Photo Credit: European Commission

The European Commission has announced that it will join the new WHO-sponsored COVID-19 vaccine facility (COVAX) with a  € 400 million commitment – inching the visionary global fund much closer to reality.  

If the new COVAX facility becomes a reality, it would set a historic precedent of multilateral cooperation, not only on the pandemic, but in the global health arena that could be a win-win for the entire world.

It would also turn the tide on a period of “vaccine nationalism” when rich countries, including the United States, United Kingdom, Japan, and even Switzerland, have hastened to pre-order quantities of leading vaccine candidates – even if they are not really sure that candidate will ultimately succeed. Such bilateral deals so far have no provisions for allocations to less well-funded nations.

An announcement of the EC commitment to the pooled vaccine purchase mechanism was made by WHO Director-General Dr Tedros Adhanom Ghebreyesus at Monday’s press conference, on the day which was supposed to have been the deadline for countries to register interest in joining what could become the biggest vaccine procurement plan in global health history. 

“As President Ursula Von der Leyen said, ‘global collaboration is the only way to overcome a global COVID-19 pandemic,’” said Dr Tedros. “I would like to thank the EU Commission for its announcement today that it is joining the COVAX Facility, and for its contribution of  € 400 million.”

Dr Tedros announces the EU Commission’s commitment to the COVAX Facility
Deadline for Final Commitments Delayed – Allows Time To Legally Formalize COVAX   

The hard deadline to join the Facility has also been pushed to September 18, when countries will be expected to make a “binding financial commitment” to the initiative, said WHO senior advisor Bruce Aylward at the press conference. 

Some 170 Member States have expressed preliminary interest in the facility, including Germany, which just publicly signed onto the Facility on Monday. 

But in fact, no firm financial commitments have yet been signed – as the facility lacks a formal legal framework. 

The three- week delay will provide time to resolve a set of complex legal and financial and governance issues so that the COVAX structure can be formalized, said Nora Kronig, Switzerland’s global health ambassador, in an interview with Health Policy Watch earlier on Monday.

That legal framework is critical to enable firm commitments by the wide range of WHO member states that have shown interest in COVAX- but operate under vastly different national rules for vaccine approval and procurement, added Kronig, head of the International Affairs Division of Swiss Office of Public Health.  

Switzerland co-chairs with Singapore an informal working group of countries that are supporting the development of the vaccine facility and have been working intensively to hammer out the arrangements. 

“We are in the latter stages of the design. But it is quite tricky,” Kronig said in the interview. “ We need to put in place legal and financial frameworks that work well together, while also catering to the needs of different countries in a highly dynamic environment.

“There are really a lot of technical dimensions that we have to find solutions to, given the different national situations. That’s what makes it really complicated, to make sure it really works, and what we are concerned with now,” Kronig added.

A safe and efficacious COVID-19 vaccine is another tool in the public health arsenal to stop the spread of COVID-19. (Photo Credit: Jernej Furman)

Facility is a Win-Win for Rich and Poor Countries    

The facility would provide an opportunity for high- and middle-income countries to purchase approved vaccines in bulk – and therefore at lower prices – with reference to a dozen vaccine candidates now in advanced stages of trials, which have received R&D support from the Oslo-based Coalition for Epidemic Preparedness (CEPI), and are thus engaged somehow with the COVAX facility.  

Countries that can’t afford to do separate deals for all of the products under development, or realistically anticipate which vaccine candidate will anyway be the most successful, would be assured of access to the best vaccine candidates through the COVAX facility.  

Countries that join the facility would be able to pre-commit to orders for doses of vaccines sufficient to supply between 3-20% of their population – enough to cover most of their high-risk groups like older people, healthcare workers or those with underlying conditions.

And at the same time, the costs of procurement for some 92 low-income countries that will depend on international aid to get their share of the vaccine pie, would be significantly reduced because of the bulk purchase arrangements.  

A Three-Track Financing Process To Cater To The Needs Of Different Countries 

The COVAX Facility could set a historic precedent for multilateral cooperation, if the legal mechanisms are worked out. (Photo Credit: Jernej Furman)

According to the structure currently under consideration, there would be three “tracks” by which countries can join COVAX, sources told Health Policy Watch, confirming earlier reports that WHO and its partners have sought to create greater financial flexibility to attract high-income countries to the sharing pool.  

While negotiations are still ongoing, the three-tracks that are taking shape appear to look something like the following: 

  • Committed Purchase Option – Countries would pay a comparatively low  “pre-order price”, per vaccine dose (e.g. about US $ 1.60 a dose) backed by a financial guarantee to actually purchase the doses at a baseline cost of somewhere between US$ 10.55 and US$ 21.10;
  • Optional Purchase Commitment –  Countries would pay a higher “pre-order price” (e.g. about US $ 3.10 per dose) with the possibility to opt out of the final vaccine purchase for doses or vaccine candidates that they ultimately don’t need or want;
  • Advance Market Commitments  (AMC)-  The 92 low- and middle-income countries that are part of the AMC of GAVI, the Global Vaccine Alliance,  which regularly negotiates vaccine purchases in bulk at concessionary prices– will receive the vaccine through that mechanism, financed by traditional international donor allocations – although the final prices for those doses is sure to be a hot topic of debate.    

“The fact that there are three different financing streams all pooled together is innovative and new, and may improve the prospects for COVAX,” the source said. 

Although COVAX is co-led by WHO, CEPI, and Gavi, the Vaccine Alliance, Switzerland and Singapore have jointly chaired the informal “Friends of the COVAX facility” group – which is attempting to iron out the final details and ensure broad participation in COVAX among high income and upper middle income WHO member states.  

Still, while the outlines are falling into place, challenges remain to be faced in working out the fine print over the next three weeks. 

“It is critical for the legal mechanism of COVAX to meet the needs of different countries and to account for the most efficient use of the doses available, as well as the fact that different vaccine technologies will have different needs, including cold-chains,” one source pointed out, adding that vaccine procurement regulations vary widely between countries, and COVAX must accommodate national legislation.  

Added Kronig, ultimately the same goal is shared by all countries – and despite the obstacles faced, that should be a stimulus to the success of COVAX.

“We also have to be mindful of the fact that we are acting in a completely unpredictable environment,” she cautioned, noting that the creation of the facility remains a work in progress.

“But we all want this to work out – because it is the best way to protect our populations and I think also to protect society as a whole.”

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Grace Ren contributed to this story

Image Credits: European Commission, Flickr: Jernej Furman, Flickr: Jernej Furman.

