days – the suspected maximum incubation period of the virus. Researchers in China and at the World Health Organization have confirmed that the disease can spread from person-to-person through a respiratory route – likely through droplets sprayed by sneezes or coughs. WHO Scientist Maria Van Kerkhove said in a Live:Q&A that there had also been rare case reports of people transmitting the virus before showing symptoms of the disease themselves.

Despite strong evidence of human-to-human transmission in China, only one confirmed case of person-to-person infection has occurred outside of China so far, in Viet Nam. The other 36 confirmed cases outside China all had travel history to Wuhan.

Van Kerkhove said that those most at risk are family and friends in close contact with an infected person. The exact reproductive number – or the number of susceptible people one infected person is likely to infect – is still unknown, although researchers have given estimates ranging between 2.0 – 6.0.

Most of the infections have been in adults, although cases have been recorded in children as young as 2 years old. Those at highest risk of infection and severe disease are elderly people with pre-existing health conditions as stated by WHO. The current case-fatality rate remains around 2-3%, less deadly than other viruses in the same family such as severe acute respiratory syndrome (SARS) and Middle-Eastern respiratory syndrome (MERS).

Some 50 million people in China were under quarantine as infections by the novel coronavirus first discovered in Wuhan accelerated rapidly, and new research suggested that it was far more infectious than previously thought.

China’s Minister of the National Health Commission acknowledged that “the epidemic had entered a grave and complex period,” as the country reported 2858 cases of the 2019-nCoV virus on Monday – three times that of Friday – along with 81 deaths.

World Health Organization Director General Dr Tedros Adhanom Ghebreyesus meanwhile rushed to Beijing to confer with authorities on their outbreak control efforts, and the Chinese sent top government officials to Wuhan – the epicentre of the outbreak.

Li Keqiang, Premier of the State Council of China, visited Wuhan on Monday to inspect and guide the outbreak control work.

A dozen countries outside of China had also confirmed cases of the novel coronavirus 2019-nCoV, including new confirmed cases in France, Canada and Australia, as well as in Nepal and Malaysia. Singapore, Japan, Taiwan and Thailand had already reported cases last week. As of Monday, more than 5000 suspected cases await clarification around the world, including 2 suspected cases in Zurich, Switzerland.

On Friday, a team of UK and US researchers published a preliminary research paper estimating that the real number of cases in Wuhan, a city of 10 million people at the epicentre of the outbreak, could be as high as 11,341 as of 21 January – in contrast to the official number of 440 on 23 January.

The paper, which has not yet undergone peer review, appeared on a health sciences preprint server, Medrxiv. Since last Tuesday, the number of diagnosed coronavirus patients in Wuhan has virtually doubled.

Their model further forecast that within 14 days, those infected could exceed 190,000 in Wuhan alone.

The model estimates that the virus’s reproduction number – e.g. the number of people one person can infect before being contained– relatively high at 3.6-4, is comparable to the infectious potential of the 2002-03 SARS coronavirus, which was 2-5. However, SARS was also deadlier with a case-fatality rate around 9%, while the current virus has a mortality rate of around 2%.

Other recent estimates have been more conservative. A team of  Harvard researchers estimated the viral reproductive number at 2-3.3 in a preliminary assessment also published over the weekend, while WHO officials had on Thursday estimated it at 1.4- 2.5.

However, there was broad scientific agreement that a much larger reservoir of people were becoming infected, and rapidly transmitting the virus, without necessarily showing symptoms themselves, as per another study published in The Lancet by a Chinese research team. The team, which examined data from the first 41 patients that had been admitted to hospitals in Wuhan, estimated that the virus incubation period is only 3-6 days and it can cause serious pneumonia-like symptoms even in healthy people, and not just older individuals with underlying health issues. A number of the

Chinese officials acknowledge grave concerns

The researcher’s concerns were echoed by the Chinese Minister of the National Health Commission, Ma Xiaowei, who spoke Sunday at a press conference captured by the government-owned CCTV network.

