WHO Director General Dr Tedros Adhanom Ghebreyesus at last week’s Executive Board meeting – held both remotely and in person.

As the World Health Organization convened its Executive Board of 33 select member states last week for the first time since May, the United States appeared to be fully back inside the WHO boardroom – despite the fact that President Donald Trump had announced in July that he would leave the global health organisation due to its alleged China bias in the handling of the COVID-19 pandemic.

While the currents could change again, and yet again, depending on the course of the US elections in November, the US presence in the chambers of WHO decision-making was an important signal, both geopolitically as well as financially for the organisation, after months of being battered by the White House. In past years, United States contributions have represented between 15-20 per cent of WHO’s budget, and even though funding was sharply cut by Trump for 2020-21, it still represents hundreds of millions of dollars for the organisation.

Politicisation of pandemic response

The executive board is WHO’s core governing body. It sets agendas, priorities, reviews and approves budgets before decisions go to the wider World Health Assembly (WHA), which includes all 194 WHO member states. The EB session last week was the first since the May WHA meeting, when geopolitical sparring between China and the US – as well as impromptu declarations by Trump to the media – disrupted the normal decorum of the meetings – and worse yet the focus on combatting the pandemic.

Return to decorum

This time around, US Deputy Secretary of Health and Human services, Brett Giroir, not only joined the WHO Executive Board meeting (5-6 October) but even referred positively to the “progress” being made by a series of independent panels and committees that are reviewing the WHO’s pandemic response — as well as that of WHO member states.

“We appreciate the progress made,” said Giroir, asking that EB members be briefed again in November and in early 2021. Significantly, he also made no reference to Trump’s earlier announcement that the US would withdraw from WHO.  Although European observers who are close to the proceedings said that it remained unclear if the United States was back for good — or only until 2021, when the written commitment by Trump to withdraw would actually take effect.  Wait until after the election and then we will know more, they whispered.

US Deputy Secretary of Health and EB representative, Brett Giroir

However the demeanor of Giroir, at least, was revealing, in what he did not say.  While he did pointedly refer to the “billions” of people impacted by Covid-19, as well as the “failure” of some member states to quickly respond, he politely refrained from attacking China by name:

“Despite the many advances in technology, international cooperation and instantaneous communication, and the positive steps in response outlined this morning,… we cannot overcome the failure of any member state to provide accurate, complete and timely information on outbreaks and potential health emergencies,” Giroir said.

China’s EB representative, Zhang Yang, was similarly restrained. Sidestepping the simmering debate over the timing of China’s alerts to the global community on the virus, he focused on the role that the various review panels could play in recommending measures that could “further support countries with weak health systems.”

He also called about the review panels to “inform members states of their work in a timely manner and use their platforms to enhance direction with member states.”

Overall, such exchanges represented a kind of “return to decorum” that is the traditional hallmark of WHO member-state meetings.

Perhaps member states were also reflecting on the interim findings of the Independent Oversight Advisory Committee (IOAC), which were presented at the EB meeting. The committee, charged with reviewing WHO’s Health Emergencies response, also pointedly noted in its summary findings that:

“The politicization of pandemic response is a material impediment to defeating the virus.”

Europe steps forward

Although US and Chinese remarks were subdued, European Union flexed its muscles.

Germany’s EB representative Björn Kümmel

Germany, speaking on behalf of the European Union bloc on Tuesday, said member states need to consider “strengthening WHO’s perogative in terms of access to information”:

“We look forward to discussing ideas such as increased accountability of member states on preparedness, for example, through the establishment of a periodic review mechanism, as proposed by the African Union, and all strengthening WHO’s prerogatives in terms of access to information… Emphasis must also be placed on development of proper and unified health data collection at all levels.” Björn Kümmel, Germany’s EB representative.

Criticis have said that one of the main shortcomings of the current legal frameworks in which WHO operates is that it has no real legal perogative to demand access to information from a sovereign nation – which may be vital to coping with an emerging global health crisis. Regardless of whether China really did delay the release of data about the emergence of a mysterious pneumonia-like virus in Wuhan by days or weeks in late 2019, as the US has claimed, European member states and other nations are deeply concerned.  They want more transparency to be built into global health emergency alert systems, so that potentially devastating delays in reporting don’t occur and such questions don’t arise again.

In that light, Kümmel’s frank appeal to the three panels that are now exploring the pandemic response from various angles is also particularly striking:

“In your evaluations, do not be afraid to tell uncomfortable truths. In your recommendations, do not be afraid to challenge…member states, to questions current modes of operation and to show boldness and vision. You can count on the full support of the EU and its member states.”

Weathering the pandemic storm

If the WHO organisational boat seemed to be riding through rough waters in May, with major leaks in the budget engine, this recent meeting signalled a kind of stabilisation, and a back-to-business approach. And so far, WHO director general Dr Tedros Adhanom Ghebreyesus, who faces re-election in May 2021, seems to be weathering the storm while also remaining firmly at the helm himself, despite the blistering criticism directed at him in past months by WHO’s most powerful member state: the US.

Bright spots on horizon –  maybe?
Johns Hopkins COVID-19 Dashboard – 7 p.m. Monday, 12 October. Numbers change rapidly.

There are some bright spots on the horizon – however distant they still may be. The pandemic continues to expand daily, with some 37 million reported infections and over one million deaths now reported  worldwide.

China or not, many insiders say that WHO’s early guidance on issues such as masks or travel restrictions was clumsy and delayed – saying neither would be useful when in fact both proved to be essential as containment strategies used by countries worldwide.

At the EB meeting, Austria also asked the organisation to develop more detailed and up-to-date guidance about how airlines and countries can safely organise travel now as countries seek to revive their airline industries – using a patchwork of testing and quarantine approaches. It is often precisely around such guidance that WHO is particularly hesitant – either lacking the in-house expertise or else fearing that it might tread on the sovereign toes of member states.

But on the more positive side, the organisation has in fact, been key to the mobilisation of an unprecedented global response.

This has included everything from bolstering COVID lab test capacity across Africa and doling out millions of pieces of protective gear for health workers in the early days, to far more sophisticated initiatives.  These include the massive WHO-coordinaed “Solidarity” trial that is pooling methods and results for the hundreds of clinical trials going on around the world to test Covid-10 therapies. In addition, WHO in partnership with the Global Fund and others, is also now rolling out the procurement of hundreds of millions of rapid tests in low-income settings, where they could make a huge difference. And WHO has ramped up its daily reports and commenting on pandemic trends and issues, from not only headquarters but also its African, Americas and European regions, to a level where media is chasing to keep track of the latest news release.

Perhaps its most stunning achievement to date is the co-creation with Gavi, The Vaccine Alliance of a massive “COVAX” vaccine procurement pool, to which some 180 high and low-income countries have formally committed, most recently China and the Republic of Korea.  The broad buy-in, described by WHO officials as “moving from success to success” is intended to help reduce the costs of manufacture, and facilitate the rational distribution of available supplies of the most effective vaccines, as soon as they become available, to health workers, older people, and other groups most at risk. The Covax pool has so far drawn over $16bn in donor support and World Bank finance.

So while the recent EB meeting was largely dominated by diplomatically-framed debates centred around the independent reviews of WHO’s performance and ideas for improvement going forward, Dr Tedros and his team also had their moment in the sun to explain what they have accomplished so far. The list in the powerpoint slides certainly looked impressive – and member state reactions were largely supportive.

