Colorized electron microscope image of SARS-CoV-2 (yellow), the virus that causes COVID-19
Thomas Cueni

Now, more than ever, the pharma industry has been thrust into the limelight – as the world races to find new drugs and a hoped-for vaccine to beat COVID-19 and ensure universal access to critical treatment. Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), talks about the old-new tensions between profit and public needs and how a fiercely competitive industry is testing new models of cooperation.

Health Policy Watch: There is finally an agreed text on the EU-led resolution on COVID-19 Response, that was passed unanimously at the World Health Assembly on Tuesday.  What is your take on the result?

Thomas Cueni: Resolutions quite often have symbolic meaning. When I look at the outcome, it has the right focus, tasking the global community to work together to contain and one day to defeat COVID 19.   It does address the issues of health systems resilience; it does look at lessons to be learned and it calls for collaboration with WHO.

In the development of the call to action, which has become the ACT Accelerator, there are three pillars: vaccines, therapeutics and diagnostics. But there is also a focus on health systems. We’ve been working on the ACT A for three weeks now, and we are making progress in working together towards a common goal to tackle COVID 19.

There are, however, three references to countries’ rights to override patents with the use of WTO  TRIPS flexibilities in the text – something civil society saw as a modest victory.

What we got was a united, rapid, unprecedented industry response to COVID 19, in terms making decisions collectively, repurposing existing medicines, joining together for development of vaccines. When you look at who holds the keys to these, I think there is a recognition that it is indispensable to partner with the private sector and more specifically the biopharmaceutical industry. There has been a recognition among the broader health community that the industry has responded at amazing speed.  It is scaling up manufacturing, in some cases joining up, and committing to huge collaboration efforts in vaccine development. This is not our normal business model. Companies are putting aside normal rivalry and fierce competition, and working on the basis of high risk for high reward. Here companies are acting very differently, with a deep sense of responsibility. As a founding partner of the ACT Accelerator, pharma joins with it a strong belief in the need for solidarity, equity, and a clear notion that what comes out of our labs needs to be affordable.

[The reference to TRIPS] is symbolic and to some extent concerning. It is thanks to a flourishing, thriving innovation ecosystem based on IP that we have so many treatments and vaccines already being tested. Pharma companies moved really extremely fast opening, for example, their libraries to NIH and IMI [Innovative Medicines Initiative].IP has not been a hindrance to finding solutions, it has been an enabler. Without the IP system, we would not be where we are in just three months.  The pharma industry is teaming up with regulatory agencies around the world. It is sharing data. It did not need to be forced to move into discussions about how we can ramp up. Gilead has already contracted with the Medicines Patent Pool – [for voluntary licensing of remdesivir].  The scale, the size of [pharma’s engagement] is unprecedented. All of this is done voluntarily.

So, I was somewhat concerned that there are institutions or people that try to hijack COVID-19 to pursue the traditional attack on IP.  It’s not necessary right now – because companies are doing the right thing.  Undermining IP will be extremely dangerous, because when we have future pandemics and we will have future pandemics, it sends the signal that your IP won’t count for anything.  Honestly, that would be a dangerous signal because companies are doing the right thing. If somebody is already doing the right thing and is met by threats of coercion that would not be the best way to get them to engage.

HPW: Can you talk a little more about the Gilead collaboration with MPP on remdesivir for voluntary licensing of the treatment and these other industry collaborations?  

TC: Gilead is working with MPP, but they also have bilateral contracts. There are multiple ways of doing voluntary licenses.  Decisions in terms of testing, further ramping up [production], giving away huge doses, all of that, to the best of my knowledge was done by Gilead.

It is also important that companies maintain oversight over who they choose to collaborate. They have a responsibility to pick partners based on quality checks and assurances, because quality does matter.

One initiative that underscores our common goal of solidarity and equity, and I think has not been given adequate attention, is the ACT Accelerator initiative launched on April 24 by Dr Tedros. So many leaders among them: the European Commission President Ursula von der Leyen, French President Macron, German Chancellor Merkel, South African President Cyril Ramaphosa, and others spoke of this as they supported the WHO Conference Call for action that day.

In a matter of weeks, this [ACT Accelerator] has been implemented. We are making great progress in the work of these various accelerators. CEPI and GAVI are in the lead of an effort searching for a vaccine from end to end.  And everyone agrees that WHO should play a major role when it comes to allocation. We know that at the beginning [when a vaccine or hopefully vaccines are available], demand will far outstrip supply. In the industrialized world there are only handful of companies with the skill sets to scale up the manufacturing of vaccines, which are going to be needed in the hundreds of millions and probably billions [of doses]. In the case of vaccines, it is not just a question of IP, it is also a question of know-how and that you acquire over time. We will need global guidance on who should get the vaccine first: health care workers and vulnerable populations. This is why we support the vaccine accelerator.

Similar for a therapeutics accelerator. People are keen to get more guidance in terms of clinical practice. We should not focus on a few countries. We need a global focus on what is the best clinical practice in terms of treating COVID-19 patients.

HPW: Overall, there has been less talk about collaboration in the therapeutics accelerator ? Can you recap.

TC: There are three pillars under the ACT umbrella:vaccines diagnostics, therapeutics.

It is really good to see that there are tremendous dynamics coming out of ACT, based on the understanding that there will be a light touch coordination mechanism. And there will be leading roles for the likes of CEPI, GAVI, The Global Fund and FIND.

The Vaccine Accelerator is by far the most developed in terms of global approach. In therapeutics, you have a lot of progress happening at national level.  In the therapeutics, testing the different treatments is a key preoccupation. For therapeutics you already have leading regulatory agencies involved, and market mechanisms, whereas for vaccines, you need end-to-end collaboration. At the same time [whether for COVID-19 treatments or vaccines] you are confronted with the same problem: you want to know once they work that they also need to be made available to low- and middle-income countries.

HPW: Is IFPMA completely opposed to the use of TRIPS Flexibilities – or are there times this is justified?   

TC: Most countries have national emergency frameworks. In times of war, in times of crisis, countries can sequester production facilities through public interest compulsory license. I see it as a last resort. It would be very dangerous if this was seen as something that should be done systematically. It would send the wrong signal. If the industry engages in voluntary licenses in collaboration, emphasizes the importance of equity, then I believe that a general call for compulsory licensing would frighten them, and it would not be conducive to what needs to be done. Industry is already sharing the data, they are going to member states, WHO, asking for advice in allocation.  For example, UNICEF [which is also involved in the ACT Accelerator] in quite a number of cases has a huge experience in medicines and vaccines deployment and delivery. It is easier to get results if everyone has a common purpose than if you approach it in antagonistic manner.

HPW: What about transparency ?  There have been calls for more transparency around the prices of new COVID-19 drugs and particularly R&D costs for drugs such as remdesivir, which received very large public sector investments?  

TC: We are likely to see that there will be differential pricing. If you want to make sure that everyone who needs has access, there will have to be tiered prices

As for the transparency of R&D costs for new COVID-19 drugs and vaccines. I would expect that the affordability issue is handled through public private partnerships. It does include the know-how of who puts in how much.

Image Credits: NIAID.

Unlike China’s President Xi Jinping, United States President Donald Trump didn’t appear on camera yesterday at the opening of the first-ever virtual World Health Assembly.

Instead he used Twitter to get his message across about China’s alledged coverup of early news about the novel coronavirus and WHO’s failure to act assertively vis a vis Beijing.

In a letter to WHO Director General Dr Tedros Adhanom Ghebreyesus, released early Tuesday morning on his personal Twitter account, @realDonaldTrump, the US President said he would permanently halt funding to the Organization and reconsider US membership if WHO does not commit to “substantive improvements within 30 days.”

“My Administration has already started discussions with you on how to reform the organization. But action is needed quickly. We do not have time to waste. That is why it is my duty, as President of the United States, to inform you that, if the World Health Organization  does not commit to major substantive improvements within the next 30 days, I will make my temporary freeze of United States funding to the World Health Organization permanent and reconsider our  membership in the organization.   I cannot allow American taxpayer dollars to continue to finance an organization that, in its present state, is so clearly not serving America’s interests.”

Annual 73d World Health Assembly – Votes on COVID-19 Resolution in Virtual Format

Hours after Trump’s letter was published, the World Health Assembly approved a European Union-led resolution that responded, at least initially, to two of the most key US demands. The resolution mandates an independent, “stepwise” review of the WHO’s performance in the  pandemic response, as well as a scientific investigation into the origins of the virus emergence in China.