Mental health training-less than 1% of international health and development assistance goes to mental health needs.

Billions of people around the world have suffered from new or increased mental health stress as a result of COVID-19, which makes it time to redouble investments in one of the most neglected areas of public health.

This was the main message of a joint call by the World Health Organization, together with a number of NGO partners, to increase investments in mental health prevention and treatment, which currently account for only about 2% of national health budgets.

WHO, together with The World Federation for Mental Health and its partner organization, United for Global Mental Health, issued the call in a press release issued ahead of World Mental Health Day, which is celebrated on 10 October.

WHO notes that that international aid for mental health conditions in low and middle income countries has never exceeded 1% of health developent assistance. This is despite the fact that for every $1 US invested in scaled up mental health treatment for common disorders such as depression and anxiety, there is a return of US$ 5 in improved health and security.

Said Dr Tedros Adhanom Ghebreyesus in a media briefing on Thursday “Mental health was already a neglected health issue before COVID. Globally, 1 billion people are living with a mental disorder. 3 million people die every year from the harmful use of alcohol. 1 person dies every 40 seconds by suicide.”

Now, he added, “We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.

“World Mental Health Day is an opportunity for the world to come together and begin redressing the historic neglect of mental health.”

Events will include a virtual online march on 9 October, including a 24 hour livestream featuring mental health leaders and influences, along with people talking about their own mental health experiences. In addition, partners ranging from Human Rights Watch to Alzheimer’s Disease International will organize hour-long sessions on themes such as mental health and older people, youths, rights for the LGBTQ+ community as well as human rights more broadly. This will be followed by a global online advocacy event, hosted by WHO on 10 October. Underlining the efforts is a new campaign being launched by the partners and its affiliates, including Speak Your Mind “Move for mental health: let’s invest.”

Few People Have Access to Quality Mental Health Services

Few people around the world have access to quality mental health services.

In low- and middle-income countries, more than 75% of people with mental, neurological and substance use disorders receive no treatment for their condition at all. Furthermore, stigma, discrimination, punitive legislation and human rights abuses are still widespread, according to WHO.

The limited access to quality, affordable mental health care, and particularly in humanitarian emergencies and conflict settings, has been further diminished due to COVID-19 as the pandemic has disrupted health services around the world.

New barriers to treatment include: the risk of infection in long-stay facilities such as care homes and psychiatric institutions; barriers to meeting people face-to-face; mental health staff being infected with the virus; and the closure of mental health facilities to convert them into care facilities for people with COVID-19.

“It is nearly 30 years since the first World Mental Health Day was launched by the World Federation for Mental Health,” said Dr Ingrid Daniels, President of the World Federation for Mental Health. “During that time, we have seen an increasing openness to talk about mental health in many countries of the world. But now we must turn words into actions. We need to see concerted efforts being made to build mental health systems that are appropriate and relevant for today’s – and tomorrow’s – world.

 

Image Credits: WHO/K. Carswell .

Dr. Tedros Adhanom Ghebreyesus, at regular virtual press conference

The World Health Organization will establish a new high level review of the Organization’s capacity to respond todisease outbreaks in the framework of the International Health Regulations (IHR) that govern emergency response. 

The aim is to ensure that WHO is “as effective as possible in operations as they unfold,” announced Director-General Dr. Tedros Adhanom Ghebreyesus on Thursday. 

The announcement follows from last week’s Franco-German proposal outlining ten key reforms to prop up the WHO, and to improve funding for the agency, whose two-year $US5 billion budget is as little as that of a ‘sub-regional hospital’, in the reported words of the draft proposal seen by Reuters.

Dr Tedros delivers the closing speech for the seventy-third World Health Assembly in May 2020

Depending on progress, the IHR review committee may present a preliminary assessment of WHO’s response capacity, and reform recommendations, as early as November at the second edition of this year’s World Health Assembly (WHA). The WHA met in abridged session in May, due to the pandemic.  

“Earlier today I informed WHO’s Member States that I plan to establish an IHR Review Committee to advise me on whether any changes to the IHR may be necessary to ensure this powerful tool of international law is as effective as possible,” said Dr. Tedros on Thursday.

In other developments, the WHO recommended that in light of the surging number of COVID-19 cases and limitations of current tests, countries must focus on targeted COVID-19 testing strategies geared towards the ‘right individuals’ – although “new possibilities” may allow for COVID-19 testing in the wider population as early as next year.

A New Committee To Examine the IHR And Recommend Reforms   

Even before the pandemic, past health emergencies like eastern DRC’s Ebola outbreak had demonstrated that ‘some elements’’ of the IHRs, the WHO’s legal framework that governs preparedness and response for health emergencies, “may need” to be reviewed, said Dr. Tedros on Thursday.

One of the less controversial reforms under discussion is the IHR’s mechanism to declare international health emergencies, which Tedros described as “binary” this Thursday.

“The system of alert right now is either we have an emergency or we have nothing”, said Gian Luca Burci, former World Health Organization head legal counsel, at a webinar several months ago, at which he outlined key reforms to bolster the Agency. “There is a growing consensus [that this system must be replaced by] something much more incremental.”

The new IHR committee will be made up of independent experts that will examine “various aspects of the IHRs”, in collaboration with the Independent Panel for Pandemic Preparedness and Response, which was created last month – and with the Independent Oversight Advisory Committee for the WHO Health Emergencies Programme.

Image Credits: WHO / Antoine Tardy, WHO, WHO / Antoine Tardy.

SARS-CoV-2 (yellow) attacks a dying human cell (red)

This Tuesday, European researchers documented two new cases of COVID-19 reinfection, just a day after the first genetically proven case of reinfection was reported in a 33-year old man in Hong Kong. The 33-year old had contracted two genetically distinct strains of Covid-19 over a period of four and a half months.

The potential for people to be reinfected with genetically distinct strains of COVID-19 months after recovering from their initial infection, has raised alarm bells among policymakers struggling to contain the virus, as well as among researchers racing to develop a vaccine. However, the frequency of such events, and their implications on coronavirus transmission, immunity, and the development of an effective vaccine, remain poorly understood.

A Puzzling Finding With Unclear Implications On Immunity & Vaccine Development

The possibility that recovered COVID-19 patients can become reinfected further dashes hopes that the global population could develop a certain level of “herd” immunity to the SARS-CoV-2 virus. Reinfection events also raise questions about whether a vaccine developed to treat one strain of the virus will be long lasting and effective against other viral strains.