“According to recent clinical data, the novel coronavirus seems to be more infectious,” Xiaowei said. “Currently the transmission of the epidemic is rather speedy which has posed some challenges and pressures on the prevention work. Experts have predicted that the epidemic has entered a rather grave and complex period.”

Ma further added that the epidemic was still in an “early and sporadic phase.” Therefore, given the increased pace of the outbreak, he predicted “it may last for some time.”

“It is likely that there will be a rise of the number of cases in the coming period,” warned Ma.

However, as stringent outbreak control measures implemented in the area around Wuhan and “top-level” public health emergency responses take effect throughout the country, “the epidemic intensity of the outbreak will go down.”

Such outbreak control measures include the expansion of travel restrictions to more cities over the weekend, with over 50 million Chinese citizens now under lockdown. By Monday, three military medical teams composed of some 450 doctors and nurses from Shanghai, Chongqing, and Xi’an had been deployed to Wuhan to help hospitals manage the overwhelming influx of patients.

Meanwhile, medical equipment companies ramped up production as demand for medical devices surged. Workers in over 30 factories around China worked through the annual Lunar New Year celebration to produce face masks, thermometers, and other tools for the outbreak response.

The national Chinese government increased funding for the outbreak response to approximately US $1.2 billion, according to a statement from the National Health Commission.

Coronavirus Outbreak in the Legacy of SARS:

As case numbers seem to double every day, a mixture of fear, solidarity, and hope permeate the lives of Chinese citizens over what is normally a celebratory holiday season.

One Wuhan resident currently abroad told HPW that the state of emergency imposed by this new coronavirus is giving citizens chilling flashbacks to life during the 2002-2003 SARS epidemic.

“My mom was isolated during the SARS period in 2003 for a month and a half. She didn’t have the virus, just some similar symptoms,” the person said. “I don’t have much memory of it since I was only 6, but my family keeps telling me how terrifying it was back then.”

“My parents are staying safely at home, mainly because they are the most vulnerable people that have the highest possibility to be infected. My dad currently has diabetes and high-blood pressure, and all the obesity-related diseases you can think of. Thus, it’s really dangerous for him in the current environment.

Added the person, “The most worried case is my aunt’s family, who are isolated at home because my aunt’s mother recently passed away from swine flu. It’s really terrifying given how close the timeframe is, so that’s why they chose to isolate themselves spontaneously in that way. My family was not aware of how bad the situation was when the government released the first news.”

Just this morning, the source said, a person in their aunt’s apartment complex was suspected of being sick with the coronavirus. Neighborhood committee members visited the person fully equipped in protective gear, but ultimately chose to isolate the person in their home rather than send them to the hospital.

“They did not sanitize the public area in the apartment complex at all,” the source protested.

Still, most people in Wuhan are “really behaving” and complying with the quarantine, and Chinese around the world have come together to participate in the emergency response.

Videos of whole apartment complexes singing “Wuhan, add oil!” – a common Chinese encouragement – in unison are trending on Weibo, China’s Twitter equivalent. Volunteer groups both in the country and abroad are banding together to send emotional and material support to the besieged city.

Said another Chinese citizen currently abroad who has participated in one of the many donation drives, “We just teamed up and fight for this, united all the resources we have, and donate them to Wuhan.”

Image Credits: China Government Network.

With Wuhan under lockdown since Thursday, food in the city was reported to be running low, healthcare staff are having trouble getting to work due to the lack of public transport, and some hospital services were reported near collapse under the pressure of people waiting to be diagnosed and treated. These were among the updates obtained by Health Policy Watch, from people in the Chinese cities most directly affected by the outbreak.

Scene at Wuhan Pulmonary Hospital, as portrayed by government-owned media, contrasts sharply with reports from local citizens of health system disarray.

As of Friday evening, the novel coronavirus (2019-nCoV) – had infected over 900 people, leaving 26 dead, according  to CGTN, the Chinese government-owned news service. Meanwhile, some 15 cases had been reported in seven countries, including 5 cases in Thailand, as well as one or two cases each in Japan, South Korea, the USA, Viet Nam, Singapore and Taiwan.