However, Trump’s blunt, in-your-face message, was dramatically different in tone and style from the statements being made by most of the WHO’s other 193 member states during the two-day assembly – showing solidarity with WHO in the face of the challenges posed by COVID-19, and saying the organization’s independence needs to be strengthened, not undermined.

While other member states have oft criticized WHO, even bitterly, such remarks are usually made behind closed doors, while public discourse is softened by the language of diplomatic nuance.

Style May Detract From Substance

The US delivery style may, in fact, deflect attention away from a more serious examination of allegations about China’s missteps, including the represssion of free information flow and reprisals against Chinese and Wuhan whistle-blowers in the pandemic debacle, observers said.

“President Trump is behaving like a schoolyard bully,” Suerie Moon, co-director of the Global Health Centre, Geneva Graduate Institute, told Health Policy Watch.

“One of the weaknesses of the WHO is that it is not easily able to criticize any of its Member States, neither China nor the US. Trump appears to continue using WHO as a scapegoat to distract from what continues to be a highly-concerning epidemiological situation in the US. While the US can land a punch on WHO, there’s not much WHO can do to fight back. The US has a beef with China, but instead of raising these openly in the WHA yesterday, it went after a softer target.

“The thing is, nobody likes a bully. Although the US has raised concerns that are shared by other countries regarding the origins of the virus, how it was initially handled by the Chinese authorities, and the degree to which the authorities shared information with WHO or internationally, this letter weakens the US ability to get other countries to support its desire to get answers to these questions.”

Critics also point to the White House’s own repeated statements in late January and early February that praised China’s response and played down the impacts of the virus, both in terms of its infectious capacity and its impact on human health.  These were shortcomings that Trump critics quickly replayed on his own Twitter feed just after the letter was issued, recalling statements that the President had made in late January saying “We have it totally under control,” as well as another tweet stating “China has been working very hard to contain the Coronavirus.”

The other problem, others point out, is that reducing funding to WHO also weaken’s its range of independent action in times of crisis.

“The WHO is not perfect, but it is structurally starved of core funding, leaving this unique institution, that has the potential to be the agency we all want it to be, and deliver so much, weakened, undermined and destabilized, by the very people who it serves – its member states,” said Tim Reed, executive director of the advocacy organization Health Action International.

Letter Chronicles Alleged Chinese Delays and Concealment of Early Virus Reports

The Trump chronicle of charges is roughly based on a report published by the US Congressional Research Services last week: COVID-19 and China: A Chronology of Events (December 2019-January 2020).  The Congressional record cites a 30 December “urgent notice” by the Wuhan Health Commission about cases of atypical pneumonia that leaked online in China.  By the next day thre was a flurry of Chinese media reports. Taiwan sent a warning to WHO on 31 December about an unusual cluster of cases, in isolation. And WHO sent a query to its China office for clarifications. WHO finally issued its first public alert on January 4, 2020.

Based on that, the Trump letter charges that: “By no later than December 30 2019, the World Health Organization office in Beijing new there was a ‘major public health concern’ in Wuhan, including from Chinese media reports about “evidence of a new virus emerging from Wuhan, based on patient data sent to multiple Chinese genomics companies” and reports by a Hubei Province doctor, “that a new coronavirus was causing a novel disease that was, at the time, afflicting approximately 180 patients.”

Despite the fact that “International Health Regulations require countries to report the risk of a health emergency within 24 hours, “China did not inform the World Health Organization of Wuhan’s several cases of pneumonia, of unknown origin, until December 31, 2019, even though it likely had knowledge of these cases days or weeks earlier,” the letter states.

Lancet Study Published 24 January 2020 – Refers to 1 December Coronavirus Case
Graphic shows 1 December 2019 symptom onset date for first of 41 Wuhan coronavirus patients studied, The Lancet 24 January 2020,

Trump further claims: that WHO “consistently ignored credible reports of the virus spreading in Wuhan in early December 2019 or even earlier, including reports by the Lancet medical journal.”

That was immediately rebutted by Lancet editor Richard Horton. He later told Health Policy Watch: “The first reports the journal published were on January 24, 2020. In a paper by Chaolin Huang and colleagues, the first 41 patients from Wuhan with COVID-19 were described.”

The statement added, “The allegations levelled against WHO in President Trump’s letter are serious and damaging to efforts to strengthen international cooperation to control this pandemic. It is essential that any review of the global response is based on a factually accurate account of what took place in December and January.”

In fact, a Health Policy Watch review of the study 24 January 2020 Lancet study, in question found that it refers back to 1 December – as the earliest symptom onset date for the patients studied. It notes that: “The symptom onset date of the first patient identified was Dec 1, 2019”.  Patients were hospitalized between Dec 16, 2019, and Jan 2, 2020, the study authors further noted.

WHO Policies on Travel Restrictions Faulty – Statements Pandered to Beijing – Says Trump

The Trump letter further cites a litany of alleged “grossly inaccurate” or “misleading” claims by WHO about the virus and it’s praise for China’s response.  These include reference to WHO’s tweets on 14 January that there was “no clear evidence of human-to-human transmission of the novel coronavirus (2019-nCov) identified in Wuhan China.”

The letter also alleges Chinese pressure on WHO to defer a declaration of the outbreak as an international public health emergency. And it slams WHO praise for the Chinese government’s  “transparency” with respect to its reporting on the coronavirus. Other key points mentioned include:

Reprisals against Chinese scientists and health professionals –

The letter describes how the Chinese medical expert who first sequenced the genome of the virus and posted it online 11 January, had his lab closed by the authorities the next day for “rectification” – even as the WHO praised China for its transparency in posting the genome sequence.

Travel restrictions – The letter also criticizes WHO’s reluctance to recommend international travel restrictions to contain the virus, including statements in early February that spread of the virus ouside of China was “minimal to slow” and travel restrictions caused “more harm than good,” while millions of people leaving the Wuhan epicentre spread the virus around the world: “You also strongly praised China’s strict domestic travel restrictions, but were inexplicably against my closing of the United States border, or the ban, with respect to people coming from China… Incredibly, on February 3, 2020, you reinforced your position, opining that because China was doing such a great job protecting the world from the virus, travel restrictions were “causing more harm than good.” Yet by then the world knew that, before locking down Wuhan, Chinese authorities had allowed more than five million people to leave the city and that many of these people were bound for international destinations all over the world.

WHO-led Fact-finding mission to China: The “Even after you belatedly declared the outbreak a Public Health Emergency of International Concern on January 30, 2020, you failed to press China for the timely admittance of a World Health Organization team of international medical experts. As a result, this critical team did not arrive in China until two weeks later, on February 16, 2020. And even then, the team was not allowed to visit Wuhan until the final days of their visit. Remarkably, the World Health Organization was silent when China denied the two American members of the team access to Wuhan entirely.

Virus Spread by Asymptomatic Carriers: Trump cites WHO statements in early January about the absence of proof of human-to-human transmission and from early March downplaying the risk of asymptomatic virus, saying “It is now clear that China’s assertions, repeated to the world by the World Health Organization, were wildly inaccurate.”

Discrimination Against African Migrants: And it notes that WHO failed to comment on China’s “racially discriminatory actions” against Africans migrants that were evicted or refused services – which was the subject of a complaint by several African ambassadors to China on 11 April.

Praise for China: Throughout this crisis, the World Health Organization has been curiously insistent on praising China for its alleged “transparency.” You have consistently joined in these tributes, notwithstanding that China has been anything but transparent. In early January, for example, China ordered samples of the virus to be destroyed, depriving the world of critical information. Even now, China continues to undermine the International Health Regulations by refusing to share accurate and timely data, viral samples and isolates, and by withholding vital information about the virus and its origins. And, to this day, China continues to deny international access to their scientists and relevant facilities, all while casting blame widely and recklessly and censoring its own experts.

WHO Performance In SARS Era Praised – Including Including Its Recommendations For Travel Restrictions
WHO Director General Dr Tedros speaks at World Health Assembly

The letter concludes by sharply contrasting the COVID-19 policies of Dr. Tedros Adhanom Ghebreyesus with decisions taken by former Director General Gro Harlem Brundtland, during the 2003 outbreak of Severe  Acute Respiratory Syndrome (SARS) in China, and other parts of Asia:

“Perhaps worse than all these failings is that we know that the World Health Organization could have done so much better,” he states.