“The unique Hong Kong case is puzzling and is a very unusual finding,” Barry Bloom, research professor at Harvard T.H. Chan School of Public Health, told Health Policy Watch this week, at a webinar hosted by the Harvard T.H. Chan School of Public Health.

In The Viral World, Reinfection Is The Rule Not The Exception

The reports add to a growing body of evidence that in the case of SARS-CoV-2, like other respiratory viruses – including influenza or common cold coronaviruses – true reinfection is possible. When recovered patients test positive again, it isn’t a result of prolonged viral shedding, or remnants of dead virus from the first infection.

“The Hong Kong report certainly looks like reinfection,” noted William Hanage, associate professor of epidemiology at Harvard T.H. Chan School of Public Health. “Whether it is rare or not is not clear at all.”

“First, this appears to be rare”, tweeted Ashish Jha, director of Harvard’s Global Health Institute. “Though we don’t go looking [for reinfection] often enough so [it is] unclear.”

However, even if reinfection turns out to be more common than initially thought, its significance for COVID-19 transmission is unclear.

It is possible that people reinfected with COVID-19 could spread as much virus as in their initial infection – even if they show no symptoms. And that has worrisome public health implications that require further exploration, said Hanage.

“We don’t know whether reinfected people transmit as much virus as compared to their first bout of infection,“ he added.

He also noted that the so-called ‘viral load’ during the second asymptomatic infection of the 33-year old Hong Kong patient was “reasonable”, and “neither very high nor very low”. But we’re not sure what that means yet.

“Just because reinfection can happen does not necessarily tell us how important it is for transmission of COVID-19,” said Hanage. “A football team like Arsenal can beat Liverpool, but they have to keep beating Liverpool to make a meaningful difference at the end of football season.”

HANAGE.PNG

Reinfection Is A Rare Event, Says The World Health Organization

Despite the concerns raised by experts such as Hanage, other leading experts in Geneva and at the World Health Organization, offer more reassurance.

Based on available data, “COVID-19 reinfection is seemingly rare”, said Antoine Flahault, director of the Institute of Global Health at the University of Geneva, in an interview with Health Policy Watch.

He adds that reinfection is also known to occur in “most infectious diseases”, even in cases where strong immunity is developed. It tends to happen among people that have underlying conditions , whom also have weakened their immune systems.

That’s the view, as well, among experts at the World Health Organization.

“Of the 23 million cases of COVID-19 reported so far, only two or three cases of reinfection have been reported,” Jarbas Barbosa, assistant director of WHO’s Regional Office of the Americas/Pan American Health Organization (PAHO), emphasized at a press conference on Tuesday, in response to a question from Health Policy Watch.

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Jarbas Barbosa, assistant director of PAHO

According to virologist Marion Koopmans, one of the reinfected patients reported on Tuesday was an older Dutch man whose immune system was weakened, reported Dutch broadcaster NOS.

Can COVID-19 Threaten Vaccine Development ? Hopefully Not

Some scientists worry that reinfection with genetically distinct strains of SARS-CoV-2 could also threaten the development of an effective vaccine.

However, vaccines generally aim to target regions of the virus that do not mutate – such as the spikes of the virus that may attach itself to the body’s ACE-2 receptors, said PAHO’s incident manager Sylvain Aldighieri on Tuesday.

“Even if a virus mutates, a vaccine may still confer perfect immunity because the vaccine may target a region of the virus that does not change.”

PAHO.PNG

He cautioned, however that, “genetic monitoring of circulating strains of the coronavirus must be maintained to keep a tab on any new mutations, and to study their effects.”

So far, over 3000 SARS-CoV-2 mutations have been identified, and yet they have not significantly changed the level of COVID-19 disease severity, and may thus not be an obstacle to the development of vaccine immunity, WHO experts say:

“We’ve not seen major changes in the way that [COVID-19] disease is presenting in populations”, said Catherine Smallwood, WHO’s senior emergency officer for the WHO Emergencies Programme, at a press conference last week.

“What we need to look at, is the clinical presentations [of mutations] to make sure that as the virus mutates – which is absolutely normal for viruses to do – that we track these mutations, and that we are able to interpret those mutations, and understand whether they are actually causing changes in the disease or not.”

Smallwood.PNG

More generally, WHO notes that many vaccines are “primarily intended” to prevent disease symptoms, rather than protecting against infection itself sterilizing immunity.

Immunity To COVID-19 Still Exists Despite Potential For Reinfection

There seems to be some level of agreement that an initial COVID-19 infection in humans provides some level of protective immunity against a subsequent infection, though it may not be sufficient to block reinfection of the SARS-CoV-2 virus into human cells.

It is likely that an initial COVID-19 infection confers protection by muting disease symptoms in subsequent rounds of infection, just like the 33-year old in Monday’s Hong Kong report, whose second infection was asymptomatic – in contrast to his first, symptomatic infection that took him two weeks to recover from.

“This is exactly what one would want to see with immunity — that you can pick up virus again but that it won’t cause serious illness,” tweeted Jha.

However, it is unclear how long immunity to COVID-19 lasts.

“What we are learning about [COVID-19] infection is that people do develop an immune response, and what is not completely clear yet is how strong that immune response is, and for how long that immune response lasts,” said WHO’s coronavirus expert and technical lead for COVID-19 Maria Van Kerkhove on Monday, in response to reports of the Hong Kong reinfection case.

MVK_2.PNG

Generally, common cold coronaviruses – including 229E, OC43 and NL63 strains – can reinfect individuals in less than a year, while protection against more serious coronaviruses, such as SARS-COV-1 and MERS seems to last for a few years.

A Lack Of Data

Despite some disagreement on COVID-19 reinfection among leading scientists, there is consensus on at least one issue – the lack of data.

“Before making any recommendation, at this point, we need to take a better look at the evidence,” warned Barbosa. “We need to understand reinfection better and evaluate if it is related to any modification in the virus or the immune system. It is very important to report these cases like the Hong Kong case.”

It will also be necessary to study reinfection at the “population level” to clarify whether it is a frequent or rare event, added Van Kerkhove.

According to Bloom, “serial blood samples” from reinfected individuals could help shine light on antibody responses to the coronavirus, and to understand whether they differ between the first and second bouts of infection – in terms of the quantity of antibodies produced, their affinity to the virus, and how long they last.

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Barry Bloom, research professor at Harvard T.H. Chan School of Public Health. Source: Harvard T.H. Chan School of Public Health

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Health Policy Watch published this article in collaboration with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. 