As of Friday evening, some 14 other Chinese cities, around Hubei Province where Wuhan is located, were also reportedly under travel restrictions, affecting some 37 million people, reported CNBC News Beijing Bureau chief.

Meanwhile, a day after the World Health Organization refrained from declaring an international public health emergency (PHEIC) over the outbreak of the novel coronavirus (2019-nCOV), the United Kingdom convened its own COBRA emergency committee to review the outbreak – but concluded that the risk to British residents remained low.

In an attempt to deal with the spiraling case load, China’s national government dispatched 150 military doctors and medics from Shanghai to Wuhan; said that they were allocating some $US144 million in emergency funding to Hubei Province as well as building a dedicated hospital facility in Wuhan – the epicentre of the outbreak – to handle the growing load of cases of the pneumonia-like virus. Emulating Beijing’s response to the severe acute respiratory syndrome (SARS) outbreak in 2003, the Wuhan authorities said that they plan to complete the specialized hospital, with 1000 beds, in six days.

However, the personal reports from average Chinese of health facilities disruption due to the halt in transportation services in and around Wuhan, contrasted sharply with the images on official Chinese media of well-equipped teams, responding efficiently.

As one Wuhan resident currently abroad reported on his social media account, “My cousin and his parents are suspected to have the symptoms, so they have been isolated at home as the whole healthcare system in my hometown has collapsed. “Supermarkets nearby us are currently out of supply. Basic disinfectant and medical masks are unattainable. The Wuhan government clearly did nothing but watch Chinese New Year performances… some performers are already having symptoms. I am just too furious to say anything now.

“Please don’t hate us, we are victims too. It is those who covered truth from the public who should be blamed, and the ignorant – who love eating wild animals,” the Wuhan resident concluded. The student was referring to the widespread practice of freshly slaughtering and eating meat from a range of wild birds, mammals, rodents and reptiles – one of which is believed to be the original source for the virus that leapt the species barrier. The traditional practice has come under public scrutiny among educated Chinese as the new coronavirus, similar to that of the deadly 2002-2003 SARS epidemic, spreads internationally.

Wuhan Citizens Show Solidarity – But Local Government Officials Criticized

Privately, and on social media, local government officials were being blamed both for not reacting quickly enough, as well as for making hasty decisions about quarantine measures.

Said first hand observers to Health Policy Watch, “The decision to lockdown Wuhan was made quickly so nobody was prepared and panic quickly spread. It’s estimated 300,000 people left the city the night before. Everyone with cold or expression of flu wants to get diagnosed. Many people went to the hospitals out of fear, so the hospitals were overloaded.

“Medical equipment was used up more quickly. Doctors and nurses are tired, having burnouts and emotionally exhausted, and since the public transportation within the city was shut down, there are no shuttle buses for the nurses or doctors. Taxis don’t want to drive to hospitals either. And no one wants to deliver food to the hospitals so they can’t even order a meal.”

But while critical of local government failures, the observers were more positive about civil society response. Said one:

“People are really coming together to step in where it seems the local government has failed. Wuhan citizens set up volunteer groups on Weibo [the equivalent of Chinese Twitter] to help organize donations of masks and other equipment, coordinate with shipping companies and Wuhan police, and drive health care workers to hospitals.

“Hotels near hospitals are offering free stays to medical staff because of the issues they’ve had getting around the city.

“People are pretty upset with the local government because they think they are hiding information. The central government (i.e. from Beijing) issued a statement saying that any reports of underreporting or concealment would be ‘investigated and dealt with’, and a statement like that is considered a fairly serious warning.”

Meanwhile, residents in Beijing and Shanghai reached by Health Policy Watch said they had stocked up on face masks and food, and were staying home as much as possible. Public events associated with the start of the Chinese Lunar New Year have been cancelled in both cities, and major tourist attractions are shut down.