And speaking at the GLOBSEC 2020 forum, the day after the EB sessions concluded, it was clear that Dr Tedros was clear about what he thought the key message of the independent reviews and evaluations should be:

“We look forward to the findings and recommendations of these reviews. But there are several lessons that are already staring us in the face.

“First, we must learn from this pandemic, and make political and financial commitments now, to address critical gaps in national and global preparedness. We must renew our determination as a global community – that never again will a new pathogen be allowed to spread with such destructive impact on our populations.

“The time to prepare for emergencies is before they occur. WHO support for country preparedness is rooted in the idea that the best defence for health emergencies is strong health systems based on universal health coverage and primary health care. So we need to have a real and strong commitment to universal health coverage.”

  • Originally published in Geneva Solutions,a non-profit journalistic platform dedicated to International Geneva, with which Health Policy Watch is collaborating.  With reporting by Pip Cook.

Image Credits: Johns Hopkins University.

 Illustration of the AdVac® adenovirus technology, being tested by  Johnson & Johnson, (Credit: J&J)

Johnson & Johnson, the only pharma firm currently developing a one-dose COVID-19 vaccine candidate, has “paused” its Phase 3 clinical trial due to an unexplained illness in one of the participants. A press release issued on Monday confirmed reports that a safety monitoring board had been convened to review the event and related data, but gave no further details about the nature of the illness.

Meanwhile the New York Times reported that Eli Lilly had also paused its clinical trial testing an antibody cocktail treatment for COVID-19 on hundreds of hospitalized people, due to a safety concern. The drug is simlar another antibody cocktail given to President Trump after he was diagnosed with Covid-19 earlier this month. Trump had pronounced the cocktail that he received, developed by the pharma company Regeneron, as a “cure,” and said he wanted to make it widely available for free to hospitalized COVID patients.  A few days later, Regeneron as well as Eli Lilly applied for Food and Drug Administration Emergency Use authorizations, even though the trials of the treatments were still underway.

In terms of the vaccine trial, J &J said that its pause in the vaccine clinical trial was “temporary”, not unusual when unexplained illnesses occur, and represented the high degree of concern with safety.

“We have temporarily paused further dosing in all our COVID-19 vaccine candidate clinical trials, including the Phase 3 ENSEMBLE trial, due to an unexplained illness in a study participant. Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians,” said the statement.

The announcement is significant, however, because the J&J vaccine is the only candidate being tested  that would presumably confer immunity with just one vaccine dose. The three other leading vaccine candidates now in Phase 3 trials by AstraZeneca, Pfizer and Moderna, all require two doses.

Along with the ease of distribution offered by a one-dose vaccine, the other advantage of the J&J canadidate is that the vaccine can be stored for at least three months at t 2-8° C – meaning that the vaccine would not require the special cold storage infrastructure that other vaccine candidates would need.

Like the AstraZeneca vaccine, the J&J candidate works by using an adenovirus as a vector (a carrier) of an antigen’s genetic code, to mimic components of the SARS-CoV-2 virus without causing severe disease, in a patented  AdVac® technology. The technology  also being tested in a J&J clinical trial of a vaccine against Ebola. The Astra-Zeneca vaccine was also been paused in the United States after two trial participants developed side effects, reported to be a rare form of spinal inflammation, myelitis.

In contrast, neither the Pfizer nor the Moderna vaccines so far have suffered significant interruptions.  Both companies are using a different, mRNA technology that uses an RNA fragment of the COVID-19’s characteristic spike to teach the body to mount an immune response. And in fact both companies recently said that they are on track to present the results of their Phase 3 clinical trial to the US Food and Drug Administration this fall,  later this month, in the case of Pfizer, while Moderna has said that it would present its results in late November.

The J&J Phase 3 trial started only on 23 September, late in comparison with other front-runner candidates where trials started over the summer.  But with an enrollment goal of 60,000 people on three continents, it was by far the largest trial of a vaccine candidate so far, and the one-dose regime appeared to give it a shot at rapidly yielding results.  Now those hopes appear to have been suspended, along with the trial.

 

Image Credits: Johnson&Johnson.

Colorized electron mmicrograph of SARS-CoV-2, the virus that causes COVID-19 (yellow) in a patient sample.

A study confirming the first case of a person reinfected with COVID-19 in the US and the fifth such confirmed case of reinfection worldwide was published in The Lancet Infectious Diseases journal on Monday. The findings suggest that protected immunity conferred by infection with SARS-CoV2 – a phenomenon that is not well understood yet – may not result in guaranteed total immunity. 

Infection with COVID-19 generates neutralizing antibodies in patients, however, the degree of immunity and the susceptibility to reinfection is unknown. In other coronaviruses, loss of immunity can occur within 1-3 years.  But the confirmed reports of cases of SARS-CoV-2 reinfection raise questions as to whether this virus will follow the same pattern. 

The case study of one individual in North America – who was initially infected in April and then reinfected within 48 days in June – provided genomic analyses of SARS-CoV2 on two occasions. The researchers found genetically significant differences between the two variants associated with the two instances of infection.

The patient’s second infection was more severe, requiring hospitalization with oxygen support, however, this was not a trend in three of the four other confirmed reinfection cases. The authors provided three hypotheses to explain the severity of the second infection, including the possibility that the patient was infected by a very high dose of virus the second time, inducing a more severe disease; the patient could have come into contact with a virulent version of the virus; and the presence of antibodies could make future infections worse. 

The findings of this study suggest that infection with SARS-CoV2 may not result in 100 percent protective immunity for all individuals and reinfection can occur within a short time frame. 

“There are still many unknowns about SARS-CoV-2 infections and the immune system’s response, but our findings signal that a previous SARS-CoV-2 infection may not necessarily protect against future infection,” said Mark Pandori, lead author of the study and director of the Nevada State Public Health Laboratory at the University of Nevada. 

The study was limited in its scope and calls for more research of reinfection and the degree of immunity for those exposed to COVID-19. While few cases of reinfection have been reported at this point, asymptomatic reinfection is also a possibility and likely is severely underestimated, according to the authors. 

“Overall, there is a lack of comprehensive genomic sequencing of positive COVID-19 cases both in the USA and worldwide, as well as a lack of screening and testing, which limits the ability of researchers and public health officials to diagnose, monitor, and obtain genetic tracking for the virus,” said Pandori. 

Research on reinfection and conferred immunity may have significant implications for vaccine development and application. Instances of reinfection likely mean that herd immunity can not be acquired by natural infection, instead, safe and effective vaccines, along with robust vaccination implementation, will be necessary to confer individual and herd immunity. 

 

Image Credits: NIAID.

For serious diseases, herd Immunity without large losses of life, is only attainable with vaccination (Graphic: NIH)

WHO issued a stiff warning to Covid-skeptics who have been saying that in the absence of a vaccine, policies that let the SARS-CoV-2 virus spread freely would lead to eventual “herd immunity” , and that might be preferable to continued containment and social-distancing measures. 

“Herd immunity is a concept used for vaccination, in which a population can be protected from a certain virus if a threshold of vaccination is reached, for example, that immunity against measles requires about 95% of the population to be vaccinated,” said WHO Director General Dr  Tedros Adhanom Ghebreyesus at a press briefing on Monday.   

“Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic. It is scientifically and ethically problematic,” added the WHO Director General.

