Nurses are on the frontline of the COVID-19 response

On the 200th anniversary of the birth of Florence Nightingale on Tuesday, we marked International Nurses Day, a day for the world to focus on the invaluable role that nurses play in our society. They not only have a tremendous role in health settings but are also crucial for the economic wellbeing and national security of the world.

Among the issues confronting our health care professionals every day on the front lines, is the issue of fake medicines and treatments, which has become all of the more pervasive in the COVID-19 era.

The International Council of Nurses has drawn up a position statement on sub-standard and falsified (SF) medicines which calls for a concerted, collaborative effort by health professionals, industry, governments, law enforcement bodies, customs, and other stakeholders.

Among other things, it urges governments to recognise the risk that SF medical products pose to public health and develop national action plans that include comprehensive legal frameworks, robust reporting systems, and strong national regulatory mechanisms linked to the global regulatory network as well as greater pharmacovigilance capacity.

Busting the Myths

The COVID-19 pandemic has created ideal conditions for criminals to exploit people’s fears of contracting the disease by advertising falsified treatments and vaccines, promoting fake tests and spreading unsubstantiated rumours of potential cures. In Iran, at least 44 people died in early March from drinking toxic alcohol after a coronavirus cure rumour.  An American man died and his wife went into critical care after they took chloroquine phosphate in an apparent attempt to self-medicate for the novel coronavirus. As the Alliance of Safe Online Pharmacies (ASOP) has warned: ” While the nation struggles to deal with the public health implications of the COVID-19 pandemic, criminals are exploiting fear and confusion for profit by peddling fake preventions, treatments and cures online. At best, these phony products are ineffective, at worst, they are deadly.”

The World Health Organization (WHO), like the US Food & Drug Administration (FDA), has warned against other mythical cures for COVID-19, and emphasized that, to date, there is no specific medicine recommended to prevent or treat COVID-19.

In March, Interpol’s Operation Pangea found 2,000 online links advertising counterfeit items related to COVID-19, and seized more than 34,000 counterfeit and substandard masks, “corona spray”, “coronavirus packages” or “coronavirus medicine”.

Many countries already crippled by infectious diseases and weak health systems could go under in the COVID-19 outbreak and increase the spread of misinformation and fake cures.

“COVID-19 is on the rise in Africa, and we are already facing shortages of critical protective equipment and a plethora of misinformation,” says Thembeka Gwagwa, ICN’s second Vice-President, and a nurse from South Africa. “Lack of access to care will mean many people will seek cheap, fake medicines which will have devastating consequences.”

Fake medicines as a whole are unsafe and ineffective, failing to treat or prevent the intended disease; they may have little or no effect – or cause disastrous patient outcomes, such as poisoning, disability and death.

 The Role of Healthcare Professionals

Nurse and midwife immunizes baby in Nigeria

Healthcare professionals, such as nurses, are in the front line of treating patients with COVID-19 and are vital in the fight against substandard and falsified (SF) medicines and misinformation. They administer, monitor and, in some countries, prescribe treatment and are therefore well-positioned to detect SF medical products. However, identifying SF medicines can be difficult as they are often visually identical to the original, genuine product. It may be only through monitoring a patient that either a side effect is identified or there is no effect at all, and this raises a red flag that the medication is a fake.

Nurses also play an important role in educating the public on safety concerns related to the use of SF medical products and dispelling false rumours about potential cures. They actively promote health literacy to support properly informed preventative measures and discourage self-diagnosis and self-prescribing. While nurses’ workloads are under severe pressure during this pandemic, the work of educating and informing patients and their families should not be seen as an additional burden but rather as part of safeguarding the health of the public – a vital role that nurses play throughout the year.

The Fight the Fakes campaign aims to raise awareness of fake medicines and gives a voice to their victims, is now warning of an ever-growing “infodemic” alongside the coronavirus pandemic.

The Solution

Without including nurses and other healthcare professionals in developing and implementing national action plans to combat SF medical products, we will not succeed in the fight against SF medicines. Nurses are often the principal and sometimes the only health professionals providing primary healthcare in often tough settings such as hospitals and clinics at risk of being overrun by COVID-19.

2020 is the International Year of the Nurse and Midwife. Never before has the value of what nurses do been clearer to the world. As we watch nurses and other health professionals give all they have and more to fight this pandemic, the WHO has released the first ever State of the World Nursing Report. This provides compelling evidence of the value of the nursing workforce globally and calls for governments to invest in the nursing workforce.

The fight against the COVID-19 pandemic, future pandemics and fake medicines highlights the urgent need to strengthen health systems, educate more nurses and better support the ones we have. If we are to be prepared for the next health crisis – and, undoubtedly, there will be one –the health workforce requires urgent investment.

 

Howard Catton is the CEO of the International Council of Nurses (ICN).

Image Credits: Acumen Public Affairs, WHO.

Some cautious shoppers in Geneva’s Train Station wear face masks after Switzerland enters the second phase of reopening

Countries that reopen while COVID-19 is still circulating widely will likely face strong waves of virus resurgence, and then have to reinstate severe lockdown measures. However, the cyclical relaxation and reinstatement of some public health measures, such as bans on mass gatherings or school closures, may also be normal as countries learn how to track and control the virus.