“There was one diagnosed patient who went to a shopping mall 10 minutes from my house… luckily we didn’t go there. We have enough storage at home now, so hopefully it can get under control very soon,” one Shanghai resident reported.

Said another young Beijing resident: “I’m not going anywhere, like I am not moving.”

 

https://twitter.com/i/status/1220720519797932034

Grace Ren contributed to this story

Image Credits: www.CGTN.com.

WHO’s head of Universal Health Coverage, Dr. Peter Salama, has died suddenly at the age of 51.

The Australian-born medical epidemiologist was known as an eloquent global health advocate, who dedicated his career to combatting the world’s most difficult and dangerous diseases and strengthening fragile health systems in states weakened by war and civil unrest.

After joining WHO in 2016 as executive director of Health Emergencies, Salama oversaw the winding down of a massive Ebola epidemic in West Africa, only to be confronted two years later in 2018 with the re-emergence of the deadly virus in the Democratic Republic of Congo (DRC).

But he was well-prepared. During the 2013-2016 outbreak, Salama had overseen UNICEF’s response as Regional Director for the Middle East and North Africa. Over three years, that epidemic  killed over 11,000 people, leaving behind ravaged economies and societies in Sierra Leone, Liberia and Guinea.

Dr Peter Salama on his last mission to Somalia.

Lessons learned from West Africa, along with a potent new vaccine, helped Salama and the WHO team work with the DRC health authorities to contain the outbreak there more effectively.  Although the DRC outbreak is still simmering in bursts and flames, fuelled by continued civil unrest in eastern DRC, its death toll has been much lower, and the virus has not lept significantly to other countries.

“Pete embodied everything that is best about WHO and the United Nations – professionalism, commitment and compassion,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a statement. “Our hearts are broken.”

In 2019, during a WHO internal reorganization, Dr Tedros nonetheless moved Salama out of his natural turf in Emergencies, appointing him Executive Director of WHO’s new flagship programme on Universal Health Coverage (UHC).

The new UHC programme is of premier strategic importance, although the transfer also came amidst a series of internal staff complaints within the Emergencies team. While these were primarily targeted at other staff, the waves also touched Salama. Mike Ryan was appointed  executive director of the Emergencies Programme, a position he holds today.

Salama, meanwhile, took on his new mission in Universal Health Coverage with gusto, using it as a platform to advocate for the inclusion of the world’s poorest and left-behind populations.

A talented orator, Salama was outspoken about both the challenges and the need to boost weak health systems, particularly in conflict regions, improving both their preparedness as well as routine care, issues with which he had grappled since the early days of his career.

He linked persistent health inequalities with the problems faced by fragile states. In one keynote address to a Geneva gathering of pharma manufacturers in December 2018, he said the following:

“While we have made tremendous progress tackling some stark global health inequities, there is a major fault-line that we have hardly begun to address. In recent decades it is not necessarily the poorest countries that have fallen behind the most, it is those countries or parts of countries that are facing conflict, insurgency or are fragile due to other reasons.

“In fact, more than three-quarters of the major outbreaks we see at WHO occur in these 20 or 30 places. Think, plague in Madagascar, wild polio on the Afghan-Pakistan border, yellow fever in Angola, cholera in Yemen, diphtheria among Rohingya refugees in Bangladesh, measles in Venezuela, meningitis in north-eastern Nigeria or Ebola in DRC. Conversely when we review our global goals under the Sustainable Development Framework, we see that the same set of countries accounts for more than 50% of most of the unmet targets – whether for under 5 mortality, maternal mortality or under-immunized children. Most of our global health battles will be won or lost in these countries.”

The huge outpouring of response over Salama’s death from nearly every major global health institution, as well as national health ministries, was testimony to the high regard he commanded for his work on some of the world’s most challenging diseases and health issues.

“Peter was a loyal and committed health advocate and multilateralist. He brought depth and strength to WHO. He will be missed,” tweeted Lancet Editor, Richard Horton.