Dr Tedros Adhanom Ghebreyesus, WHO Director General

He cited the lack of information about the strength and duration of any acquired immunity as being other big unknowns. 

And at best only about 10% of the global population has been infected so far with COVID-19, meaning that 90% remain uninfected and vulnerable to both the short-term risks as well as a range of emerging long-term impacts – which are still only emerging.  

“The vast majority of people in most countries remain susceptible to [COVID-19] virus,” he said.  “It is unknown how long this immunity lasts, or how strong it will end up being. Letting COVID-19 circulate would lead to unnecessary infections, suffering, and death.”

Dr. Maria Van Kerkhove, WHO Health Emergencies Technical Lead

Added Maria Van Kerkhove, WHO health emergencies technical lead, not only may acquired immunity after recovering from COVID-19 prove to be more transient than might be assumed, but the long-term effects of of the virus, even on mildly ill people, remains an open question: 

 “We are only now starting to really learn about the long term impacts on the heart on the brain on the lungs on mental health on people’s ability to to recover from COVID infection,” she said (See related story). “ And so not only do we need to work very hard at reducing mortality, and we are seeing the benefits of that we still need to reduce the numbers of infections that we are seeing.”

She stressed that the estimated infection mortality rate – that is the number of deaths in comparison not the actual degree of infection in the population – reported and unreported – is hovering around .6% – which is still six times higher than seasonal flu.  And those rates increase with age as well as in people with pre-existing infections.

Big Rise in Reported COVID-19 Cases Worldwide

Cumulative COVID-19 cases globally and by country, as well as daily new infection trends (right yellow)

The WHO officials spoke as the world continued to chalk up record increases in the number of reported new COVID-19 infections for the fourth day in a row – with numbers soaring, particularly in Europe and the Americas. Although infections in hard-hit Brazil now appear to be plateauing, those in Mexico and the USA have continued to rise. 

On Friday, the WHO announced a new high of daily COVID-19 cases worldwide, with over 350,000 reported infections, and that peak has been exceeded every day since then. The global total number of COVID-19 cases has now risen to over 37 million, with over one million deaths. 

“Around the world, we’re now seeing an increase in the number of reported cases of COVID-19, especially in Europe and the Americas,” said Dr Tedros. “Many cities and countries are also reporting an increase in hospitalizations and intensive care but at the same time, we must remember that this is an uneven pandemic countries have responded differently, and countries have been affected differently. 

Despite those increases, only an estimated 10% or less of the world’s population has been exposed to the SARS-CoV-2 virus that causes COVID, said Kerkhove, citing the pooled results of some 150 serological and epidemiological studies that have been conducted so far worldwide.

“So the world is still susceptible,” Van Kerkhove said, adding that WHO is now working with some 50 countries to provide an even more robust method for conducting such studies and pooling their results.

Not a choice between letting virus run free or shutting down 

However, with new outbreaks across Europe bringing record daily infections, populations also are showing greater resistance to renewed estrictions. Public health officials cite pandemic fatigue and a lack of public trust in health systems and governmental institutions as posing major challenges to national efforts to curb the spread of COVID-19.  

Dr Tedros urged countries to continue relying upon tried and tested tools, such as testing, isolating cases, quarantining contacts, use of masks and hygiene measures – as well as encouraging people to avoid crowds and closed settings, wherever possible. 

“It’s not a choice between letting the virus run free, and shutting down our societies.” said the WHO Director General. “This virus transmits mainly between close contacts and close outbreaks that may be controlled by implementing target measures. Prevent amplifying events, protect the vulnerable. Empower, educate and engage communities, and persist with the same tools that we have been advocating since day one. Find, isolate, test and care for cases, then test and quarantine their contacts. This is what countries are proving works.” 

The WHO officials stressed that disinfection strategies and hand hygiene also remain extremely important, particularly in light of the recent findings by Australia’s national science agency, CSIRO,  on the persistence of SARS-COV-2 virus on glass, stainless steel, plastic, and paper banknotes. The study found that the virus can survive for up to 28 days at 20 C° and 24 hours at 40 C° – although Van Kerkhove noted that the study was conducted with high virus concentrations in dark, contained settings – while sunlight and other factors in the natural environment may break down viral components more rapidly.  

The fact some countries, such as Spain may be seeing a surge in COVID-19 cases without the huge mortality impacts of the “first wave” in the spring, is testimony to the fact that the “clinical care is improving” and the world is “getting better at preventing outbreaks from happening,” said Health Emergencies Executive Director Mike Ryan. But he and Kerkhove both warned against complacency saying that right now, new infections in many European countries appear to be more concentrated among young people who have fewer underlying conditions. But even so, if infection rates are left to spin out of control, that could be “catastrophic” for older and more vulnerable groups.

WHO Advice For US President Donald Trump?  – ‘CDC Has Its Own Guidance’

Dr. Michael Ryan, WHO Executive Director of Health Emergencies

Asked to comment about the controversy surrounding President Trump’s decision to hit the presidential campaign trail again,  even before he has produced a negative COVID-19 test following recovery from his infection, the WHO officials refrained from offering advice to the US President – at least explicitly.  

“I am not going to give specific advice about individuals,” said Ryan. “But what we can say is that the US public health services have very clear criteria in place for what represents the release of an individual from what might be isolation.

“From WHO’s perspective, we allow both testing and duration of the number since the onset of symptoms, both approaches are offered to our Members States as mechanisms,” he added, saying that the duration of the isiolation should be counted as “Ten days from the onset of symptoms, plus three days from the … cessation of the last symptoms. And again, all countries have adapted that according to their national protocols, and therefore we will not comment on whether any specific individual meets the requirements of their national protocol.”

Image Credits: NIH Image Gallery, R Santos/HP Watch, Johns Hopkins University.

Human Brain

Cognitive symptoms are being reported by thousands of COVID-19 survivors, even those with mild symptoms and no previous medical conditions. The symptoms often include memory loss, confusion, difficulty focusing, and dizziness. 

A study published just last week covering more than 500 hospitalized patients in Chicago, found that some 82% had experienced neurological symptoms at some point during the course of their disease. The most frequent manifestations were myalgias or muscle pain, (44.8%); headaches (37.7%); encephalopathy, or altered brain function  (31.8%); dizziness (29.7%), dysgeusia, or distorted sense of taste (15.9%); and anosmia, or a loss of small (11.4%). Overall, neurologic pathologies were associated with increased morbidity and mortality, according to the study published in the journal of the American Neurological Association. 

Other studies of post-discharge patients hospitalized with COVID-19, found a wide range of common persistent symptoms, including fatigue, dyspnoea, loss of memory, concentration, and sleep disorders. 55 percent of patients experienced fatigue and 34 percent had loss of memory even 110 days after being discharged.

A report published in the CDC’s Morbidity and Mortality Weekly Report, surveyed 274 symptomatic adults with mild COVID-19 symptoms and found that 35 percent of interviewees had not returned to their usual state of health 2-3 weeks after their initial positive test result. For individuals aged 18-34, 26 percent experienced prolonged illness. 

Some researchers suspect that COVID-19 infections can cause long-lasting changes in the immune system, but further research and long term follow-ups are needed to understand the processes at play. 

WHO – We Are Only Beginning To Understand Long-Term Health Impacts

“We are only beginning to understand the long-term health impacts among people with ‘long-COVID’ so we can advance research and rehabilitation,” said WHO’s Dr Tedros Adhanom Ghebreyesus, speaking at a WHO press conference on Monday, where he warned about the dangers of letting the virus to run free with the hope that the global population might reach some kind of herd immunity.