At a WHO briefing on Wednesday, Mike Ryan, WHO Health Emergencies Executive Director warned that “this virus may become just another endemic virus in our communities.  This virus may never go away,”  he added, comparing to other new infections that have emerged only in recent decades, notably HIV. “HIV has never gone away… but we have found drugs and therapies that … can allow people to live long and healthy lives.”

After a sharp spike in cases, Lebanon on Wednesday reinstated stay-at-home orders, re-shuttered restaurants, and closed temples after easing restrictions in April. That followed patterns in a number of other countries including Algeria and the Japanese island of Hokkaido – which had reopened businesses and schools, only to see a spike in cases that forced further closures.

A new cluster of coronavirus cases also was reported in Wuhan China, the original epicenter of the outbreak, on Sunday – the first since the city reopened in late April. City health officials announced an ambitious plan to test all 11.5 million city residents in the next ten days on Tuesday. Mass gatherings were banned, and travel restrictions were reinstated in Jilin, another city in China, this week after a cluster of cases was identified. 

The South Korean capital of Seoul also delayed reopening schools and shut down bars and clubs, following a spike in cases last week that was linked back to just one man. At least 85 confirmed cases were linked to the man who had visited a series of nightclubs last week.

“Some [of these cases] are cautionary tales and some represent actually, the kind of things we expect. It’s all about scale and it’s all about how much you understand the problem,” said WHO Executive Director of Health Emergencies Mike Ryan in a Wednesday press briefing. “What we all fear is a vicious cycle of public health disaster followed by an economic disaster followed by a public health disaster followed by economic disaster.”

“If you reopen in the presence of a high degree of virus transmission, then that transmission may accelerate. If that virus transmission accelerates, and you don’t have the systems to detect it, it will be days or weeks before you know something’s gone wrong. And by the time that happens, you’re back into a situation where your only response is another lockdown,” said Ryan.

The purpose of lockdowns, Ryan explained, was to keep people from coming into contact with each other frequently, therefore curbing the spread of the virus. 

“If you can get the day to day case numbers to the lowest possible level, and get as much virus out of the community as possible, when you open, you will tend to have less transmission, or, much less risk,” said Ryan.

Switzerland Mobilizes Money To Address ‘Unimaginable Levels of Poverty’ During Phased Reopening

Meanwhile, Switzerland was grappling with the fallout of a COVID-19 economic crisis, including what one journalist described as “unimaginable levels of poverty” as one of Europe’s most affluent countries reopened for business again.

Many Swiss cafes and restaurants, which had been anticipating seeing regulars again, were stunned to have barely any customers. Almost one-third of Geneva’s cafes will be unable to reopen due to poor business prospects.

On the other hand, more than 1600 packets of free food were distributed in one central Geneva location in just six hours, mostly to undocumented migrants and those who had lost their jobs due to coronavirus. Queues were over 200 metres long, albeit with proper social distancing measures between the waiting customers. 

New cases in Switzerland have continued to drop or stabilize as the country entered the second phase of its deconfinement plan on Monday. The country of about 9 million people has so far reported 30,433 confirmed cases with 1,564 deaths, one of the highest per capita case rates in Europe. Geneva, the nearby canton of Vaud, Zurich as well as Valais and Ticino, which abut the border with Italy are the most affected cantons.  

Less-affected cities, however, have seen anti-lockdown protests demanding faster relaxation of anti-coronavirus measures. Police broke up protests in Bern, Zurich, St. Gallen and Basel, which disregarded the ban on gatherings of more than five people. This move was criticised by the Swiss branch of Amnesty international, which called it a violation of freedom of expression. 

In light of the economic need, Swiss Federal Council sanctioned 57 billion CHF to be released in urgent credits — the largest amount ever to be released in such a format. Additionally, around 8 billion CHF is expected to be spent on short-term workers compensation, bringing the total financial package to more than 65 billion CHF. 

In addition, the Swiss Solidarity Fund has raised over CHF 37 million to help those most in need, including socioeconomically strained groups, older people, people with disabilities and the homeless. 

“It is a priority to provide assistance to individuals and families who are not or insufficiently covered by the Federal Council’s assistance measures,” stated Fabienne Vermeulen, the Head Of Swiss Programmes. The money has been distributed in the form of food aid, financial assistance, care services and community engagement through over 80 already-existing Swiss agencies, ranging from the Swiss Red Cross and Caritas.

Nevertheless, the long queues for food might be a new reality for Switzerland, warns journalist Grègoire Barbey, as the country faces “unimaginable levels of poverty.”

KTX trains undergo disinfection for COVID-19 at Seoul Station, Seoul
New Cases Spur Fears Of A Second Wave in China and South Korea 

Wuhan, China which had not recorded a single new case since April 3, has instituted a 10-day testing plan in response to a cluster of new cases, and will be testing all of its 11 million inhabitants for coronavirus. The reemergence of the virus has already had ramifications for the local government. State media reported Monday that Zhang Yuxin, chief official of Changqing, the area in Wuhan where the new cases had been detected, was removed from his post “for failures in epidemic prevention and control work.”