“Just a few years ago, under the direction of a different Director­ General, the World Health Organization showed the world how much it has to offer. In 2003, in response to the outbreak of the Severe Acute Respiratory Syndrome (SARS) in China, Director­ General Harlem Brundtland boldly declared the World Health Organization’s first emergency travel advisory in 55 years, recommending against travel to and from the disease epicenter in southern China.

“She also did not hesitate to criticize China for endangering global health by attempting to cover up the outbreak through its usual playbook of arresting whistleblowers and censoring media. Many lives could have been saved had you followed Dr. Brundtland’s example.

Investigations Mandated by European Union-led Resolution at the WHA – Key to Way Forward

The letter concludes with reference to the European Union-led resolution that should pave the way for an indepdent investigation of the origins of the virus and a review of WHO’s performance, stating that the resolution will fill the gap in areas where WHO has failed to act firmly:

“The World Health Organization has failed to publicly call on China to allow for an independent investigation into the origins of the virus, despite the recent endorsement for doing so by its own Emergency Committee.

“The World Health  Organization’s failure to do so has prompted World Health Organization member states to adopt the “COVID-19 Response ” Resolution at this year’s World Health Assembly, which echoes the call by the United States and so many others for an impartial,  independent, and comprehensive review of how the World Health Organization  handled  the crisis.  The resolution also calls for an investigation into the origins of the virus, which is necessary for the world to understand how best to counter the disease.”

“….It is clear the repeated missteps by you and your organization in responding  to the pandemic have been extremely costly for the world,” Trump states in the letter’s concluding paragraph. “The only way forward for the World Health Organization is if it can actually demonstrate independence from China.”

 

Image Credits: Donald Trump, WHO.

US Health and Human Services Secretary Alex Azar

China’s Xi Jinping announced a sweeping US$ 2 billion funding initiative for COVID-19 response in China’s opening speech at the World Health Assembly. Later in the day, the United States, disgruntled and having withdrawn funding from WHO, said it had spent US$ 9 billion on Covid-19 response and would soon be funneling over US$500 million to 40 of the most “at risk” countries – although the remarks were delivered by US Secretary of Health and Human Services Alex Azar and not President Donald Trump.

Xi said the China would create a “global humanitarian response capital and hub” in China and “green” corridors to Africa to fast track customs and ensure vital health supplies reach the continent. China will also partner with some 30 major African hospitals, accelerate the building of the China Centres for Disease Control headquarters, and pursue a debt suspension initiative.

Finally, he said that Beijing would ramp up its research and development of a COVID-19 vaccine, and ensure that it is made available as a “global public good.”

“The vaccine when available, will be made a global public good, this will assure China’s contribution to assure vaccines accessibility,”  said Xi, speaking in a web-broadcast statement at the first-ever virtual World Health Assembly.

Significantly, China was the first world leader to address the Assembly’s opening, just after a welcome by WHO host country Switzerland. Xi was followed by French President Emmanuel Macron, who echoed the call for a vaccine as a “global public good;” as well as the Republic of Korea’s Moon Jae-in, Germany’s Angela Merkel, and South African President Cyril Ramaphosa.

The increasingly bitter US rivalry with China hovered over this year’s World Health Assembly meeting, even as global leaders sought a way forward on cooperation to confront the pandemic that has locked down societies, devastated economies and reached most countries around the world.

The United States Responds – Alleges WHO Failure

In his response, Azar he took the World Health Organization to task – and Beijing indirectly – for failing to warn the world early enough about the risks that were posed by the appearance of a mysterious new coronavirus in Wuhan, China.

“We must be frank about one of the primary reasons this outbreak spun out of control,” said Azar, “There was a failure by this organization to obtain the information that the world needed, and that failure cost many lives.

“In an apparent attempt to conceal this outbreak, at least one member state made a mockery of their transparency obligations, with tremendous costs for the entire world,” Azar added. “We saw that WHO failed at its core mission of information sharing and transparency when member states do not act in good faith. This cannot ever happen again. The status quo is intolerable. WHO must change, and it must become far more transparent and far more accountable.

Azar said the US wanted “an independent review of every aspect of WHO’s response to the pandemic. We all must come together to ensure that WHO fulfills its key mandate, and that member states comply with the International Health Regulations.”

A review of WHO’s performance is in fact mandated in a European Union-led draft resolution on COVID-19 response, due to be approved by the Assembly on Tuesday. Diplomatic sources said that the United States appeared set to tacitly back the resolution, albeit while disassociating itself from paragraphs referring to the patent overrides and sexual and reproductive health – which the White House regards as code words for abortion rights.

The resolution also calls for a scientific inquiry into the original source of the coronavirus, and the pathway by which it leapt to humans, another key US demand.

The virus is typical of pathogens that circulate in bats in China’s Yunnan province, although no one has yet found an exact match for the SARS-COV-2 that first began to circulate widely around a Wuhan food market selling wild animals, in late 2019, which is almost 1,000 kilomterrs away. While WHO has said the virus almost certainly emerged from a natural source, some critics, including US President Trump, have also suggested that it could have have escaped from a nearby virology research lab.

Overt Rift Over Taiwan Avoided At Opening Ceremony –  Member States Hint at Inclusion
World Health Assembly 73 President, Keva Bain, Bahamas, announcing the decision to defer vote on Taiwan until WHA73 resumes later this year

Despite the obvious US-China tensions, the most immediate point of conflict – a request by Taiwan to join the Assembly as an observer – was quietly postponed for consideration at this month’s abridged WHA73 session.  Agreement on the postponement was reached in  informal consultations between the US, China and its allies over the weekend.

In response to a motion by new WHA president Keva Bain of The Bahamas, Member States agreed to resume discussion on Taiwan when the 73rd session reconvenes later this year, presumably with a full agenda.

Even so, a growing undercurrent of support for Taipei’s participation in the WHA seemed apparent at the Assembly, and may signal stronger pushback against Beijing down the line at the full agenda WHA.

Leading WHO donors such as Germany, hinted that the past practice of excluding Taipei should not remain the status quo:  “WHO should be a place for all relevant players who are able to contribute experiences in successfully fighting COVID-19.  WHO must become more independent from external interference,” said German Health Minister, Jens Spahn.

Only a handful of states, including Syria, overtly supported a “one-China policy” in the Monday virtual session.

The proposal to reinstate Taiwan’s observer status at the WHA – a role it held between 2009-2016, was made by some 13 countries, led by Belize and Guatemala, as well as other Central American, Caribbean, and Pacific island states.

It has received backing not only by the United States, but also from Australia and New Zealand, and others concerned about China’s growing web of geopolitical influence reaching deep into the Pacific region as well as westwards to Europe, the Eastern Mediterranean and Africa.

US says it hopes to “join consensus” on European Union Resolution for COVID-19 response

Despite bitter criticism of WHO, US Ambassador to the UN in Geneva Andrew Bremberg, said earlier on Monday that he hoped that the US “will be able to join consensus” around the proposed European Union-led resolution for COVID-19 response.

The resolution, which was hotly debated for the past three weeks behind closed doors, has now snowballed with overwhelming support from over 100 countries in every WHO region, including African member states. The long list of major government co-sponsors also includes the United Kingdom, Norway and Japan; India, Indonesia and Bangladesh in South-East Asia; Jordan, Qatar and Saudi Arabia in the WHO’s Eastern Mediterranean, and Canada and Mexico, Chile, Brazil and Peru in the Americas.  Notably, Switzerland is missing from the list of European government co-sponsors, which extend from Iceland in the west, to non-EU members such as the Russian Federation, as well as Monaco, Montenegro, Macedonia, Moldova, Turkey, Kazakstan and Albania in the east.

The final draft, agreed to last week, calls for a voluntary patent pool for new treatments and vaccines; a strong role for WHO along with an independent “stepwise” examination of the global and national pandemic response “at the appropriate time”; and an affirmation of the rights of countries to override patents altogether in case of need.

But the US delegation may also “dissociate” itself from at least two passages in the resolution, while stopping short of blocking consensus, sources said.

The controversial sections, debated at length by member states last week include: a) a reference to countries’ rights to patent overrides – which the US had wanted to be balanced with a reference to the importance of intellectual property in stimulating private sector R&D; and b) a reference to continued routine health services provision during the pandemic, including services for “sexual and reproductive health”, which the US Trump Administration views as code words for abortion rights.