These persistent symptoms are having serious consequences for patients’ jobs and their ability to return to their daily lives. Speaking to the New York Times, Rick Sullivan, a COVID-19 survivor who has had cognitive symptoms since his recovery in July, said “It is debilitating. I’ve become almost catatonic. It feels as though I am under anesthesia.”

“There’s no question that there are a considerable number of individuals who have a post viral syndrome that really, in many respects, can incapacitate them for weeks and weeks following so-called recovery and clearing of the virus,” said Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, in a review article of the issue published by the JAMA network in late September, entitled “As Their Numbers Grow, COVID-19 ‘Long Haulers’ Stump Experts.”  

Fauci noted that in some individuals, the symptoms are suggestive of myalgic encephalomyelitis/chronic fatigue syndrome, however the causes of persistent COVID-19 cognitive symptoms are currently unknown. 

Mady Hornig, a faculty member of Columbia University Medical Center’s epidemiology department, was quoted in the same review saying, “because of the large number of COVID-19 cases occurring simultaneously, we have a unique scientific window and a huge responsibility to investigate any long term consequences and disabilities that COVID-19 survivors may face.”

Both WHO as well as other experts and researchers have thus underlined the importance of telling the public about the risks of prolonged COVID-19 symptoms and illness. Even if individuals are not considered high risk, precautionary measures need to be taken to avoid infection with SARS-CoV2 and the potential post-viral syndrome after COVID-19, Dr Tedros emphasized in his press conference, using “every tool in the toolbox.”  

-Raisa Santos contributed to this story.

Image Credits: DigitalRalph.

China’s Foreign Ministry Spokesperson Hua Chunying at Friday’s press conference.

China has announced that it will join the WHO co-sponsored COVAX vaccine procurement pool, along with the Republic of Korea.

WHO’s Director General Dr Tedros described it as a major boost to the global effort to manufacture and distribute 2 billion vaccines worldwide equitably by the end of 2021.

“This week, China and the Republic of Korea have now joined the COVAX facility, bringing the total number of countries and economies that are part of the global initiative for vaccine accesses to 171,” said Dr Tedros, speaking at a WHO press conference on Friday.

Tedros said that the facility would enable WHO to “distribute vaccines simultaneously to priority populations, including health care workers, older people and those with underlying conditions.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General at a press conference on Friday.

In a related move, the WHO Director General said, “We also welcome the announcement by one vaccine developer, Moderna, that it will not enforce its patent rights over its COVID-19 vaccine during the pandemic.”

The company, in an announcement Thursday to shareholders, said it would “not enforce” its COVID-19-related patents against other companies making vaccines to combat the pandemic – and would also be willing to license intellectual property for their COVID-19 vaccines for the post pandemic period.

But Moderna’s chief executives stopped short of saying whether the company would formally offer its vaccines through the COVAX procurement pool that WHO and Gavi, the Vaccine Alliance, are co-sponsoring, or whether it would engage with the ‘COVID-19 Technology Access Pool,’ which aims to reduce IP barriers for low and middle income countries that need to access COVID-19 health products.   

Said Dr Tedros, “We look forward to learning more about what this announcement means in terms of technology transfer. We appreciate this act of solidarity, which is in line with the principles of the COVID-19 Technology Access Pool.”

In announcing the move to join the vaccine facility, a Chinese Foreign Ministry spokesperson said: “We are taking this concrete step to ensure equitable distribution of vaccines, especially to developing countries, and hope more capable countries will also join and support Covax.” 

The moves by China, as well as Korea, mark a major signal of support for the global initiative, particularly after the United States in September said it didn’t want to be “constrained by multilateral organizations influenced by the corrupt World Health Organization and China.” The US go-it-alone approach to COVID-19 vaccine access and distribution, is based on its own sizable pre-purchase agreements with leading pharma developers of front-runner vaccine candidates, including Moderna, Pfizer, and Johnson & Johnson. The European Union has also thrown its support behind the facility, along with non EU  Switzerland and Norway, as well as Japan.

Vaccine Campaigns Need to Be Restarted

In other matters, Dr Tedros called upon the global community to jumpstart stalled immunization campaigns for other diseases, following a meeting on Wednesday of WHO Strategic Advisory Group of Experts (SAGE) on Immunization.

“Millions of children globally are missing out on life saving vaccines. Rapidly restoring immunization clinics, campaigns, and outreach activities is the only way to prevent predictable outbreaks and deaths from diseases like measles and polio,” said Dr Tedros at a press conference on Friday. 

A report by SAGE found that over 80 vaccination campaigns have been either delayed or cancelled by the COVID-19 pandemic in more than 50 countries, leaving millions of children and adolescents unprotected against deadly, but vaccine preventable diseases.

The WHO expert group highlighted the double danger that interrupting vaccine campaigns could pose during the pandemic, saying it could lead to a resurgence of deadly preventable diseases, including measles, polio, diphtheria, and yellow fever. 

Press conference on Friday on the recent biannual meeting of Strategic Advisory Group of Experts on Immunization.

The interruptions have been due both to the extra burden on health systems caused by COVID-19, as well as the decreased demand for vaccination because of national lockdowns and physical distancing requirements, the expert committee said.

Prior to the COVID-19 pandemic, approximately 14 million children under the age of one did not receive any vaccines. According to a recent study, the pandemic and national response policies reduced daily vaccination visits by 52 percent in Karachi, Pakistan and immunization doses given by outreach services dropped by 88 percent. 

Backsliding could prompt renewed outbreaks 

Alejandro Cravioto, Chair of SAGE, underscored the importance of learning from the Ebola epidemic in the Democratic Republic of Congo, where an outbreak of measles was occurring simultaneously in 2019. The measles outbreak had higher rates of deaths and confirmed cases than Ebola, with the worst impact on children. 

“Our immunization services are really compromised when we have another problem we’re handling,” said Cravioto at a WHO press conference earlier on Friday. “I think what is important is to make sure that we see all of these as a single entity, as the single problem that we have.

We might be vaccinating the elderly against COVID. And we have to make sure that we’re vaccinating the younger ones against all the other diseases for which we have a vaccine. But this has to be an integrated approach.”

Guidelines produced by SAGE in March provide countries with a roadmap to the provision of immunization services during the COVID-19 pandemic. While individual countries are advised to make domestic risk assessments, SAGE informs decision makers of the necessity to continue immunization services – prioritizing catch-up immunization on vaccine preventable diseases – and strengthen health system capacities and provision of essential health services. 

“We have to stand back up the immunization program, which is the bedrock for primary health care services in so many countries, and will be the bedrock for the delivery of COVID vaccines,” said Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals at WHO.

WHO Addresses the Toll of COVID-19 on Mental Health

In his Friday briefing, Dr Tedros also highlighted the need for increased attention to and investment in mental health, a deeply neglected issue. Close to one billion people globally are living with a mental health disorder and one person dies every 40 seconds by suicide, according to WHO. 

The lack of access to quality mental health services is especially prevalent in low and middle income countries – with over 75 percent of people with mental, neurological and substance abuse disorders receiving no treatment. And on average only two percent of countries’ health budgets are spent on mental health. 

The COVID-19 pandemic has exacerbated existing mental health issues and has triggered new ones. A recent WHO survey found that over 90 percent of the world’s countries reported disruptions of critical mental health services as a result of COVID-19.