The platform is centered around five core themes — Peace & Humanitarian, Climate, Global Health, Sustainable Business & Finance, and Technology — as well as opinion pieces. Its newsletter, the GS Daily Brief, goes out at 6 AM Monday to Saturday and covers thematic news as well as global news events. Geneva Solutions’ editorial culture is based on constructive journalism principles, leveraging Geneva’s historical and ongoing efforts to finding solutions to global issues.

Image Credits: NIAID.

US FDA Commission answers questions about the benefits of convalescent plasma treatment for COVID-19 patients. He later walks back the claims.

The US Food and Drug Administration Commission Stephen Hahn on Monday apologized for overstating the effectiveness of convalescent plasma as a treatment for COVID-19, after the agency faced backlash for Hahn’s claims that the treatment could reduce mortality by as much as 35%, made during an announcement of the FDA emergency approval of the therapy on Sunday.

“”I have been criticized for remarks I made Sunday night about the benefits of convalescent plasma. The criticism is entirely justified,” Hahn tweeted Monday.

Hahn had described the treatment as  “groundbreaking” at a much-trumpeted White House press conference, announcing the FDA authorization for the use of the antibody-rich blood plasma, collected from recovered COVID-19 patients. In his statement, Hahn had claimed that the FDA-reviewed data showed that “out of 100 people with COVID-19, 35 would have been saved because of the administration of plasma”.  US President Donald Trump and Health and Human Services Secretary Alex Azar also both repeat the claims of a supposed 35% reduced mortality risk, with Trump describing it as a “tremendous number.”

Leading scientists called that a “gross misinterpretation” of the data.

The debate centered around the findings from an observational study by researchers at the Mayo Clinic, which looked at survival outcomes for over 35,000 patients in the US who had received the convalescent plasma treatment. The study was published on the preprint server MedRxiv, and is still awaiting peer review.

The study found a 7-day mortality rate of 8.9% in seriously ill patients who received plasma with high levels of SARS-CoV-2 antibodies. In comparison, the 7-day mortality rate in seriously ill patients who received plasma with low levels of antibodies was 13.7%.

That means the so-called 35% reduced risk in the Mayo Clinic study is reallly a “35% change in small numbers,” according to Harvard epidemiologist William Hanage.

“So it’s like, going from 8% of people showing improvement to 13% of people showing improvement,” Hanage told reporters on Tuesday. “And that’s a sort of statistical quirk in the way that you have interpreted the outcomes of these things.”

Additionally, the Mayo Clinic study only compared mortality outcomes in patients who had received different levels of the antibody treatment. It did not include a control group – meaning it was not able to compare mortality outcomes in patients who had received plasma as compared to outcomes in  patients who had not received any plasma at all.

“What I should have said better is that the data show a relative risk reduction not an absolute risk reduction,” Hahn admitted in his tweet.

Experts said even the retraction, however, was still full of holes. “You need to correct the 35 lives saved per 100 sick with COVID-19 so that people understand that was absolutely wrong, Steve…There is no evidence at this juncture to support any survival benefit…We need RCTs,” tweeted Eric Topol, director of the Scripps Research Translational Institute, after Hahn issued his retraction.

Already on Monday, World Health Organization Chief Scientist Soumya Swaminathan cautioned against premature optimism over the convalescent plasma treatment, telling reporters the evidence supporting the treatment was still “inconclusive” and “very low quality.” More randomized control trials, which include well-designed control groups, must be performed.

“We recommend that convalescent plasma is still an experimental therapy. It should be continued to be evaluated in well-designed randomized trials,” Swaminathan told reporters.

She noted a range of challenges for the treatment, including inconsistencies in the level of antibodies that might be delivered by the plasma taken from other COVID-19 patients, as well as technological challenges faced in collecting blood from donors and making transfusions. Other WHO officials noted that the procedure can also lead to significant side effects.

Image Credits: Official White House Photo by Shealah Craighead.

Part of a series of stories about how the coronavirus lockdowns and relaxations are playing out in different parts of Africa. For more on this, see our stories on South Africa and Ibadan, Nigeria.

Crowed market scene in Kampala – some wear masks and others do not.

Kampala, Uganda – As Uganda’s coronavirus cases double in only two weeks, the Ministry of Health is considering a second lockdown to control the SARS-CoV2 virus spread. But will another lockdown really curb the number of cases? Does the healthcare system have the capacity to handle the next wave? And what will be the cost in lives of both health workers and the general public? Reflections from an emergency room doctor in Kampala:

Since I am not one of the scientists that advises the President on public health measures like lockdowns, let me leave it to the experts to decide whether a second lockdown would be effective. We know, however, from many countries – such as the USA, Mexico, and Italy, among others – that full-blown lockdowns may not halt transmission of the coronavirus – and it won’t prevent deaths from the disease either.

So far, the death toll in our country has been exceedingly modest, compared to countries in Europe, Asia and the Americas as well as countries on our continent, such as South Africa. Since the first case of the coronavirus was reported in Uganda on March 19, the virus has claimed a little more than twenty lives. However, the situation now is rapidly changing. Over the past  weeks, Uganda’s number of Covid 19 cases has doubled, with its highest number of new cases in just 1 day being 318.

Mask distribution in a village in Uganda.

Our President, Yoweri Kaguta Museveni, has repeatedly appealed to Ugandans to follow the Standard Operating Procedures (SOPs) that his government has put into place. Based on WHO recommendations, they focus on: physical distancing, universal mask-wearing on public transport and in public spaces, as well as basic hand hygiene.

In hospitals and clinics, WHO guidelines call for the continuation of basic health services, while strictly separating COVID-19 cases from others seeking health care. At the same time, health workers need extra protection, so that they don’t become ill and risk infecting others.

Regrettably, even as we now face a serious uptick in new infections – we are falling short both in the public sphere and in our hospitals. Ugandans seem to be either indifferent or unable to follow the president’s directives. And this threatens our entire effort to keep people safe and healthy – including health workers.

Deadly Lockdown Guidelines

Empty road in Kampala, Uganda, during the first lockdown in March – June.

Admittedly we hardly had any COVID-19 cases when the police and other security organs enforced a a strict lockdown between March and June.  But that was also a crude tool with often cruel consequences.

At a time when all transport was shut down, I received a call from a pregnant woman in labour, who was trying desperately to reach a hospital as her baby was in a breech position – which meant she really needed a cesarean.

I knew this because I had examined her myself only a couple of weeks earlier while visiting my hometown in eastern Uganda.