Tedros: World Doesn’t Need More Plans; It Needs to Implement Existing Ones – And Strengthen WHO
WHO Director General Dr Tedros speaks at World Health Assembly

Meanwhile, WHO’s Director General Dr Tedros Adhanom Ghebreyesus, whose record has been under attack, welcome a EU-sponsored plan for a step-wise evaluation of the WHO but also said the countries often failed to learn from the lessons of past epidemics.

“The world can no longer afford the short-term amnesia that has characterised its response to health security for so long,” he said, calling for a more “comprehensive chain for pandemic preparedness,”  Dr Tedros said in his opening address.

He said that he would nonetheless initiate an evaluation of the COVID-19 response “at the earliest possible moment.”

“The virus has made us humble,” Dr Tedros said. ‘”We all have lessons to learn from the pandemic…every organization must examine itself,” he said, noting that a WHO oversight had already published its first assessment of the pandemic,  “WHO is committed to transparency, accountability and continuous improvement,” he said.

But he also told countries that more than a review, political will and global solidarity is required to learn from the already obvious key lessons of COVID-19.

“We don’t need a review to tell us that we must do everything in our power to ensure that this doesn’t happen again,” Dr Tedros said.  “Whatever lessons we might learn from this pandemic, the greatest lesson would be not to learn from them and to leave the world as vulnerable as it was before.

“The world doesn’t need another plan, another system or another committee. It needs to strengthen, implement and finance the systems and organizations it already has including WHO.

“What it has lacked is the sustained commitment to use the science, the tools and the resources that it has. That must change, and it must change today. Today, I am calling on all nations to ensure that it will do everything it can to make sure that the 2020 COVID pandemic is never repeated.”

Key Donor Countries Express Strong Support For WHO – But Also For Independent Review of COVID-19 Performance  
(top-down, left-right) Emmanuel Macron, Angela Merkel, Simonetta Sommaruga, Moon Jae-in

Key European delegations such as France and Germany attempted to strike a conciliatory note by upping their financial contributions and calling for increased funding for the WHO, while at the same time supporting the call for an independent review into the agency’s handling of the crisis. Many countries also called for the International Health Regulations to be strengthened.

“The WHO is the legitimate world organization for the area of health, and so we should continue to work to improve procedures within [the agency],” said Germany’s Chancellor Angela Merkel. Germany will increase its WHO contribution to a total of €176 million, according to Spahn. The country doubled its funding allocation for WHO’s Health Emergencies Programme to €50 million. 

French President Emmanuel Macron announced that France had “substantially increased” its contribution to the Organization, saying, “We need WHO for its irreplaceable coordinating role, scientific expertise, and knowledge of the situation on the ground.”

He too, however, supported the independent review, saying: “We need to look at the situation clearly, and… carry out an honest and vigorous assessment of what’s worked and what hasn’t worked in the way this international crisis has been managed.” 

The French and German Heads of State’s comments were echoed by President of the Swiss Confederation, Simonetta Sommaruga, who firmly declared that an international, multilateral response to the pandemic should be “strengthened” rather than “undermined.” Sommaruga also announced a new Swiss-led initiative to form regional coalitions to assure countries’ adherence to the International Health Regulations – the body of international law governing WHO’s pandemic response.

Germany, France, The Netherlands and the Republic of Korea also supported giving the IHR more teeth, with some even calling for the establishment of binding legal measures for countries. 

“We must update the WHO International Health Regulations and other relevant norms and augment them with binding legal force,” said Republic of Korea President Moon Jae-in. “A novel infectious disease could emerge at any time and we must be able to respond more quickly and effectively. Infection-related data should be shared among countries in a more transparent manner, and an early warning and cooperation mechanism must be jointly established at the G20 June 21st Summit.” 

Svet Lustig Vijay, Grace Ren, and Tsering Lhamo contributed to this story

Image Credits: Korea.net / Korean Culture and Information Service (Jeon Han).

Grammy Award Winner Ricky Key (left) with Lonnie Park (right) singing for Walk The Talk

This weekend, over 16 million people from all over the globe came together for the WHO’s third Walk the Talk: The Health for All Challenge. The two-day virtual event began Saturday in the Philippines and concluded on Sunday, with a 5-hour jam-packed virtual programme broadcast from Geneva – and boasting a vibrant range of physical activities and live chats with health experts to get people moving for their own health and that of others.

“It’s time to get moving. Exercise is so good for you. It’s good to walk, it’s good to breathe deeply, and you can do it in your house, but stay healthy. I’m going to get up, I’m going outside. I’m going to do my walk and walk the talk,” said US-based rhythm & blues artist Kim Sledge in support of WHO’s event.

On Sunday, Walk The Talk offered about 30 interactive events for all ages, ranging from a refreshingly positive concert with Grammy Award winner Ricky Kej, as well as art therapy; cooking classes; and dance, cycling and fitness workshops.

International Basketball Federation presents ‘paper-ball at home’ activity

The event featured some 50 guests and organizations, including leading personalities from groups as diverse as the Fédération Internationale de Football Association (FIFA), the International Olympic Committee, the International Basketball Association, the World Food Programme, the European Commission, and more.

As We Adapt To New Realities, Looking After Our Health Is Ever More Important 

As we adapt to new realities of working from home, unemployment, or homeschooling, it is ever more important that we look after our physical and mental health, said WHO’s director of Mental Health and Substance Use Devora Kestel.

Physical inactivity is already the fourth largest driver of global mortality – and may increase given stay-at-home measures. Accounting for 6% of deaths globally, physical inactivity is responsible for 1 in 4 breast and color cancers, as well as almost 30% of diabetes and 30% of ischaemic heart disease.

However, regular and adequate levels of physical activity can help improve quality of life and reduce the risk of non-infectious diseases like hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer, depression and the risk of falls.

Interactive field hockey drills organized by Geneva-based Servette Field Hockey group.

Looking after our mental health is equally important as times change. Having a routine and not being too hard on oneself is important, emphasized Kestel:

“Try to keep an eye on daily routines, as much as possible. Eat healthy meals, do some exercise, even if at home, and keep in touch with people you care about. Make sure that you make time for yourself to do things you enjoy doing. Don’t be too hard on yourself, keep informed, keep yourself and your loved ones safe. More importantly, take care of yourself and be kind to one another.”

Artist Ann Tracy presented interactive activity on Sunday

One daily coping strategy could include art therapy, as art has positive effects on people’s physical and mental health, said artist Ann Tracy during her interactive art workshop on Sunday. According to research, art therapy reduces blood pressure, heart rate, anxiety, and can also help with depression.

Achieving Universal Health Coverage: Solidarity, Cooperation And Healthcare Workers

To effectively fight COVID-19 while achieving universal health coverage, the world needs to tick together in solidarity, agreed panelists:

“Leaving just one person behind can be catastrophic for all of us. There is no more time to waste on the talk. Let’s start walking now, once and for all, towards universal health coverage. Everyone safety depends on it,” said António Vitorino, Director-General of the International Organization for Migration.

To achieve universal health coverage, international cooperation and multilateralism will be crucial, added Ambassador Walter Stevens, head of the European Union delegation to the UN.

“This is a time of solidarity. This is a time of international cooperation and multilateral response. And the WHO is crucial in those efforts to improve global health.”

Acknowledging the importance of healthcare workers will be crucial in fighting COVID-19 as well as attaining universal health coverage, said Elizabet Iro, WHO Chief Nursing Officer.

“We need to invest in nurses and midwives…The COVID-19 pandemic is a stark reminder of the vital role nurses, midwives and other health workers play without them. We will not win the battle against outbreaks. We will not achieve the Sustainable Development Goals, or universal health coverage [without healthcare workers]. They need our support and respect.” 

Stay-At-Home Notices Have Had Some Good Repercussions: Healthier Cities

Lockdowns have improved air quality and healthy cities

Though the raging pandemic has wreaked economic havoc around the globe, some good things have come out of it, suggested WHO’s Director of Social Determinants of Health Etienne Krug.  Air quality in cities is better, and people have begun cycling and walking to get around, while avoiding crowded public transport:

“For the last few months, our air has been cleaner and people walk and cycle safely [in cities]. We have to make sure that we continue to walk and cycle as much as possible] to guarantee cleaner air” and good health, said Krug. “I encourage all cities to think about more cycling and walking.”

Stay At Home; Get Tested; Implement Physical Distancing; Wash Your Hands;

Walk The Talk also reinforced key messages to better confront the pandemic, including stay-at-home measures, physical distancing and copious handwashing.