“It’s time to increase investment in mental health services on a massive scale so that access to quality mental health services becomes a reality for everyone,” said Dr Tedros. 

On Saturday, World Mental Health Day, the WHO is hosting an online global advocacy event, The Big Event for Mental Health on its @WHO Twitter and Facebook channels. The event, including musicians, film, artists and speakers, co-designed with United for Global Mental Health and the World Federation of Mental Health, to focus attention on mental health and increase funding for mental health services.

Image Credits: Ministry of Foreign Affairs of the People's Republic of China, WHO.

Refugees in Uganda receive their monthly emergency ration from the World Food Program.

The United Nations World Food Program (WFP) has been awarded the 2020 Nobel Peace Prize for its efforts in fighting hunger in a year when food supplies for millions of people have been disrupted by COVID-19, destroyed by flooding and devoured by unprecedented locust swarms spreading across Africa and beyond.

In Friday’s announcement, the Oslo-based Nobel Committee, said it had awarded the prize to WFP “for its efforts to combat hunger, for its contribution to bettering conditions for peace in conflict-affected areas and for acting as a driving force in efforts to prevent the use of hunger as a weapon of war and conflict.”

“Until the day we have a medical vaccine, food is the best vaccine against chaos,” said Berit Reiss-Andersen, Nobel committee chair, in announcing the award. She called upon the international community to boost funding for WFP at a critical moment when the COVID-19 pandemic is wreaking havoc with the global economy.

WFP replied, saying, “WFP is deeply humbled… “This is in recognition of the work of WFP staff who put their lives on the line every day to bring food and assistance to more than 100 million hungry children, women and men across the world.”

World has Faced Special Challenges in Food Security This Year

In its award announcement the Nobel Prize Committee noted that: “The World Food Programme is the world’s largest humanitarian organisation addressing hunger and promoting food security. In 2019, the WFP provided assistance to close to 100 million people in 88 countries who are victims of acute food insecurity and hunger.

“The coronavirus pandemic has contributed to a strong upsurge in the number of victims of hunger in the world,” Reiss-Anderson said. “In recent years, the situation has taken a negative turn. In 2019, 135 million people suffered from acute hunger, the highest number in many years. Most of the increase was caused by war and armed conflict.

“In countries such as Yemen, the Democratic Republic of Congo, Nigeria, South Sudan and Burkina Faso, the combination of violent conflict and the pandemic has led to a dramatic rise in the number of people living on the brink of starvation. In the face of the pandemic, the World Food Programme has demonstrated an impressive ability to intensify its efforts.

The award commitee stressed that the fight against world hunger has special meaning in the pandemic year.

“According to the most recent reports, the COVID-19 pandemic could tip over 130 million more people into chronic hunger by the end of 2020, due to the economic disruptions that have occurred worldwide, often hitting hardest at the poorest countries and economies.”

In the WHO African region alone, an additional 22 million people were undernourished as a result of the economic fallout from COVID-19 lockdowns – on top of the 200 million Africans that are already undernourished, said World Food Programme officials predicted earlier this year. 

The UN State of World Food Security and Nutrition published in July, estimates that almost 690 million people went hungry in 2019 – up by 10 million from 2018. High costs and low affordability also mean billions cannot eat healthily or nutritiously. The hungry are most numerous in Asia, but expanding fastest in Africa.

The majority of Africa’s population lives hand-to-mouth, and lack of income opportunities under the lockdowns have left many people unable to afford food. The cost of basic foodstuffs increased, and deliveries of essential food supplies were also delayed due to trade and travel restrictions imposed earlier in the year.

Over the course of 2020, East Africa and the Horn of Africa have also faced a series of unprecedented, overlapping natural disasters, including a record season of flooding and locusts, according to a recent report by the International Federation of the Red Cross (IFRC).

The widespread flooding in Ethiopia, Kenya, Somalia, South Sudan, Tanzania, Rwanda and Uganda during the spring displaced around 500,000 people. The flooding also set back key interventions against the worst locust crisis the area has faced in decades.

Announcement ends Speculation of WHO and Greta Thunberg as contenders

The announcement ended speculation about a range of other contenders for the prize, from the World Health Organization to climate activist Greta Thunberg, who was also passed over in 2019.

“Are there really people who seriously believe that I will win. It’s not serious. Of course not, I won’t win. Why would I win?”  the climate activist, Thunberg told reporters while appearing at a Fridays for Futures climate protest in Stockholm Sweden.

Speaking at a press conference later Friday, WHO Director General Dr Tedros Adhanom Ghebreyesus, said “I would like to congratulate the World Food programme upon being awarded the Nobel Peace prize today. Every day WFP does tremedous work in countries. We are delighted for WFP and for the whole UN family.”

Added the WHO head of health emergencies, Mike Ryan, who worked with the agency in West Africa, “WFP rocks. Well done WFP.”

World Food Programme lauded for its Work Addressing Upsurge of Needs

Created in 1961, the World Food Programme today provides food for over 90 million people a year. It has stepped up its operations significantly in recent months as the impact of the Covid-19 pandemic has expanded.

WFP has faced a drop in financial contributions in recent years as countries reduce funding for global organisations – and it was clear that the Nobel Committee’s award aimed to send a message to donors.

“This is also a call to the international community not to underfund the World Food Programme,” Reiss-Andersen said. “This is an obligation, in our mind, of all states of the world to ensure that people are not starving.”

-Pip Cook/Geneva Solutions contributed to this story

 

Image Credits: Flickr – USAID, Flickr – USAID.

Mother practices breast feeding her baby in the hospital maternity room in Ethiopia.

One stillbirth occurs every 16 seconds worldwide with approximately 2 million stillborn babies a year, says the first UN-wide report to document the global scale of the issue.

And COVID-19 related interruptions in maternal and child care services, particularly emergency obstetric care, could lead to an additional 60,000 to 200,000 stillbirths over the next 12 months, warns the report that was jointly produced by UNICEF, the World Health Organization, the World Bank and the Population Division of the United Nations Department of Economic and Social Affairs.  

“COVID will have an increase, reversing the gains that we have made,” said Anshu Banerjee, Director of the Department of Maternal, New born, Child and Adolescent Health and Ageing at the WHO, speaking at a press briefing on the report, which was released today. “However, we have seen that it is possible to make progress,” by strengthening health systems, improving the quality of care, and increasing the skills of birth attendants.” 

The WHO defines a stillbirth as babies born with no signs of life at 28 weeks of pregnancy. Approximately 2 million babies are stillborn every year. Often, these are deaths that lead to long-lasting psychological and financial consequences for women and their families.

In the majority of cases, stillbirths could have been avoided with high-quality care antenatally and during birth. The global issue of stillbirths is largely neglected in terms of research, data collection, and funding for interventions – although there is increasing recognition of the issue as a critical global health problem. 

“Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Executive Director of UNICEF Henrietta Fore. 

The report finds several reasons for these preventable deaths, including: absence of or poor quality of care during pregnancy and birth, lack of investment in preventable interventions, absence of global and national leadership on the issue, and few established global targets. 

Access to Emergency Obstetric Care Could Reduce Scale Of Problem

With over 40 percent of stillbirths occurring during labour, access to emergency obstetric care and improved monitoring could reduce their scale, the report finds.  

“The tragedy of stillbirth shows how vital it is to reinforce and maintain essential health services, and how critical it is to increase investment in nurses and midwives,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. 