‘’I am 8-months pregnant and bleeding for 2 days now,” the woman lamented over the phone. According to the lockdown guidelines, however, anyone traveling to the hospital had to first get permission from the Resident District Commissioner’s (RDC’s) office in-person.  And the RDC office was too far for her to walk, bleeding alone.

I was working at my hospital in Kampala and thus unable to provide immediate help. She told me that she would try to reach a traditional birth attendant (TBA). When I eventually spoke with her again two days later, she told me she had walked to the neighboring village, and was being cared for by a TBA.

‘’The bleeding has increased and I’m becoming weaker and weaker, I doubt that I will make it this time.’’

My heart sank as she spoke to me in her the voice of someone who was dying. I looked for ways to reach the RDC directly myself, to request an ambulance to save the mother and her child.

Luckily enough, I finally got through to him, and knowing me, he offered us an ambulance. The driver rushed her to Mbale Regional Referral Hospital, where I was already making arrangements so that a team of health workers would be ready to receive her. The doctors performed a successful cesarean, but her baby had died in the womb by the time it was performed.

I’m glad that my efforts at least helped save the mother – because we would have probably lost both mother and infant had we not reached the hospital. I can only imagine the pain she went through.  But if we face another lockdown now, will the same scenes be repeated elsewhere?

Does Uganda’s Healthcare System Have The Capacity To Handle The Next Wave?

Unprotected medical workers lean over the bed of a sick patient in a Uganda hospital – some of whom may be infected with COVID-19.

To cut a long story short, sadly NOT. That’s because very little has changed since the first wave – which was contained by a public lockdown.

The alternative to a lockdown this time around would be strict public adherence to mask, hygiene and social distancing measures as well as a nimble health system response.

But the public remains lax and the health system is still under-funded. We still face the same shortages in human resources, supplies, and crucial infrastructure that would allow for the effective and timely testing, tracing and isolation of COVID-19 cases.  We can’t follow the WHO guidelines for proper management of COVID cases.

Not Enough PPE – Suspected COVID-19 Cases Mixed With Regular Patients

Here’s an example from one recent shift in the emergency room of the hospital where I am working now. A restless, 52 year-old business man with known hypertension came through our doors late one night. He had been suffering with a cough for the past two days, had difficulty breathing, and also had hypoxia, or low blood-oxygen levels – all signs of the SARS-CoV-2 virus.

The internist on night duty, a friend and colleague of mine, contacted the designated COVID-team, which did not hurry to examine him –  initially telling him to first rule out other causes of the symptoms. Finally, he admitted the man, with a diagnosis of suspected community-acquired pneumonia.

The COVID-team, fully gowned with extensive personal protective equipment, came to the emergency ward, collected a nasal sample, and left within 20 minutes. The following day, with the COVID test still being processed, the patient was moved to a general ward, in close proximity to the other patients who were being treated for other, unrelated conditions.

Except for the fully protected members of the COVID-19 team who took the nasal sample, the other medical staff who saw him over the following hours – from senior doctors to internists like myself, nurses, and administrative staff – have access only to a surgical mask and disposable gloves. Including myself. These are the people who must collect patient history, conduct routine exams, connect oxygen, provide treatment, and remain within close proximity of the patients for more than 12 hours a day.

The man died as a team struggled to administer him oxygen – his test results later confirmed that he had COVID-19.

Following that, we all had to be tested – and those among the medical staff who tested positive are now under quarantine. I was among the lucky ones who tested negative. This was particularly reassuring for me.  As a diabetic, I am also at higher risk from COVID-19.

But the reprise is only temporary.  In fact, day after day, virtually all the staff in our wards, and in the whole hospital, are at constant risk of exposure to suspected COVID-19 cases, and thus at risk of exposing other patients, as well as outpatients, to a potentially deadly virus.

And all of the medical staff also return home to their families everyday – or in my case, on the occasional weekend when I manage to make the journey back to my hometown in eastern Uganda.

So what happens when the next patient arrives at our emergency room, with a suspected COVID-19 case?

The COVID team says it lacks the capacity to quarantine and treat suspected COVID patients – even if they are very ill – until a test-confirms their diagnosis. Meanwhile, health workers remain exposed, and are thus exposing everyone around them.

This is the case in most regional referral hospitals. This is where we are as a country.

What is the fate of health workers?

Health workers deaths due to COVID-19 in Africa, Asia and Europe.

As of 13 July, over 3,000 health workers in some 79 countries have died from the coronavirus, according to Amnesty International. And healthcare workers in almost 63 countries have reported serious shortages in PPE.

Like other hospitals in Uganda and many other countries elsewhere, our fate as health workers is uncertain.

On the one hand, vigorous campaigns are underway in the community to introduce Ugandans to masks and reinforce handwashing and hygiene measures.

Health workers demonstrate handwashing to villagers in eastern Uganda – to prevent COVID infection.

But in the hospitals, the basic preventive measures we could take are weak.

We can only pray that patients we manage everyday for community-acquired pneumonia do not have actually have COVID-19. And if they do, which has already happened in past months, we shall all be quarantined.

As case numbers increase, more of us, depending on the degree of exposure, will contract the coronavirus – and many will die.

The senior medical staff who decided to neglect us will be forced to emerge from their administrative offices to treat many of us – while also managing malaria, hypertension and women in labour – COVID or not.

Many will be called heroes. Heroes who were left to die. Heroes who were sent out as sacrifices with no protection. Heroes who had no choice but to work in unsafe environments set out for them.

 Countering The Pandemic

Samson Wamani wearing a non-medical mask that he uses when not on duty.

Still, I refuse to be only a complainer. We can be part of the solution that addresses the issues our country is facing. All we really need to do is to put the lofty rhetoric issued at the top policy echelons into real action in our hospitals and wards.

“Africa can only counter this pandemic through robust policy responses in every single country on our continent, with additional support from our partners around the globe, declared Charles Leyeka Lufumpa, vice president for economic governments at the African Development Bank Group, in an editorial this week.

“In the short-term, African countries should prioritize health care spending to supply us with essential personal protective equipment (PPE) and to accelerate local production of vital healthcare products –  including PPE, vaccine and other medicines,” he added.

Health workers and management must unite and acknowledge existing shortcomings. Let us set out on a journey to solve the problems of the system once and for all. We must stand our ground on the numerous shortfalls in human resources, PPE supply, and health infrastructure.

The Government must invest in the system with appropriate funding, facilities, supplies and human resources.