He was, “an amazing person and a relentless champin for the universal right to health for every child,” said UNICEF’s global director of communications, Paloma Escudero.

Before joining WHO, Dr Salama was Regional Director for the Middle East and North Africa at UNICEF, an organization that he joined in 2002, with his first posting in war-torn Afghanistan.

He is still remembered there. Suraya Dalil, Afghanistan’s minister of public health, said: “Dr Peter Salama worked with UNICEF Afghanistan in 2002-3 and immensely contributed in the construct of an equitable health care including the Basic Package of Health Services. His legacy to make the world a better place will continue in our continued collective work,”

Salama also served as UNICEF’s Representative in Ethiopia and Zimbabwe (2009–2015), Chief of Global Health and Principal Advisor on HIV/AIDS in New York (2004–2009).

Dr Peter Salama meeting with health officials in Somalia.

He also worked in the past with Médecins Sans Frontières and Concern Worldwide in several countries in Asia and sub-Saharan Africa. And he also spoke and published widely on health issues related to war and conflict zones, vaccine-preventable diseases, and HIV/AIDS.

Given the importance of UHC to the WHO strategic agenda, the search to find a replacement of Salama’s stature will be a difficult one, observers said.  WHO’s ambitious aim is to extend affordable, accessible and quality health care to everyone across the world by 2030, in line with the UN High Level Declaration of September 2019.

More than that, the global health leaders said that they will miss the human touch of a man whose work touched the lives of so many millions somehow.

“Dr Peter Salama’s last mission was in Somalia where he wanted to change the health systems making it fit for UHC,” tweeted the WHO office in Somalia today. “He dreamt of a society where everyone everywhere can access health care without any financial hardship. He dreamt of a health system which is devoid of inequality and social disparity. His dream was to transform and build the health system of Somalia that can ensure Health For All.

“He was immensely touched to see how the work of WHO can immensely impact the lives of millions. We will miss him but would carry forward his dream into a reality.”

Salama, who was reported to have died of a heart attack, is survived by his wife and three children.

 

 

 

 

 

Image Credits: WHO , WHO.

Former British Prime Minister Tony Blair appeared Wednesday at a World Economic Forum (WEF) side event hosted by The Economist Events, and supported by tobacco giant Philip Morris International (PMI), Health Policy Watch has learned.

The Davos stage was not the first prestige event in Switzerland to which PMI has recently attached its name. In October 2019, a senior PMI representative also appeared alongside United Nations and OECD representatives at a roundtable discussion in Geneva, co-sponsored by the International Chamber of Conference.

Blair’s appearance on the Davos stage of the PMI-supported panel event, “Confronting Global Challenges, Solidarity in an era of retreat,” was unannounced due to security reasons.

Tony Blair at PMI-supported panel

However, a Twitter post by another panellist, Alexander Stubb, vice president of the European Investment Bank captured the moment – with the PMI logo clearly visible on the background banner.

Blair did a one-on-one interview with moderator, Irene Mia, Global Editorial Director of The Economist Intelligence Unit, before stepping down, and other members of the panel, including PMI Chief Executive André Calantzopoulos, joined the stage.

Along with Calantzopoulos, the power line-up included Stubb, also a former Finnish Prime Minister; John Rutherford Allen, president of the Brookings Institute; and John Chipman, chief executive of the International Institute for Strategic Studies.

While Blair’s appearance at the PMI-supported forum largely slipped under the radar, it did not go by entirely unnoticed by participants at the 2020 Davos meeting.

“The Economist promotes tobacco at the #WEF20,” tweeted Ilona Kickbusch, Advisory Board Chair of the Global Health Centre, Geneva Graduate Institute. “Confronting #cdoh [commercial determinants of health] is clearly a global challenge.”

Just prior to the event, Adrian Monck, of the WEF managing board, called on the The Economist to cancel the collaboration with the tobacco industry.