84 percent of stillbirths occur in low- and middle-income countries, with 3 in 4 stillbirths taking place in sub-Saharan Africa or Southern Asia, according to the report. In sub-Saharan Africa, 1 in 46 babies are stillborn, compared to the global average of 1 in 72 or the European and Northern American average of 1 in 321. 

Stillbirth rates globally per 1,000 births in 2019.

There are substantial disparities in stillbirths between income groups. And strikingly, one-half of all stillbirths occur across six countries – India, Pakistan, Nigeria, Democratic Republic of the Congo, China, and Ethiopia. The risk of a stillbirth is 23 times higher in the worst affected countries compared to countries with the lowest stillbirth rates. 

Access to health care, maternal education, socioeconomic status, and ethnicity are other factors that contribute to the variations in stillbirth rates. Notably, higher rates are observed in rural areas, among women without post-secondary education, in groups on the lower end of the socioeconomic spectrum, and among ethnic minorities. 

Over the past two decades there has been slow progress on preventing stillbirths. Although the global stillbirth rate declined by 35 percent since 2000, progress has lagged in comparison to achievements in reducing maternal and under-five mortality rates. 

The Every Newborn Action Plan (ENAP) was launched in 2014 to provide evidence-based solutions to prevent newborn deaths and stillbirths. It established a target rate of 12 stillbirths per 1,000 total births to be achieved by 2030 and issued guidelines for national steps to achieve this goal, which includes investing in quality antenatal and delivery care. 

Projected number of stillbirths by different scenarios from 2020 to 2030.

Currently, 56 countries are at risk of missing the ENAP target by 2030, 34 countries are at risk of missing it by 2050, and eight countries will not meet the target by the end of the century, according to the report. 

Projections for the next decade estimate that 20 million babies will be stillborn by 2030, of which 2.9 million could be prevented. In order to curtail the current trend, the new report calls for increased political will, smart policies, and targeted investment in antenatal and delivery care to accelerate progress towards the ENAP aims and Sustainable Development Goals. 

COVID-19 Exacerbates Existing Stillbirth Trends

The COVID-19 pandemic has disrupted health systems and services globally, including antenatal and labor care. The report projects that these disruptions could lead to 60,000 to 200,000 additional stillbirths over 12 months, increasing the global number of stillbirths by 3.2 to 11 percent. The impact is expected to be greatest in Armenia, the Dominican Republic, Jamaica, Egypt, Iraq, Pakistan, and South Africa, among others. 

“COVID-19 has triggered a devastating secondary health crisis for women, children and adolescents due to disruptions in life-saving health services,” said Muhammad Ali Pate, Global Health Director for Health, Nutrition and Population at the World Bank. 

The collective action plan provided by the report emphasizes the importance of reducing stigma, supporting bereaved families, strengthening health systems, nationalizing and localizing stillbirth targets, prioritizing equity through investment, and improving the measurement of stillbirth data. 

 

Image Credits: Flickr – UNICEF Ethiopia, UNICEF.

Moderna’s mRNA research and innovation centre

Moderna, Inc., developer of one of the four front-running COVID-19 vaccine candidates, announced on Thursday that the the company would “not enforce” its COVID-19-related patents against other companies making vaccines to combat the pandemic – and would also be willing to license intellectual property for their COVID-19 vaccines for the post pandemic period. 

“We feel a special obligation under the current circumstances to use our resources to bring this pandemic to an end as quickly as possible.” said the company’s statement, which raises the bar on corporate policies around patents as the world fights a pandemic. “Accordingly, while the pandemic continues, Moderna will not enforce our COVID-19 related patents against those making vaccines intended to combat the pandemic. 

“Further, to eliminate any perceived IP barriers to vaccine development during the pandemic period, upon request we are also willing to license our intellectual property for COVID-19 vaccines to others for the post-pandemic period. Moderna is proud that its mRNA technology is poised to be used to help end the current pandemic.”

Speaking at a webcast of the company’s 8 October update where the announcement was made public,  Stephen Hoge, president of Moderna told investors, “It is our responsibility to be upfront and transparent, but we’re not going to be using those patents and try to enforce them.”    

Added Tal Zaks, Moderna Chief Medical Officer at the presentation:  “It is the right thing to do, to protect the population.”  

Leading Medicine Access Advocate Applauds Moderna Announcement – Others Demand More 

The announcement was greeted with applause by one leading medicines access advocate, Jamie Love of Knowledge Ecology International, who said that the new Moderna policy offers a model that other pharma companies should follow: 

Statement by Moderna on Intellectual Property during COVID-19 Pandemic

“Moderna is the only company manufacturing a drug or vaccine that has made a pledge to openly share its COVID-19 patents,” Love, generally an outspoken critic of pharma positions, told Health Policy Watch.  “And the statement includes both the period during the pandemic, and an offer to license in the post-pandemic,”

Love added that the commitment, “should be matched by every manufacturer of a therapeutic, vaccine or diagnostic test…”  

Love contrasted the Moderna pledge with the fact that Oxford University had granted the pharma company AstraZeneca exclusive rights to the IP associated with the adenovirus vector vaccine technology that they are co-developing, with backing from the Bill and Melinda Gates Foundation.  

“This makes the deal that Oxford and Gates struck with AstraZeneca look absurd,” Love said, adding that no matter how rights are used during the pandemic, the framework of the latter also leaves AstraZeneca to “tighten the screws” when the pandemic is over while, “Moderna will provide licenses that extend post-pandemic.”    

A KEI statement, however, added that Moderna should still go further and “engage with the WHO COVID-19 Technology Access Pool (C-TAP) and the Medicines Patent Pool” – which are serving as vehicles for more systematic pooling of vaccines and their patents. “Every manufacturer of a vaccine, drug or diagnostic should follow suit and publish the patents relevant to the technology, waive or license rights in those patents, and  provide constructive transfer of manufacturing know-how and access to cell lines and data when necessary”.

Other advocates expressed skepticism about the reasons behind the moves, saying that the announcement was motivated by pending legal challenges to Moderna IP claims, as well as rising consumer and political pressures:  Moderna “should not be lionized for taking baby steps on access when we are in a race for our lives,” stated an op-ed by Asia Russell, Brook Baker and Jessica Bassett, published by HealthGap Global Access Project:

“It is no accident that Moderna’s announcement comes less than a week after South Africa and India filed a petition to the World Trade Organization calling for waiver or suspension on the granting or enforcement of any intellectual property protections on COVID-19-related medical technologies for the duration of the pandemic.

“But Moderna knows that this non-enforcement-of-patents concession is meaningless without a commitment to share not only the patents, but also all the information, know-how, data, and biologic resources needed for other qualified vaccine manufacturers to produce the vaccine economically and at scale to meet global need. Moderna should fully commit to sharing all necessary rights and knowledge through the WHO COVID-19 Technology Access Pool (C-TAP), with no artificial time limitation based on the severity of the pandemic.”

Moderna To Submit Vaccine Candidate to FDA 25 November for Approval

The Moderna announcement comes just days after Moderna’s chief executive officer Stéphane Bancel said that the company aims to submit the candidate vaccine to the FDA for emergency use authorization by 25 November 2020. The company then intends to submit the vaccine as a candidate for the general population by late January. If approved, the vaccine would be available for widespread distribution by spring 2021. 