Just yesterday, ministers and officials from over 40 different Member States across WHO’s Africa region met virtually for the WHO Regional Committee for Africa, and agreed that the pandemic has been a tragic reminder that we must invest more in our health systems.

“The coronavirus pandemic has proven once again the importance of investing in health systems, enhancing equitable access to care and improving readiness to prevent and control outbreaks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Recovering from this pandemic will be incomplete without strong measures to bolster health systems. We must seize the opportunity and make the leap for a better tomorrow.”

Let us stop pretending that things are okay. That we are ready to die only due to reckless circumstances. That we are more patriotic than leaders who have paid a deaf ear and blind eye to the obvious problems we’re all facing.

Let us decide to protect ourselves, our patients, our families and country at large by not being part of the system that spreads a disease that’s actually preventable through evidence-based public health measures.

There is still time to save Uganda from a larger wave that’s flooded other countries on the continent, such as South Africa. This war can be won if we stop talking and start doing. The time is now!

  • Postscript: 9 September – Two Ugandan doctors have since died due to corona-related complications, in Lira and Mbarra regional hospitals. The COVID Treatment Unit (CTU) in my hospital is full to capacity. But suspected cases are still being mixed into the general wards unless and until their infection is confirmed by a test.  The government is planning to open schools beginning September 20th – but there are no practical measures put in place to control the spread of the virus.  We are bracing for huge numbers – we only hope that we shall not get many with severe disease.  

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The above are my personal opinions.

Dr Samson Wamani is “examined” by one of his young patients – just weeks before the pandemic began.

Samson Wamani, is currently working as a frontline medical doctor in a COVID-19 referral hospital in Kampala, Uganda. He is also the Executive Director of RAIN Uganda, an NGO that offers HIV education and testing in the Mbale area. He previously headed a health centre in eastern Uganda, as well as serving as the health and development officer for the NGO, Innovation Africa. He has a passion for maternal and child health.. 

 

Image Credits: Samson Wamani , Samson Wamani, Ndahiro derrick, Amnesty International, Sasmson Wamani .

An oral polio vaccine is administered to a child.

Brazzaville – The independent Africa Regional Certification Commission (ARCC) for Polio Eradication officially declared on Tuesday that the World Health Organization (WHO) African Region is free of wild poliovirus.

This marks the eradication of the second virus from the face of the continent since smallpox 40 years ago.  And while vaccine derived polio is still circulating in 16 countries, there is a new strategy to tackle that next.

“Today is a historic day for Africa. The African Regional Certification Commission for Polio eradication (ARCC) is pleased to announce that the Region has successfully met the certification criteria for wild polio eradication, with no cases of the wild poliovirus reported in the Region for four years,” said Professor Rose Gana Fomban Leke, ARCC Chairperson.  

The ARCC’s decision comes after an exhaustive, decades-long process of documentation and analysis of polio surveillance, immunization and laboratory capacity of the region’s 47 member states, which included conducting field verification visits to each country.

In 1996, African Heads of State committed to eradicate polio during the Thirty-Second Ordinary Session of the Organization of African Unity in Yaoundé, Cameroon. At the time, polio was paralyzing an estimated 75,000 children, annually, on the African continent.

In the same year, Nelson Mandela with the support of Rotary International jumpstarted Africa’s commitment to polio eradication with the launch of the Kick Polio Out of Africa campaign. Mandela’s call mobilized African nations and leaders across the continent to step up their efforts to reach every child with polio vaccine.

The last case of wild poliovirus in the region was detected in 2016 in Nigeria. Since 1996, polio eradication efforts have prevented up to 1.8 million children from crippling life-long paralysis and saved approximately 180,000 lives.

“This is a momentous milestone for Africa. Now future generations of African children can live free of wild polio,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This historic achievement was only possible thanks to the leadership and commitment of governments, communities, global polio eradication partners and philanthropists. I pay special tribute to the frontline health workers and vaccinators, some of whom lost their lives, for this noble cause.”

“However, we must stay vigilant and keep up vaccination rates to avert a resurgence of the wild poliovirus and address the continued threat of the vaccine-derived polio,” said Dr Moeti.

Vaccine derived poliovirus continues to circulate

While the eradication of wild poliovirus from the WHO African Region is a major achievement, 16 countries in the region are currently experiencing vaccine-derived polio outbreaks (cVDPV2), which can occur in under-immunized communities.

While rare, vaccine-derived polioviruses cases can occur when the weakened live virus in the oral polio vaccine passes among under-immunized populations and, over time, changes to a form that can cause paralysis. If a population is adequately immunized with polio vaccines, it will be protected from both wild polio and circulating vaccine-derived polioviruses.

The 16 countries in Africa currently affected by circulating vaccine-derived polioviruses outbreaks include: Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ethiopia, Guinea, Ghana, Mali, Niger, Nigeria, Togo and Zambia.

Responding to circulating vaccine-derived polioviruses

To address the growing challenge of circulating vaccine-derived polioviruses, the GPEI’s new ‘Strategy for the Response to Type 2 Circulating Vaccine-Derived Poliovirus 2020-2021’ is focused on working with affected and at-risk countries to control circulating vaccine-derived polioviruses outbreaks ongoing across the African Region.

The first stage of this targeted strategy involved launching a rapid response team specifically to respond to circulating vaccine-derived polioviruses. Formed in September 2019, the team is coordinated from WHO’s Regional Office for Africa in Brazzaville and is composed of 20 experts in operations and vaccination management, epidemiology, logistics, and communications, drawn from GPEI’s core partners.

“Africa has demonstrated that despite weak health systems, significant logistical and operational challenges across the continent, African countries have collaborated very effectively in eradicating wild poliovirus,” said Dr Pascal Mkanda, Coordinator of WHO Polio Eradication Programme in the African Region.

“With the innovations and expertise that the polio programme has established, I am confident that we can sustain the gains, post-certification, and eliminate cVDPV2,” added Dr Mkanda.

“The expertise gained from polio eradication will continue to assist the African region in tackling COVID-19 and other health problems that have plagued the continent for so many years and ultimately move the continent toward universal health coverage. This will be the true legacy of polio eradication in Africa,” said Dr Moeti.

Polio is a viral disease that is transmitted from person to person, mainly through a faecal-oral route or, less frequently, through contaminated water or food, and multiplies inside the intestines.

During the lifespan of the Global Polio Eradication Initiative, polio cases have reduced by 99.9% since 1988, bringing the world closer than ever before to ending polio. The initiative is a public-private global partnership comprising national governments; WHO; Rotary International; the United States Centers for Disease Control and Prevention; UNICEF; the Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance; and a broad range of long-term supporters.