“Stay home, walk the talk. Join WHO in this fantastic virtual event. Stay home, keep social distancing and clean your hands. And if you feel symptoms, go and get tested. It’s so important,” said Didier Pittet, director of Geneva University’s Infection Control Programme.

As he closed the 5-hour event on Sunday, WHO director Dr. Tedros Adhanom Ghebreyesus, said that the Walk The Talk even provides a positive Launchpad for Monday’s 73rd virtual World Health Assembly, where the world will come together in attempts to “protect the most precious gift of health.” 

Dr Tedros personally presided over the first major, Geneva-wide Walk the Talk event just prior to the 2018 World Health Assembly – and ever since WHO has sponsored similar events before the WHA. At the last UN General Assembly in September 2019, WHO sponsored an event featuring music, culture and athletics in Central Park.  

“Welcome to the third edition of the who walk the talk, house for all challenge, live from Geneva, Switzerland. Unlike past years, when thousands of people gathered in Geneva us to dance, walk and move for health, today we are coming together and connecting in new ways to celebrate. 

“Today’s virtual Walk the Talk is the culmination of a two day global event,” Dr. Tedros said, referring to the fact that along with the events in Geneva, WHO regions have been hosting their own virtual Walk the Talk events, each in their own time zone.  “Yesterday, people from Manila to Washington DC showed that achieving our goal of promoting health for all has never been more important than today.”

Hopefully, the kind of cooperation that was evidenced in Sunday´s event also will help bring the world out of this crisis, said Valentin Zellweger, the Swiss ambassador to the Permanent Mission of Switzerland to the UN.

“Let’s now celebrate Walk The Talk today and hope that we will find a good outcome of the World Health Assembly [on Monday]…common action and cooperation [will] bring us out of this crisis as quickly as possible. So please join us in discussing these issues,” said Zellweger to participants.

“There is one thing we can learn from coronavirus. To get to the end of the tunnel, we all have to stay strong. We have to stay active, and we have to stay healthy. So, please, come on, get active right now,” said Thomas Back, President of the International Olympic Committee, which is based in Lausanne, Switzerland.

Image Credits: WHO.

World Health Assembly 70th meeting in 2017, at Geneva’s Palais des Nations – This year’s virtual format to be a first.

The world seems set to make at least a symbolic display of unity in the battle against the COVID-19 pandemic  at the upcoming World Health Assembly (WHA), which begins on Monday. The WHO’s 194 member states are expected to overwhelmingly approve a European Union-led resolution that aims to step up the global COVID-19 response, and ensure equitable access to treatments and future vaccines. Along with EU member states, the resolution, published Friday on the WHO website, is supported by an impressive list of 28 other countries worldwide, including Canada, Brazil, Chile, Norway, Indonesia the Republic of Korea, South Africa, Zambia and the United Kingdom.

But the show is unlikely to go off as smoothly as some might hope, and not only because the 73rd Assembly is meeting for the first time ever in a virtual format.

Rising geopolitical tensions between the United States and China – are also likely to be vivid display at the very beginning of the two day event. Before countries can start talking about COVID-19, they face a likely vote over a procedural proposal to invite Taiwan to the Assembly as an Observer.

The proposed has been made by 13 countries, including Guatemala – is set to be the first country speaking at the WHA.

The issue is less about Taiwan, however, than about the conviction in Washington as well as in other western capitals that China’s reporting on the SARS-CoV-2 virus and its possible origins has not been entirely transparent, particularly in the early days. Lining the COVID issue are strong US concerns, shared by countries in the Western Pacific region and beyond, about the expanding web of Beijing’s geopolitical influence.

Meanwhile, as US and WHO legal and technical teams worked behind the scenes to mitigate effects of the recent US suspension of funds to WHO, Fox News reported that the White House was now considering an agreement “to pay up to what China pays in assessed contributions,” according to a draft letter obtained.

Fox News Report aired Friday in the United States

Sources in Geneva told Health Policy Watch if the deal is successful, it could even be announced at the WHA. China’s assessed contribution for 2020 is US$ 28.7 million – about half of the US$ 57.8 million due from Washington. However, the US also has almost US$ 41.3 million in unpaid bills outstanding from last year, according to the 30 April 2020 WHO account.

“This is an unprecedented moment for WHO. It is also in the line of fire as it has never been before. We see WHO walking a tightrope between two major world powers,” said Suerie Moon, co-director of the Global Health Centre of the Geneva Graduate Institute, which is hosting a two-week series of events around the WHA that kicked off Thursday.

She described the COVID-19 pandemic as “a stress test for the global health community. It’s a stress test that can narrow or widen the divisions that we already see.  What we need to do is to think  beyond business as usual, to move beyond politics as usual – and the WHA will be a test for that.”

So while things could still change rapidly over the weekend, here is the latest state of play for the WHA.

European Union Resolution Has Large Consensus

On the unity side of the coin, Thursday, member states quietly endorsed the draft of a proposed WHA resolution on COVID-19 response. The draft resolution, the main item on this year’s official  agenda,  includes far-reaching provisions for the creation of a voluntary pool of patents for COVID-19 treatments [see related story]; investigation into the origins of the virus; and strong affirmation of WHO’s central role in global health balanced by a call for a “stepwise examination” of the agency’s response to the pandemic.

“I think we are seeing possibly the best… in terms of international cooperation. I am not saying we won’t also see the worst,” said French Global Health Ambassador Stephanie Seydoux, referring to the range of COVID-19 initiatives that have been launched by the global community in recent weeks, and which are captured somehow in the draft WHA resolution.

In a modest victory for civil society, the resolution also makes several references to the rights of countries to legally override international patent rules during a health emergency, making use of so-called “flexibilities” in World Trade Organization Trade Related Aspects of Intellectual Property Rights (TRIPS).

The resolution had been the subject of tense, closed-door deliberations for weeks. It was characterized by usual sparring between countries more protective of industry and those member states, backed by civil society groups, keen to break what one key advocate, James Love, described as “patent monopolies” over critical health products.

“Everything right now should be preparing to scale up as fast as possible, use as many manufacturers as possible, and have no monopolies on any of these technologies,” said Love, head of Knowledge Ecology International, speaking at a webinar Thursday on the planned WHO COVID-19 Technology Pool, including leading civil society and UN advocates.

The formal WHA resolution is focused on voluntary pooling of innovations and recognizes the private sector role. But it’s worthy of noting that major European powers, including France, the United Kingdom, Switzerland and Germany, all home to large pharma interests, back a final compromise draft that also repeatedly referred to the rights of countries to break patent rules.

This is no doubt due, in part, to the growing fears among Europeans also been hard-hit by the virus, that reliance purely on market mechanisms to ensure equitable distribution of the next treatment or the first vaccine might also leave them out in the cold. The inherent challenges to  ensuring access is equitable and broad were immediately visible this week in the French uproar over a Sanofi statement that the US would get the first pick of any vaccines that it produces because they had invested more in its development.

United States Sought Last Minute Changes – Mostly Technical or Cosmetic
President Donald J. Trump listens as Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases briefs media Saturday, April 4.

In the final hours of the negotiations over the EU draft text, it appeared that the United States was the main actor still trying to make changes.  And even there, seasoned observers say, Washington’s proposals were in fact fairly technical or cosmetic in nature – an extra nod to industry in some key clauses as well as requests for clearer definitions of terms like “equitable access” – but not opposition to the concept, as such.

It still remains to be seen if the White House will indeed back the final COVID-19 Response resolution when it finally comes before the plenary – where the resolution is expected to adopted.

In the WHA, where tradition has most resolutions adopted by consensus and support for the  measure is overwhelming, the US is unlikely to demand a vote. Washington may still choose to “disassociate” itself from the resolution or from certain sections with which it doesn’t agree  – particularly language referring to the continuation of health services, including services for “sexual and reproductive health” regarded as code for abortion by the White House.

But there are also clearly elements in the draft resolution that the United States appears keen to support. This includes the call for a thorough, science-based investigation into the sources of the virus; as well as an “examination” of the performance of WHO (as well as other UN agencies and countries) in the overall pandemic response – in a  “stepwise” approach – that countries hope can make the investigation timely without detracting from the overall pandemic response.

While deferring comment on the resolution, per se, a US Mission spokesperson told Health Policy Watch: “The United States will be present and vocal at the World Health Assembly, as in all years past. Addressing global health threats effectively would be impossible without the United States, which contributes close to 40 percent of the world’s global health assistance – nearly five times larger than the next largest donor, and more than 20 times more than China…. We expect the Secretary of Health & Human Services Alex Azar to be the leader of our delegation to the WHA this year.”