Stéphane Bancel, CEO of Moderna

Based in Cambridge, Massachusetts, Moderna is a biotechnology company pioneering the development of messenger RNA (mRNA) vaccine and therapeutics. The mRNA-1273 technology contains the “coding” for a stabilized form of the Spike (S) protein that is characteristic of the SARS-CoV2 virus that, which was co-developed by Moderna and investigators from NIAIDS’s Vaccine Research Center.

Moderna’s vaccine candidate uses novel mRNA technology to prime and boost the immune response in regards to antibody neutralization across all age groups. Effectively, the vaccine  “teaches” human cells to induce an immune response that could build the body’s own defense against COVID-19. 

The company’s Phase 3 study of RNA-1273, the vaccine candidate against COVID-19 began in July, and is close to its target enrollment of around 30,000 US participants.

AstraZeneca and Pfizer are also in late-stage Phase 3 testing; however, AstraZeneca’s timeline has been stalled after reports of severe side effects from several trial participants administered its vaccine candidate, which is based on a different technology. Participants from both Moderna and Pfizer’s Phase 3 studies have reported symptoms of high fever, body aches, headache, and exhaustion after receiving the respective candidate vaccines. The two companies have recognized that there is potential for the recipients of their vaccines to induce “mild” side effects similar to mild COVID-19 symptoms.

Tal Zaks, chief medical officer at Moderna
Other Pharma Companies Received Billions in Public Subsidies – But Holding Patents Close

Only recently, KEI sharply criticized Moderna for failing to disclose public funding from BARDA [US Biomedical Advanced Research and Development Authority]as well DARPA, (Defense Advance Research Projects Agency), in its patent applications, and the two agencies are currently examining the alleged omissions.

But even if the company made the announcement under burgeoning consumer and government pressure, its new policy still contrasts sharply with other firms that have benefited from similar public subsidies for urgent COVID-19 research, but are retaining their patent rights close to their chest.  

Among those, BioNTechSE, partner of Pfizer Inc., have been adamant about their about complete ownership of their vaccine patents – even when they, too, benefitted from large US government subsidies. 

 “Contrasts should be drawn between Moderna and other companies, including in particularly those that have benefited from massive subsidies from governments and foundations, that are not even making patent landscapes transparent, let alone making the inventions widely available,” said Love in the KEI statement..

“Moderna is also making it clear that government agencies like the NIH [National Institutes of Health] and BARDA have been too willing to grant or enable exclusive rights when subsidizing COVID-19 research.”

 

Image Credits: Moderna, Moderna, Moderna, Moderna TX.

Punjab, India – Crop burning reduces crop yield and worsens air pollution.

With fires from crop stubble burning spreading across northern India heralding the beginning of Delhi’s winter air pollution season, Delhi’s Chief Minister Arvind Kejriwal has pledged to take pre-emptive action – announcing a ‘war on pollution,’ led from a ‘war room’ that he will personally command. His arsenal includes a seven-point action plan that will include:  tracking the city’s hotspots; launching a ‘green Delhi’ mobile app to address open air burning complaints; and repairing the city’s potholed roads to control dust.  But his most powerful weapon for now could be a cheap and simple rapid compost brew, Pusa Decomposer that he hopes will inspire farmers in surrounding rural states to turn their crop waste into valuable fertilizer rather than burning it.

If Kerjiwal’s initiative succeeds, that could mark a turning point in decades of inaction contributing to northern India’s bleak air pollution situation – as well as climate change.

If not, Delhi and neighboring areas are headed for what Indians are now calling an ‘Airpocalypse’, or toxic pollutant-laced air that is poised to exacerbate COVID-19 respiratory disease in a country that has the second highest coronavirus case toll in the world.

In particular, cases are surging in the very regions facing potential air pollution emergencies. While Punjab is about to cross one 100,000 positive cases, Haryana has reported 118,000 cases so far. Delhi, one of the worst affected states of the country, has 260,000 infections so far. And the evidence that air pollution puts people at an increased risk of COVID-19 is strong.

But the war on air pollution has only been declared. And time for Delhi is quickly running out, as the seasonal crop burning in neighbouring rural regions of Punjab, Haryana and Uttar Pradesh, which fuel Delhi’s air pollution, has aleady begun, while the city’s Air Quality Index already crossed the 200 mark yesterday after months of double digit levels. 

In addition, it’s so far unclear how much backing Kerjriwal will receive for his war from Prime Minister Narendra Modi – a political rival who has remained largely indifferent to the criticism heaped upon him nationally and globally over his failure to take action on practical matters like stubble burning – as well as the bigger picture of expanded dirty coal power production. His ruling Bharatiya Janata Party is already grappling with farmers already agitating against the passage of three agriculture bills in Parliament last month.

New Delhi, India – Toxic smog blocks out the sun.

Crop waste fires contribute to nearly half of Delhi’s Pollution in Peak Season

Due to an unfortunate convergence of weather and geography, the impact of rural crop burning on Delhi and other parts of northern India’s plains is huge. Particularly in the autumn months, preveailing winds bring the smoke emitted by crop burning into the city. Low wind speeds, dry weather, and temperature inversions combine to keep pollutants trapped in and around the metropolis and the wider region. The Himalayas form an additional barrier to the north, preventing toxic pollutants from dissipating. Past year’s have seen record air pollution events, with levels reaching hundred of times higher than the WHO’s recommended limits, and urban average are among the highest in the world. 

Altogether, it is estimated that crop burning in the States of Punjab and Haryana last winter accounted for up to 44% of Delhi’s air pollution during peak burning periods in autumn 2019, Central Pollution Control Board Member Secretary Prashant Gargava stated.  The burning of crop stubble by farmers in Punjab and Haryana cause fires so large that they can be seen from outer space.

This year, again, Nasa satellite data tracking PM2.5, the most health-harmful particulate pollutants, has already begun showing small spikes caused by farm fires, although the worst is yet to come. Fires usually peak to around 4,000 per day by late October and smoke from these add to the existing urban pollution load of vehicles, construction, road dust and other sources. So any measures to deal with crop stubble, if successful, would be significant.

True colour image and aerosol optical thickness (AOT) showing smoke depth from open agricultural burning in India in fall 2016 spreading across the northern plains, NPP VIIRS satellite data, NOAA View

At the same time, to really turn the corner on air pollution year round, the Delhi leader also needs to update plans on existing solutions like increasing electric buses for public transport; enacing stricter waste management measures; stricter enforcement and penalties for emissions from coal power plants; and better controls on upcoming government construction projects that could have a large pollution footprint. 

On the plus side, critics see it as a good sign that the Delhi Chief Minister’s initiative addresses multiple sources of pollution – instead of only focusing on the politically-charged crop residue burning by farmers from neighboring states. He has, in fact, reiterated his commitment to strengthen the newly-announced electric vehicle policy and denounced coal power plants that aren’t meeting their emission norms, while also announcing a renewed focus on transplanting mature trees rather than saplings to replace those sacrificed to new construction.

Serious implementation of a mix of these initiatives, including the composting technology, will be key to any significant reduction in air pollution, especially as the economy gears up to recover from the Covid-induced lockdown.