For more details about polio, see WHO’s press release: Africa eradicates wild poliovirus.

Image Credits: WHO.

Convalescent plasma from recovered patients may help treat COVID-19`

There is insufficient evidence that treating people hospitalized for COVID-19 with blood plasma from recovered patients is safe and effective – and more randomized clinical trials are thus needed, warned the World Health Organization on Monday. 

Evidence overall remains “inconclusive,” said WHO chief scientist Soumya Swaminathan at a WHO press conference on Monday. 

She spoke just a day after the United States Food and Drug Administration (FDA) issued an emergency authorization for use of the antibody-rich cocktail from the plasma of recovered coronavirus patients in people hospitalized with COVID-19.

Swaminathan added that while blood plasma has been used to treat a variety of infectious diseases for over a century, it is still an “an experimental treatment” for SARS-CoV-2, the virus that triggers COVID-19.  

In the US, over 71,000 hospitalized COVID-19 patients have already received convalescent plasma as part of the nation’s Expanded Access Program. However, evidence supporting its use is still “inconclusive” and “very low quality”, said the Organization.

WHO chief scientist Soumya Swaminathan

“There are a number of clinical trials going on around the world looking at convalescent plasma compared to standard of care, and only a few of them have actually reported results, and the results are not conclusive,” said WHO Chief Scientist Soumya Swaminathan, at a press conference on Monday, in response to a question from Health Policy Watch. “The trials have been fairly small [and while some] trials report some benefit…[the evidence] is still very low quality.”

“The most important question really is about its efficacy and safety being proven and randomised trials, and I hope that we get that evidence in the coming weeks.” 

“At the moment, it is still a very low quality of evidence.. So we recommend that convalescent plasma is still an experimental therapy. It should be continued to be evaluated in well-designed randomized trials.

“Of course countries can do emergency use listings, if they feel that the benefits outweigh the risks,” she added, in a nod to the US FDA move. “But that’s usually done while you’re waiting for more definitive evidence.” 

US President Trump Calls Plasma “Beautiful Ingredient” – Others Less Sure 

Despite the expert reservations, Sunday’s FDA authorization of the treatment was trumpeted at a White House press conference, where US President Donald Trump hailed the plasma as a ‘beautiful ingredient’ that would be a game-changer for COVID patients. 

US Health and Human Services Secretary Alex Azar called it a “milestone achievement” while FDA Commissioner Stephen Hahn, FDA Commissioner, said that data from some 70,000 people pointed to as much as a 35% reduction in mortality.  

The largest such study of some 35,000 people, undertaken by Minnesota’s Mayo Clinic, suggests that people given plasma treatment within 3 days of being hospitalized had somewhat better survival rates than others, as did people who received plasma with higher levels of SARS-CoV-2 antibodies.  This was according to preliminary data published on medrxiv.org, which has not been peer-reviewed yet.

“We dream in drug development of something like a 35 percent mortality reduction. This is a major advance,” Azar. 

However, a number of leading US health experts, including Dr Antony Fauci, one of Trump’s top COVID advisors, last week had urged the FDA to hold off on its emergency approval of the plasma treatment, saying that existing data was still not strong enough to support wider plasma use. 

Notably, the Mayo clinic data was gathered only from “observational” studies and not from randomized controlled studies that are the gold standard for evaluating treatment efficacy. 

In a Twitter blast last week, Trump had impatiently blamed the “deep state” for delaying approval of COVID-19 vaccines and therapeutics.  And speaking at Sunday’s press conference, Trump made it clear that he saw the FDA approval as an election issue – suggesting that the authorization might initially have been delayed for political reasons.  

Critics Say Hasty Approval Threatens FDA’s Credibility

After the FDA issued the emergency use authorization anyway on Sunday, some health policy experts blasted it as a move that had been expedited due to politics, not health concerns, in a week where Trump is heading into the Republican National Convention and wants to show fast results in the COVID battlefront. 

The FDA approval threatens to “further damage” the Agency’s credibility at a crucial time, said Rachel Sachs, Associate Professor of Law at Washington University. 

“Given the explicitly political pressure on the FDA to rush the approval of COVID-19 products, authorizing a new product 1) without publishing the evidence and 2) without a supporting randomized trial risks further damage to public trust in the agency.”

“To be clear, some data from observational studies have been released. But because randomized trials have not yet shown a benefit, it’s not clear than opposing observational data can support an emergency use authorization. It will be critical to see more randomized clinical trials.”

Convalescent plasma isn’t the first product to receive emergency approval despite a shaky evidence base. The antimalarial hydroxychloroquine received emergency approval in late March, after it was widely touted by Trump; its emergency use was later revoked in mid-June after the treatment failed to deliver results in patients. 

Convalescent Plasma May Trigger Side Effects And Could Be Difficult To Scale-Up

Although convalescent plasma has been used against infectious diseases for almost 100 years, it is not risk-free, and may not be suitable in all contexts, added WHO experts at Monday’s press conference. 

Most notably, the actual levels of antibodies received cannot be well-controlled since each plasma portion has different antibody titres, said Swaminathan. So even if convalescent plasma proves to be effective and safe, it may be ‘very difficult’ to deliver a standardized therapy to patients.

“One of the challenges with convalescent plasma is each individual may have different titles of neutralizing antibodies after recovery, and it’s very difficult to standardize that”, Swaminathan observed.

She also added that scaling-up convalescent plasma therapy may be difficult in countries or hospitals that lack the necessary facilities to screen, extract and store plasma from the blood of recovered patients.

Given that convalescent plasma contains a range of different antibodies – including the highly specific neutralizing antibodies – it may result in side-effects like mild chills and fevers, as well as “more severe” lung-related injuries, or even circulatory overload, noted Bruce Aylward, WHO’s Senior Advisor to the Director-General. According to the FDA, circulatory overload is the second leading cause of death in people that receive transfusions.

“For that reason, clinical trial results [for convalescent plasma therapy] are extremely important to know that we have here demonstrated efficacy” and safety, he added.

Convalescent Plasma Versus Monoclonal Antibodies  

Usually, extraction of plasma from the blood requires continuous centrifugation and subsequent freezing within a day of collection. Also, any convalescent plasma sample must be screened for blood-borne infectious diseases – like human immunodeficiency virus (HIV), hepatitis B or C, or even syphilis – and clinicians must match suitable blood types together to prevent adverse immune reactions. 