Amidst Attempts to Show Unity – Taiwan Is Thorny Reminder of a Divided World
Taiwanese President Tsai Ing-wen, speaks about the health system response to the COVID-19 pandemic

Admidst the attempts to display global unity, however, the simmering issue of Taiwan is a sober reminder of the big divisions that shape real-time political responses to the virus.

Thirteen WHO member states have asked for the inclusion of a supplementary WHA agenda item, iinviting Taiwan to attend the health assembly as an observer.

“Consultations are going on, to reach an arrangement. But if there is no arrangement and there has to be a vote, it could be a vote by a roll call and it could take a long time. It could be disruptive,” said Gian Luca Burci, former WHO legal counsel speaking at a WHA Overview webinar, convened by the Geneva Graduate Institute’s Global Health Centre, yesterday.

This is hardly the first time the issue of Taiwan has surfaced at the WHO.  Between 2009 and 2016, Taiwan was invited personally by then WHO Director General Margaret Chan, herself a native of Hong Kong, with the tacit agreement of both China and the United States.  That was when relations were also warmer between the Taiwanese government and mainland China.  But after the 2016 election of Taiwan’s new president, Tsai Ing-wen, a China-skeptic, chill set in, and the protocol for WHA changed.  For the past several years, since WHO Director Tedros Adhanom Ghebreyesus took the helm, two member states would propose to the WHA Committee setting the meeting agenda that Taiwan be included.  Two other countries would object. And then the matter would be quietly set aside.

Already at February’s WHO Executive Board meeting the atmosphere was heating up around the Taiwan issue.

Pointed references then by some Latin American and African member states to Taiwan’s role in supporting their COVID-19 response, met with sharp protests from Chinese delegates at the meeting, who objected to Taiwan’s name even being mentioned in WHO meetings.

At that time, however, Washington was still making friendly overtures toward Beijing. Weeks later, as the United States began to blame China publicly for holding back on vital information about the new coronavirus, WHO was also drawn into the fray, with positions US President Donald Trump described as “China-centric”.  Taiwan revived and circulated its initial emails to the WHO, particularly one sent on 31 December 2019 referring to the emergence of a mysterious virus in Wuhan that had some patients in isolation, which it says was ignored. Soon after that, President Trump said he would suspend WHO funding for 90 days, pending an investigation of its response.

But the US concerns go well beyond the virus or WHO’s performance. In fact its about China. Washington is increasingly concerned about web of influence that Beijing is building not only in the Pacific region, but also as a result of its “Belt and Road” initiative reaching westward to Europe and the eastern Mediterranean. Strikingly, a visit by US Secretary of State Mike Pompeo to Israel last week was more focused on the perceived strategic threat from new Chinese investment in Israeli infrastructure, including ports, a light rail system and a desalinization plant – than regional conflicts, Israeli media reported.

So while striking a positive note, vis a vis the upcoming WHA, the US position on the inclusion of Taiwan in the Assembly is unequivocal:

“We look forward to participating in this year’s WHA, and remain determined to see Taiwan join those conversations as an observer,” the US Geneva Mission spokesperson told Health Policy Watch.

“We have long supported Taiwan’s membership in international organizations where statehood is not a requirement, and believe their successful actions in response to COVID-19 would be of significant benefit to the rest of the world.  The People’s Republic of China would rather that success not be shared, no doubt to avoid uncomfortable comparisons.”

Is a US Funding Resumption to WHO in the Cards?

The US suspension of funds to the WHO, announced last month, was linked to the US criticism of the agency over its alleged tilt towards Beijing.  Hints now about a possible resumption of funds  come on the heels of several weeks in which WHO’s African Region, in particular, warned of serious impacts on its heavily-US-funded operations. Rumors of possible fallout, including the risk of layoffs, had begun to circulate among staff at WHO’s Geneva headquarters. Meanwhile, WHO legal and technical teams have been negotiating behind the scenes with their US counterparts over ways to mitigate the damage – including possibly funneling urgently needed monies directly to those groups or agencies working directly in the field so that vital frontline disease control activities are less seriously harmed.

Announcement at the WHA of a partial resumption in monies, then, would be a huge breakthrough.  Payment of even part of the $US 57.8 in assessed funding to WHO for 2020, would be an important symbolic step forward in breaking the ice around the current impasse, paving the way for a full restoration of funding, more quietly later on.

Closing the hefty back bill owed by the US from last year would also certainly help cover any immediate shortfalls. And in this area, WHO has some leverage to wield – since this US$41.3 million is legally-owed to the organization in any case and pre-dated the White House announcement of the COVID-19 related suspension.

Also worthy of note:  so-called “assessed funding” due from the United States for the current budget period of 2020-21 is US$ 116 million. But that represents only a fraction of its total spending. In 2018-19 the US channeled nearly US$ 500,000 to the Agency- including so-called voluntary contributions for specific programme activities.

Total US contributions, in turn represent about 15% of WHO’s total budget – and an even higher proportion of its activities in Africa.

What remains to be seen if any White House announcement of a partial funding resumption will be somehow be tied to a WHO or a WHA member state gesture that restores “observer” status to Taiwan, which recognized or not, is represented by a democratically-elected government.

– Updated 18 May 2020

Image Credits: WHO, WHO, Fox News , flickr/The White House. Official White House Photo by Andrea Hanks, By Office of the President – Flickr, CC BY 2.0,.

Carlos Alvarado Quesada announces the launch of a COVID-19 intellectual property pool

Costa Rica and the World Health Organization today announced that a voluntary intellectual property pool for COVID-19 related technologies will be officially launched on May 29, following the World Health Assembly on May 18 to 19.

The official launch comes more than two months after the Costa Rican president and health minister first published an open letter to WHO calling on the agency to establish a COVID-19 intellectual property pool in order to promote access to new and existing technologies.

Dr Tedros Adhanom Ghebreyesus

“At the beginning of the pandemic, President Alvarado asked me to set up a health technology repository for vaccines, medicines, diagnostics and any other tool that may work against COVID-19,” said WHO Director General Dr Tedros Adhanom Ghebreysus in a prepared statement Friday. “WHO has accepted this visionary proposal from his excellency President Alvarado and will, in the next few weeks, launch a platform for open, collaborative sharing of knowledge, data and intellectual property on existing and new health tools to combat COVID-19.”

When pressed about whether US President Donald Trump would be likely to support the initiative, Dr Tedros said, “I mean, I cannot answer that question, I think you better ask the president.”  

The United States had just two days ago attempted to disassociate itself from language referring to countries rights to override patent protections during global emergencies in a European Union draft resolution to be discussed next week. In a modest victory for access advocates, the US objections were overridden.

Dr Mariangela Simao

Chile has joined on to support the Costa-Rica initiative, but other Member States are still finalizing negotiations with Costa Rica. However, “Member States from all [WHO] regions” are expected to sign on to support the initiative by the official launch date on 29 May, said WHO assistant director-general for Access to Medicines, Vaccines and Pharmaceuticals Dr Mariangela Simao, in response to a query from Health Policy Watch.

“This is a call for Member States. It’s a call also for academia, for the private sector and companies, for research institutions, and for cooperation agencies, all around the world,”  said Costa Rica President Carlos Alvarado Quesada. “We want to see these innovations and technologies as global public goods to protect humanity against this threat.”

“We’re also calling for this to be a repository created on a voluntary basis, because now we need solidarity,” added Alvarado Quesada.

Sebastián Piñera

“We recognize that WHO is the main mechanism for health matters and… health policy. Pandemics affect all people, whatever their age, gender or race, and particularly have a disproportionate effect in developing countries,” said a Chilean delegate, reading an official statement from Chile’s President Sebastián Piñera. “And that’s why we are very glad to join Costa Rica’s initiative.”

The pool will be built off of the Medicines Patent Pool, an existing UN mechanism funded by Unitaid that pools voluntarily released patents for essential medicines, and then licenses the patents to generics manufacturers. Both the MPP and Unitaid’s Boards have released open letters supporting the Costa Rica initiative, endorsing a temporary expansion of MPP’s mandate to include all COVID-19 related vaccines, diagnostics, drugs, and other technologies.

Image Credits: Government of Chile.