India had the world’s highest outdoor air pollution rate in 2017

Composting crop waste to save Delhi’s air 

In the states of Haryana, Punjab, Rajasthan and Uttar Pradesh, farmers produce almost 50 million tons of straw a year, four fifths of which are burnt, concluded a joint industry-government report in Bloomberg. CIMMYT’s more conservative estimates say farmers in northern India burn an estimated 23 million tons of straw from their rice harvests. That enormous mass of straw, if packed into 20-kilogram 38-centimeter-high bales and piled on top of each other, would reach a height of over 430,000 kilometers — about 1.1 times the distance to the moon.

Burning of crop residue not only releases toxic gases into the air, it also burns precious nutrients away from soil, reduces crop yields, and promotes excessive use of fertilizers, according to the International Wheat and Maize Improvement Center. Use of fertilizers is not only more expensive for governments, which provides massive fertilizer subsidies, it also increases costs for farmers.

In mid-September, a task force led by PK Mishra, principal secretary to Prime Minister Narendra Modi met with the states of Punjab, Haryana and Uttar Pradesh to brainstorm how farmers can limit stubble burning and reduce pollution.

Of all the measures that are being discussed, the Pusa Decomposer seems to be the most promising.  The technology includes four ‘bio-decomposer’ capsules that can be dissolved into a liquid formulation, sprayed on shredded paddy straw, turning it into manure, said Dr YV Singh, principal scientist at the Indian Agricultural Research Institute. 

“The four capsules in a pouch can be used to make 25 litre solution which can then be used on one hectare or 2.5 acres of field,” he told India Today last week. “This capsule will help in curbing the practice of crop burning. This can be used in all forms and on any farm.”

Whereas rice paddy straw from the summer’s harvest normally takes 45 days to compose even if it is shredded, the Pusa Decomposer speeds up the process to  25 days, according to Singh. Shortening the process would give farmers time needed to prepare fields for their winter wheat crop – without harming having to burn their fields.  

Delhi officials are now trying to promote the idea amore widely: ‘This will end stubble burning and pollution to a huge extent,” said Delhi State’s Environment minister Gopal Rai. “We are planning to provide all sorts of help to farmers so that Delhi is safe from stubble burning,” he added. 

Growing the wrong crop at wrong time in wrong state

Wheat field in Punjab, Pakistan – sown after the rice harvest is finished.

Crop-stubble burning isn’t new. But it has become much more common in the past decade, after a government order in 2009 compelled farmers to begin sowing their rice seeds in June at the beginning of the monsoon season, rather than in April, when the weather is still hot and dry. The new policy was intended to ensure that the first monsoon rains recharge groundwater reservoirs before the rice planting began, but it backfired.

As a result of delaying the time of the harvest to early autumn, farmers have struggled to clear their fields in time for the next planting season, leaving them no other choice but to burn their fields – the quickest option they had.

Winds also change direction by October, so if paddy fields are on fire due to the later harvest, toxic smoke from the north blows directly towards urban areas with dense populations such as Delhi, as well as satellite towns known as the National Capital Region –  choking roughly 46 million residents in the area.

More fundamentally, rice is one of the most water-hungry crops in the world, and Punjab isn’t the ideal location to grow rice at all, as its groundwater levels are chronically low; rice also requires standing water in its early stages of growth.  Traditionally the area grew wheat and other nutrient-rich legumes and grains, which were more in tune with local conditions – and also healthier diets. 

However, over the past few decades, government rice subsidies encouraged farmers to grow so much rice that India has now become one of its largest exporters, at 12 million tonnes a year. Even the government’s own stocks are now more than twice the required level. By growing so much rice, environmentalists, the country is effectively exporting its most precious resource – water – out of the country. Some have theorized that Punjab’s shifts in crop sowing and production patterns have also been encouraged by the government and industry promotion of genetically modified Bt rice seeds.  The agrochemical conglomerate Monsanto has been promoting the seeds, which include genetic material from the Bacillus thuringiensis to ward off pests across Asia, although so far China has resisted, India was more accomodating. 

Monsanto seeds are less nutritious than traditional varieties, and result in high levels of silica in soil

An analysis by the NGO Ecologise Network explains that the government subsidies, along with the industry promotion of GM seed varieties has, over time, undercut production of  more nutritious, traditional varieties of legumes, grains and seeds. These were not only less water-hungry but also easier to manage after harvests because they did not require widespread burning. Some of the new varieties of rice also leave high silica levels in paddy stalks, making them unusable for use as animal fodder.   

The network also charges that other Monsanto GMO maize and wheat products are contributing to the destruction of bee colonies that pollinate 90% of the world’s food supply, including plants vital to Indian food production, also replacing human food stocks with ones destined for animals.  

“Monsanto’s GMO maize is also not fit for human consumption and is primarily used as chicken feed. Likewise, most of Monsanto’s wheat is used to feed animals because it is unfit for human consumption,” charges the NGO.  

Getting more with less: the power of ancient grains  

Merely by shifting its subsidy policies and food support, the government could easily persuade farmers – and consumers – to switch back to traditional Indian coarse grains that are more nutritious, use less water, and don’t need to be burned at  the end of the season, critics say. These include pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize – all of which are traditionally grown in India. These grains have a high iron content and are perfect for a country that harbors one quarter of the world’s cases of anaemia. 

These traditional crops would also give farmers a longer window of time to clear their fields so they don’t have to slash and burn so hurriedly. Furthermore, with India’s ethanol policy 2018, any ethanol produced as a by-product can help farmers augment their income. For the country as a whole, investing in ethanol would also help create new employment opportunities and to save on oil imports.  

Until recently, the government’s main alternative to crop burning involved the promotion of tractors such as the ”Happy Seeder”, that mechanically cut stubble and sow seeds, and which have become popular in Punjab. However, critics say that the diesel-run machines are not only polluting but expensive to operate.  And they have not gained widespread acceptance either. Farmers in the neighboring state of Uttar Pradesh, for instance, have instead opted for more traditional farming techniques, as well as seed varieties that produce less stubble and silica than their counterparts in Punjab.

India could halt subsidies for the Happy Seeder – a dirty diesel-run machine to cut stubble and sow seeds

Improving Appetite For Stubble – IKEA Leads Way

At the same time, whether or not stalk waste is  processed by big tractors or more traditional methods, farmers will stop burning crop stubble if they can cut it and sell it. So solutions that reuse farm waste, and preferably monetize it, also  incentivize farmers not to burn it. Some advocates have proposed that the government directly pay farmers to deposit crop waste at collection centres or link it to their support price payments. 

Still other solutions would involve subsidies to entrepreneurs that create solutions to tackle crop stubble burning, such as green refrigeration systems powered by farm waste or ecologically-based crockery or textiles, which also reduces plastic use.

The Swedish home furnishings company IKEA, for instance, recently launched its Forandring collection of home accessories like baskets and mats, textiles,  made  in collaboration with local industries, and which are using rice stubble pulp.  The collection is part of IKEA’s  Better Air Now initiative which is collaborating with the UN Environment Programme’s  Climate and Clean Air Coalition.

“No-till” farming can improve soil quality and crop yields

There is yet another way to reduce the air pollution and greenhouse gas emissions from crop burning by almost 80%  – and it can also maximize profits for farmers, according to a 2019 study published in Science.

No-till practices that leave straw on top of the soil as mulch can preserve soil moisture and improve soil quality and crop yields in the long-run, said Principal Scientist of the International Maize and Wheat Improvement Center M.L Jat, who co-authored the Science study.

Image Credits: Neil Palmer, Sumitmpsd , Our World In Data, AishaSaleemkhan100, Karen Eliott, Science Direct, Maggilautaro .