Given the drawbacks of convalescent plasma, some scientists have instead been suggesting that there may be greater potential for developing more specific and standardized monoclonal antibody treatments, as per their use in past outbreaks, such as Ebola. 

“There’s a lack of willingness, so there isn’t enough [convalescent plasma] around, but I think the most important question really is about its efficacy and safety being proven and randomised trials, and I hope that we get that evidence in the coming weeks,” said Swaminathan.

Image Credits: Sarah Chapman / Evidently Cochrane, WHO.

Some 101 public health organizations have called on the International Automobile Federation (FIA) to put an end to all tobacco advertising in connection to the world-famous Formula 1 (F1) races that FIA sponsors. The organizations issued the call in an open letter to FIA President Jean Todt, released by the tobacco industry watchdog STOP last week.

The call follows on the heels of a call by the World Health Organization last year for sporting bodies, including Formula 1, to adopt stringent polices to prevent participants from receiving any sponsorship through tobacco companies, in line with the WHO Framework Convention on Tobacco Control (FCTC).

Currently, the door remains open for tobacco companies to market their products to Formula 1 fans, despite claims by FIA, Formula 1’s lead sponsor, that its organization is FCTC compliant.

In fact, Phillip Morris International (PMI) and British American Tobacco (BAT) spent US $110 million on Formula 1 sponsorships in 2019. A recent report estimated that the two companies will spend over US $115 million on F1 sponsorships in 2020.

Tobacco marketing expenditures were not mentioned in the new Concorde Agreement, the contract between FIA, Formula 1 and all F1 teams wishing to compete, which sets guidelines for the sport through the next five years, including for the recruitment and allocation of advertising revenues.

“The sport represents one of the last vestiges of Big Tobacco’s global marketing to lure young people into addiction through sports,” the open letter stated. ” Continued tobacco sponsorship in Formula 1, and the promotion of tobacco company’s brands, either directly through brand stretching and extensions, on and off the track is a violation of public health laws and United Nations (UN) norms. Federation Internationale de l’Automobile’s (FIA’s) continued tolerance of this situation defies good governance and is inconsistent with the commitments the FIA has made to UN global road safety and climate change initiatives,” states the open letter.

“While it committed to removing tobacco from the sport, under its watch the industry’s spending is on the increase. FIA cannot claim to be the regulator if it cannot control its races and shirk its responsibility by giving excuses,” said Mary Assunta, from Global Center for Good Governance in Tobacco Control, a partner in STOP, in a press release. “FIA represents the last major hurdle to complete a sweeping change that shows tobacco has no place in sports.”

The organizations accuse tobacco companies of taking advantage of Formula 1’s fast growing fanbase under the age of 25 and marketing tobacco products to youth, which is illegal under the WHO’s FCTC. The Convention has been ratified by 182 countries.

The letter also criticizes the FIA Foundation for claiming that it supports the WHO FCTC, as well as participating in a range of other formal UN-sponsored initiatives, while ignoring WHO’s calls for Formula 1 to end tobacco sponsorship.

“FIA’s continued failure to take responsive action to prevent violations could make it complicit with the tobacco industry,” the letter states.

FIA has made official commitments to both UN global road safety and climate change initiatives, and is officially listed on the WHO website as a partner in the “Friends of the Decade of Action for Road Safety 2011-2020. FIA President, Jean Todt, is also the UN Special Envoy for Road Safety.

“FIA’s commitment to protect the planet and promote safety is a sham if it continues to be a vehicle for tobacco sponsorships that contribute to killing people and destroying the planet.” the open letter added.  “Even if FIA manages to reduce Formula 1’s 256,551 tons of carbon footprint (2019), it continues to contribute 845,000 tons of cigarette butts per year. This staggering amount of waste kills animals, pollutes land and sea, slows sustainable consumptionand undermines the basic principles of the UN framework.”

Todt’s own role as a UN Special Envoy for road safety creates a further conflict of interest, the tobacco control groups say.

“There is a conflict between Mr. Todt’s role as President of the FIA, the governing body of a sport that is promoting tobacco industry interests, and his public health commitments as a UN representative. FIA’s claims about being ‘PurposeDriven’ ring hollow when you look at its resistance to ending tobacco industry involvement in the sport,” said Phil Chamberlain from the University of Bath, a partner in STOP, in a separate press release.

“The tobacco industry is a major driver of disease and death; it targets youth, women, minorities and other vulnerable groups; it profits from the exploitation of vulnerable workers in tobacco farming, and it harms the environment.”

Image Credits: Flickr: Indrid_Cold.

A new US $200 million program, financed by the United States Agency for International Development (USAID), aims to strengthen health data systems in developing countries.

USAID is currently developing the scope of this project, including country participation, according to a spokesperson from global health NGO and partner on the project, Vital Strategies.

Strengthening health information systems is particularly important in the context of COVID-19. An effective pandemic response is dependent on pinpointing the communities where the virus is spreading, which can only be done with a fast-reacting health information system.

“All aspects of governments’ responses to COVID-19 should be informed by data, including decisions on tightening or loosening public health and social measures, performance of contact tracing, maintenance of essential health services and opening of schools,”José Luis Castro, president and CEO of Vital Strategies told Health Policy Watch.

“Health information systems can centralize this data and inform policymaking as close-to-real time as possible—both helping governments understand the pandemic’s true human scope and scale, and accelerating the implementation of lifesaving measures,” added Luis Castro.

A well-oiled health information system will also be able to inform decision makers about where the highest health inequities are.

“This is especially urgent given that the pandemic is not impacting all communities equally; Black and Latinx people in the US are twice as likely to die from COVID-19 as white residents, and this is a challenge surfacing globally as well. In every country, we need high fidelity and rapid data to detect and respond to these inequities, and ensure that public health decision-making is reaching our hardest hit communities,” said Luis Castro.

In many countries, health data collection is reliant on paper forms, which must then be reentered into digital health systems. But sometimes, different platforms are used for different disease areas, and health surveillance officers must manage data across a variety of platforms, as well as other responsibilities.

USAID’s Country Health Information Systems and Data Use (CHISU) Program aims to build up and streamline health information infrastructure, as well as support training in using data for decision making at the sub-national and national level.

One of the first projects of its kind in USAID’s portfolio, the program will be led by public health firm JSI Research and Training Institute. in collaboration with Vital Strategies, research firm RTI International, and digital health NGO Jembi Health Systems. A consortium of leading public health academic centers in low and middle-income countries, GEMNet Health, is also a partner in the program.

Image Credits: David Snyder/CDC Foundation.