Kawasaki disease is a severe inflammatory disease in children

Children are 30 times more likely to experience Kawasaki-like disease in Bergamo, Italy’s epicentre of infections and deaths, reported a Lancet study of 29 children on Wednesday. The SARS-CoV-2 virus could trigger symptoms similar to those of a severe cardiovascular illness called Kawasaki disease.

While there were 19 cases of Kawasaki disease in the past five years between January 2015 and February 2020, there were 10 cases of Kawasaki-like disease between February-April 2020.

Initial calculations suggested that the rate of Kawasaki disease shot up by a factor of ‘at least’ 30 between February-April 2020, in comparison to the pre-pandemic period between January 2015 and February 2020. However, the initial calculation is an underestimate, said researchers, as emergency referrals in Bergamo’s hospital were 6 times higher in the pre-pandemic period compared to the months leading up to COVID-19.

After correcting for the 6-fold difference in emergency referral before and after the pandemic,  the total incidence of Kawasaki disease shot up to 3.5% in February-April 2020 compared to 0.019% between January 2015 and February 2020, or a 184-fold increase.

Kawasaki disease incidence has surged since COVID-19

The Italian retrospective cohort study of 29 children, which compared the number of patients with Kawasaki-like disease before and after the pandemic began, provides the most convincing evidence yet that the SARS-CoV-2 virus can trigger Kawasaki-like disease.

In the group of 10 children that developed Kawasaki-like disease between February-April 2020, 8 of them developed IgG antibodies for COVID-19:

“These results and considerations support the hypothesis that the immune response to SARS-CoV-2 is responsible for a Kawasaki-like disease in susceptible patients.

“Kawasaki-like disease….has a clear starting point after the first case of COVID-19 was diagnosed [in Bergamo],” said researchers from Hospital Papa Giovanni XXIII in Bergamo, Italy.

While all the children diagnosed with Kawasaki-like disease during the COVID-19 pandemic survived, they had more severe symptoms than those in the last 5 years, with 6 of 10 patients having heart complications, compared with only 2 of 19 (11%) of those diagnosed before.

5 of the 10 children diagnosed during the pandemic had signs of toxic shock syndrome, compared with none of the children diagnosed previously. Toxic shock syndrome is a rare, life-threatening illness with symptoms including a high fever, low blood pressure, and rash.

While the Lancet study acknowledged some limitations, such as the need for a larger sample size to confirm the strong link between COVID-19 and Kawasaki-like disease, they warned that “a similar outbreak of Kawasaki-like disease is expected in countries affected by the SARS-CoV-2 pandemic.” 

Kawasaki disease has been spotted all over the map since COVID-19 arose, with 125 cases in France, 100 cases in New York, 10 cases in London and 3 in Switzerland.

These findings have important implications for policy-makers as they begin lifting their lockdowns, said researchers:

“The association between SARS-CoV-2 and Kawasaki-like disease should be taken into account when it comes to considering social reintegration policies for the paediatric population.”

Although the cause of Kawasaki disease remains unknown, the Lancet study builds on an existing body of evidence that coronaviruses like SARS-CoV-2 can trigger the disease.  

In developed countries, Kawasaki disease is the most frequently acquired heart disease, affecting “no more than one in 1000 children exposed to SARS-CoV-2”, said the researchers. 

A Third Of Patients With COVID-19 Have Acute Kidney Failure, Reports New York Study

In a parallel development, it is becoming more apparent that severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, is more than a respiratory disease – Of some 5 500 hospitalized COVID-19 patients in New York, a third had acute kidney injuries and nearly 15% required dialysis, reported a study on Thursday published in Kidney International.

“Acute kidney failure occurs frequently among patients with COVID-19 disease..It occurs early [in the disease] and is associated with poor prognosis,” said researchers.

Mechanical ventilators can help patients with severe COVID-19 breathe.

In the study, almost 40% of patients with COVID-19 entered the hospital with kidney failure, suggesting that kidney failure occurs early in the disease.

Once patients were placed on a ventilator, kidney failure was even more likely, as 90% of patients on ventilators developed kidney failure. 

Individuals most at risk of acute kidney failure included those with diabetes type II, heart disease, hypertension, older people and people of black ethnicity.

Image Credits: BruceBlaus, The Lancet, Agência Brasília .

Worldwide distribution of people that are undernourished

An additional 135 million people globally will be unable to feed themselves if measures are not put in place to ensure food security, said World Food Programme Regional Director for West and Central Africa Chris Nikoi, in a regular press briefing on Thursday. In the WHO African region, an extra 22 million people will be undernourished as a result of the economic fallout from COVID-19 lockdowns on top of the 200 million Africans that are already undernourished.

The majority of Africa’s population lives hand-to-mouth, and lack of income opportunities under the lockdowns have left many hungry and unable to afford food. The cost of basic foodstuffs has increased, and essential food supplies have been delayed due to trade restrictions imposed since the lockdown – with major repercussions on older populations, which are more vulnerable to COVID-19:

Chris Nikoi, UN World Food Programme (WFP) Regional Director for Southern Africa

“If this aging population is beginning to be affected by the pandemic, then it will have serious implications for food production going forward. West and Central Africa is now going to enter planting season and just imagine if most of rural Africa with older people who farm are falling ill,” said Nikoi.

Africa’s population is already vulnerable to COVID-19 given its high burden of pre-existing diseases like HIV/AIDS, malaria or tuberculosis – and undernourishment weakens the immune system even more. 

“Undernourished people have weaker immune systems, which may make any infection worse,” said WHO Regional Director for Africa Matshidiso Moeti, who also spoke at the press conference.

Governments should allow supply chains and trade to function. Production, distribution and consumption must be maintained, Nikoi said – or there will be serious malnutrition across the continent. 

In a parallel development, a new United Nations report projects that the world economy will shrink by 3.2% in 2020. The United Nations Department of Economic and Social Affairs forecasts a prolonged economic slump and a slow recovery, with global poverty rising for the first time since 1998. 

Image Credits: World Food Programme , Our World In Data.

Celebration of Older Adult Mental Health Awareness Day in the USA

The raging pandemic has highlighted an urgent need to incorporate mental health into COVID-19 recovery plans and to ‘substantially’ improve mental health funding – Or the world will face a ‘massive’ mental health crisis in upcoming months, reported a United Nations policy brief on Thursday. 

“The impact of the pandemic on people’s mental health is already extremely concerning,” said WHO Director-General Dr Tedros in a statement on Thursday. “Social isolation, fear of contagion, and loss of family members is compounded by the distress caused by loss of income and often employment.”

COVID-19 has increased psychological distress worldwide, report national 2020 surveys

All over the globe, mental health difficulties have worsened due to COVID-19, leaving vulnerable populations like healthcare workers, children, women and older people at particular risk. In Ethiopia, the number of people with symptoms of depression has tripled. Meanwhile in China, almost half of healthcare workers have reported depression and anxiety, and 34% have insomnia, according to a study published in JAMA from late March. 

As well as healthcare workers being disproportionately affected by COVID-19, children have faced COVID-related psychological distress, with parents reporting difficulties concentrating, as well irritability, restlessness and nervousness in children – and lockdowns have increased the risk of domestic violence and abuse.

Parents’ reports of children’s difficulties during COVID-19 confinment (Italy and Spain)

COVID-19 lockdowns have strained mental health services that were already fragile. Community services like self-help groups for alcohol and drug dependence have not met for months, and mental health facilities in hospitals have been converted to care for people with the coronavirus, leaving mental health needs unmet.

Adapting Policy: Incorporating Mental Health In Recovery Packages & Improving Funding 

It is critical that people living with mental health conditions have continued access to treatment, said a WHO statement from Thursday – and some countries have begun adapting policy, with some signs of success. 

To ensure continuity of care, teams from Egypt, Kenya, Nepal, Malaysia and New Zealand, among others, have ramped up mental health capacity through emergency telephone lines for mental health to reach people in need.  

Some countries have even considered mental health as an ‘essential’ component of the national response to COVID-19.

In Madrid, local-policy makers have deemed emergency psychiatry services as ‘essential services’, enabling mental health-care workers to continue outpatient services over the phone and through home visits. While Madrid has converted over 60% of mental health beds to provide COVID-19 care, people with severe mental health conditions have not been left behind – They have received care in private clinics.

As well as incorporating mental healthcare in ‘any COVID-19 recovery plan’, countries need to cover essential mental health needs in health care benefit packages and insurance schemes, said the UN Policy Brief.