“We don’t allow nicotine-peddling death cults to join the World Economic Forum, but they skulk around the edges of our meeting looking for reputation laundering opportunities” said Monck in a Linkedin post.  “I really hope The Economist reconsiders its decision to host a side event at Davos with big tobacco.”

The New York Times, picked up Monck’s comment, but buried it in a sensational news story about the alleged Saudi hacking of the cell phone of Amazon’s Jeff Bezos.

The PMI-supported panel focused on how: international cooperation traditionally faciliated by international organizations is being “undermined” by isolationist trends.

“The paradigm that defines today’s new world order is a Catch 22. As countries turn inwards, the problems they face are increasingly global in nature,” stated the online event description.

“These challenges don’t respect national borders and isolationism therefore won’t solve them. International organizations – traditionally responsible for facilitating cooperation – are being universally undermined.

“Their inability to foster collaboration is threatening significant progress on pressing issues like climate change. The need for a supranational organization has never been greater. Yet even on a domestic level, the disaccord that characterizes today’s politics is preventative. What hope then of navigating these uncharted waters?

That choice of topic was ironic, insiders observed, in light of the tobacco industry’s position vis a vis international agreements such as the WHO Framework Convention on Tobacco Control – one of the few health-focused conventions of the UN system.

This is not the first such forum where PMI has popped up recently on the Swiss scene, either.

Last October, PMI Vice President Luisa Moreira featured in the line-up of the 5th Geneva Business Dialogue Roundtable, co-sponsored by the Geneva-based International Chamber of Commerce. The topic was “Regulatory Policy in a Changing World.”

Appearing alongside PMI’s Moreira was Organisation of Economic Development and Co-Operation (OECD) representative, Miguel Amaral and Teresa Moreira, a senior official at the UN Conference on Trade and Development (UNCTAD).

UNCTAD featured the roundtable on its website as did the ICC. Other panelists included: Jean Yves Art, Microsoft senior director and Marcela Bliffield, a senior legal counsel at Nestlé.  The roundtable was held in a rented room of the Geneva Graduate Institute – although it was a private event and not sponsored by the academic centre.

Switzerland has long been a field of subtle, but simmering battle between the countervailing forces of global health and global tobacco. Geneva is home both to the World Health Organization, which birthed the Framework Convention on Tobacco Control in 2003, and the global headquarters of Japan Tobacco International. PMI maintains a significant presence in nearby Lausanne, as well as Neuchatel and Zurich.

While WHO and tobacco advocates have been vigilant about distancing the UN system from collaborations with the tobacco industry – the dyke is not without its cracks.

Last June, Michael Møller, departing Director General of the UN Office at Geneva (UNOG), called for a more “nuanced relationship” between the tobacco industry and the UN system in a memo penned to UN Secretary General Antonio Guterres. His remarks, later publicized, raised a chorus of opposition.

In July, a group of leading civil society tobacco control advocates published an open letter to the UN Secretary General, saying that Møller’s call for “nuance” not only threatens progress on the Sustainable Development Goals, such as reducing deaths from tobacco-caused diseases but also: “stands in direct conflict with international law, in particular Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control (FCTC), which states that: ‘Parties shall act to protect these [FCTC] policies from commercial and other vested interests of the tobacco industry.'”

“It is impossible to produce, market and sell tobacco products in a way that is compatible with public health or the UN’s 2030 Agenda,” the letter further noted. “Accordingly, tobacco companies have been excluded from the UN Global Compact.”  The letter also noted that a UN Economic and Social Council (ECOSCO) resolution “calls upon all UN agencies to implement their own policies on preventing tobacco industry interference.”

The appeal, signed by the Framework Convention Alliance, The Union, and other tobacco control groups, concluded saying: “It is alarming that an outgoing UN official of Mr. Møller’s status would feel the need to suggest softening the stance of the global community toward an industry whose products claim 8 million lives, and cost between one and two percent of global GDP annually.”

 

 

 

 

Image Credits: Twitter, @IlonaKickbusch, Linkedin.