Prior to COVID-19, only 2% of national health budgets were invested in mental health, and over three quarters of people with mental health conditions in low- and middle- income countries received no treatment for their condition.

The global economy loses more than US$ 1 trillion every year due to depression and anxiety, according to UN estimates.

Image Credits: National Center for Equitable Care for Elders, UN.

World Health Organization member states reached initial agreement today on a European Union-led draft resolution on global COVID-19 response to go before the upcoming World Health Assembly – overriding some of the previous US objections to language referring to the rights of countries to override patent rules.

The draft resolution to be submitted to the upcoming World Health Assembly Monday, May 18, would help pave the way for coordinated planning by the global health community to ensure broad access by people worldwide to COVID-19 medicines and vaccines, according the  draft obtained by Health Policy Watch.

The agreement on a text, calling for “universal, timely and equitable access” to COVID-19 treatments, was submitted by the EU-led sponsors to the WHO for public debate at the WHA next Monday after a “silence period” in which any of the 194 member states could raise formal objections expired at noon. Even after the deadline, informal negotiations reportedly continued in an attempt to bridge differences.

Those seemed to be largely centered on duels over highly technical, but politically charged language over the rights of countries to override patents for vital health remedies – which the US and some its allies reportedly wanted to be balanced with references to the importance of also encouraging private sector innovation.

However,  final draft text remained intact and diplomatic observers said that any further issues will be aired on the floor of the WHA plenary next week. It is co-sponsored by Australia and New Zealand, the United Kingdom, Zambia, Albania, Monaco, Montenegro, North Macedonia and San Marino.

The original purpose of the resolution, tabled just a few weeks ago, was to create a broad consensus around the creation of a voluntary global “patent pool” for new COVID-19 treatments – building on an initiative launched by the European Commission, together with France, Germany, the United Kingdom, Costa Rica, South Africa, and WHO, last month, and which has so far raised 7.4 billion Euros.

The final iteration of the text, however, marks a modest victory for medicines access advocates.  It refers explicitly and repeatedly in several sections to countries’ rights to legally upend international patent rules, and procure or produce generic versions of treatments, when there is an overriding public health need. The so called flexibilities in “Trade Related Aspects of Intellectual Property Rights (TRIPS),” is part of World Trade Organization negotiated frameworks. In reality, countries rarely take advantge of the exceptions – although the COVID-19 crisis has already seen a trend towards more potential use.

WHO member states had been meeting daily in private, virtual sessions, ever since the EU first announced its initiative to bring the world together around the ambitious resolution entitled “COVID-19 Response” at the WHA, meeting in virtual session for the first time ever, 18-19 May.

Language on Overriding Patent Rights Was a Key Negotiating Point

The key elements of the plan that had been opposed by the United States involved the repeated references to the TRIPS flexibilities.  The most heavily debated clause called for:

“… the universal, timely and equitable access to and fair distribution of all quality, safe, efficacious and affordable essential health technologies and products including their components and precursors required in the response to the COVID-19 pandemic as a global priority, and the urgent removal of unjustified obstacles thereto; consistent with the provisions of relevant international treaties including the provisions of the TRIPS agreement and the flexibilities as confirmed by the Doha Declaration on the TRIPS Agreement and Public Health (OP4);”

Geneva and European-based sources, who asked to remain anonymous, said that the US had wanted to insert a nod to the importance of private sector innovation, using a reference similar to the one in the September 2019 UN High Level Declaration on Universal Health Coverage.  That carefully-worded declaration also acknowledges the TRIPS flexibilities, but also talks about the “need for appropriate incentives in the development of new health products:

“Promote increased access to affordable, safe, effective and quality medicines, including generics, vaccines, diagnostics and health technologies, reaffirming the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) as amended, and also reaffirming the 2001 WTO Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property rights should be interpreted and implemented in a manner supportive of the right of Member States to protect public health and, in particular, to promote access to medicines for all, and notes the need for appropriate incentives in the development of new health products.”

Said one diplomatic observer: “The UHC language was already agreed upon. It talked about the rights of countries to protect their patents, to protect the importance of innovation and research and development.  And it acknowledged Option B, the TRIPS flexibilities.

“The point they made was that affordability is really important for everybody, but there are a lot of reserachers and companies investing billions.  So we need a balanced approach.”

Another sticking point also emerged around a proposed US amendment of the term ”universal, timely and equitable access to, and fair distribution of…”  drugs and vaccines. But there was strong pushback by the African bloc of countries on this issue.

Here, it appeared that the US concerns revolved mostly around clear definitions of meaning:  “I wouldn’t want to make it too much of it as a Trump thing,” one source said, referring to the America-first policies of the US President.  ”A Democrat like Obama or Biden, might have acted similarly. They are very careful about what they commit to, I think they would have hesitation about something that they coudn’t match up to.”

Added another diplomat, “I think there is a lot they [the US] like in this resolution” pointing to clauses calling for a “stepwise” examination of the WHO and global pandemic response as well as research into the original source of the virus.

Still, it remains difficult to predict if the US will support the final draft in next week’s plenary, or disassociate itself from particular clauses: “Now that the text is finalized, it’ll be up to Washington.”

French Tempest over US Pre-Orders of Potential Sanofi Vaccine Highlights Reapolitik of Access Challenges

While the WHA may set lofty aims, the realpolitik of how to fairly distribute any existing and new treatments clearly poses big challenges, as evident by a political storm that gathered overnight in France after the Paris-based Sanofi announced that the first doses of any COVID-19 vaccine that is produces, now in development,had been pre-ordered to the United States.

“The US government has the right to the largest pre-order because it’s invested in taking the risk,” Sanofi CEO Paul Hudson told Bloomberg News in an interview published on Wednesday. “That’s how it will be because they’ve invested to try and protect their population, to restart their economy,” he said, noting that the U.S., which expanded a vaccine partnership with the company in February, expects “that if we’ve helped you manufacture the doses at risk, we expect to get the doses first…” The multinational has offices and research facilities in the United States as well as France.

French officials quickly expressed outrage over the Sanofi remarks: “As indicated by Emmanual Macron, a vaccine against COVID-19 has to be a global public good. Equal access for everyone to a vaccine is not negotiable, said French Prime Minister Edouard Philippe in a tweet.

“For us, it would be unacceptable for there to be privileged access to such and such a country for financial reasons,” France’s deputy finance minister Agnes Pannier-Runacher told Sud Radio Thursday.  She and other officials note that the Paris-based Sanofi has also received tens of millions of Euros in research credits from the French government in recent years.

Hours later, Sanofi backed off, issuing a statement that said, “we have always been committed in these unprecedented circumstances to make our vaccine accessible to everyone.”  But Olivier Bogillot, president of Sanofi France, was quoted saying that the EU also needs to make it easier for pharma companies to fast-track new products to market.

The cross-Atlantic diplomatic brouhaha, involving just one multinational pharma firm, serves to illustrate just how complex the lofty ambition of equitable access really is, when validated treatments or vaccines really do become available.

Uniting Behind A People’s Vaccine

Meanwhile, dozens of global and national leaders, issued an appeal to the upcoming World Health Assembly to  Unite Behind A People’s Vaccine Against COVID-19” without patent restrictions.

Signatories included Pakistani President Imran Khan and Cyril Ramaphosa, president of South Africa and Chair of the African Union, as well as the presidents of Senegal and Ghana,

“Humanity today, in all its fragility, is searching for an effective and safe vaccine against COVID-19. It is our best hope of putting a stop to this painful global pandemic,” said the staement issued by the World Leadership Alliance-Club-de-Madrid.

“We are calling on Health Ministers at the World Health Assembly to rally behind a people’s vaccine against this disease urgently. Governments and international partners must unite around a global guarantee which ensures that, when a safe and effective vaccine is developed, it is produced rapidly at scale and made available for all people, in all countries, free of charge. The same applies for all treatments, diagnostics, and other technologies for COVID-19.”

Ddozens of other former European, African, Canadian and Asian heads of state also signed the petition, including Mary Robinson, UN High Commissioner for Human Rights, and former president of Ireland; Ruth Dreifuss, former president of Switzerland; and Helen Clarik, former prime minister of New Zealand; as well as Maria Fernanda Espinosa – former UN General Assembly president and Ecuadorian minister. Other signatories included former Nobel prize laureates, health ministers, UN and other public health leaders.

For more details on the issues that have been debated inside the EU draft resolution see Wednesday’s Health Policy Watch.

 

Image Credits: Jamie.