China recorded 17 new coronavirus cases on Sunday, 5 of which were in Wuhan, the country’s coronavirus epicentre, triggering fears of a second wave. Seven others were ‘imported’, coming in on a flight that stopped at Inner Mongolia for testing. 

The remaining cases were detected in Jilin, close to the borders with Russia and North Korea. The city has been put under partial lockdown, sealing borders and cutting off transport links, as well as closing cinemas, indoor gyms, internet cafes and other enclosed entertainment venues. Pharmacies have also been asked to report sales of antiviral and fever medication to authorities. The city’s four million inhabitants can leave the city only if they have tested negative for COVID-19 in the past 48 hours and complete an unspecified period of ‘strict self-isolation’.

In South Korea, Seoul officials are trying to track down about 5,000 people who had visited clubs and bars in Itaewon, a popular nightlife district during the same period when the COVID-19 infected bar-hopper had been in the area. The outbreak triggered South Korea’s steepest daily increase in new coronavirus infections in more than a month, threatening a broader easing of the country’s social distancing measures. The country has enjoyed widespread international praise for its efficient mass testing, high-tech contact tracing and social distancing measures. This new incident puts those measures to a test, yet again. 

 

Image Credits: Republic of Korea (Kim Sun-joo), HP-Watch/Svet Lustig Vijay.

The World Health Assembly in Geneva, Switzerland.

World Health Organization member states were close to an agreement Wednesday evening on a European Union-led draft resolution on global COVID-19 response to the upcoming World Health Assembly. If approved, it would pave the way for coordinated planning by the global health community to ensure wide and equitable access by people worldwide to COVID-19 medicines and vaccines, according the latest draft obtained by Health Policy Watch.

But a “silence period” in which any of the 194 member states can raise formal objections – before the final draft is officially published – was extended at the last minute until noon Thursday – indicating that the bargaining was by no means over yet – with objections from the United States as a key obstacle.

The latest iteration of text submitted by the EU and 9 other co-sponsors including Australia, the United Kingdom, and Zambia, includes pointed references to a voluntary global “patent pool” for new COVID-19 treatments.  It also refers explicitly to countries’ rights to entirely upend international patent rules, and purchase 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),” are enshrined in a number of World Trade Organization agreements. They allow countries to legally issue  licenses to import or produce generic versions of patented pharma products, when urgent health needs arise. But in reality, countries rarely resort to their use.

But it remains to be seen if any of the references to so-called “TRIPS flexibilities” – or even voluntary patent pooling – will remain intact in the final draft.

Member states continued negotiating late this evening and Thursday morning. Countries have been meeting daily in private, virtual sessions, for several weeks, since the EU first announced its initiative to bring the world together around a potentially far-reaching resolution entitled “COVID-19 Response.”

The response so far has been anything but simple.

The United States has opposed many principals of the plan, observers say, even including calls for “universal, timely and equitable access and fair distribution” of COVID-19 remedies, as per a paragraph that asks member states and WHO to work towards:

“… 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);”

As one source, who asked to remain anonymous, cautioned: “This is the text as put forward by the countries that are listed as the co-sponsors. The US has not signed off on this.. Equitable access and fair distribution is not something that the US is a great fan of…The US has proposed alternative text.”

TRIPS References Peppered Throughout Draft Proposal
A researcher tests the efficacy of a generic drug in the United States.

Other, softer references to the global pooling of patents, along with TRIPS provisions for overriding them, are also peppered throughout the proposed draft, which was submitted on Wednesday by the EU chair of negotiations. These include a call to countries to:

Work collaboratively at all levels to develop, test, and scale-up production of safe, effective, quality, affordable diagnostics, therapeutics, medicines and vaccines for the COVID-19 response, including, existing mechanisms for voluntary pooling and licensing of patents to facilitate timely, equitable and affordable access to them, 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 (OP 8.2).

However, US wants to delete language on the “voluntary pooling of patents,” other sources further told Health Policy Watch late Wednesday night. That is despite the fact that voluntary pooling of innovations is the foundational idea upon which the EU resolution was first initiated.

“This is one of those moments when having a clear message from the World Health Organization and its members could have made a difference,” said James Love, head of the access advocacy group, Knowledge Ecology International, bemoaning the direction in which negotiations seemed to be leading.

“But, instead, some countries, the US, the UK and Swiss in particular, want to protect drug and vaccine manufacturers, as if there is no real crisis, so we have text that a few experts can argue over, to figure out what it even means.

“The big issue will be when a really good drug or a vaccine that works is available, and of course, there will be capacity constraints, and unfair and unequal access, not to mention concerns over pricing.  Just acting as if that can be addressed better later, when reality begins to hit you in the face, is hardly what we want from public health leaders.”

The proposed EU draft also assigns a central role to the WHO, calling on the WHO Director General to identify options for scaling up access to COVID-19 diagnostics, drugs and [future] vaccines:

“… in consultation with Member States, and with inputs from relevant international organizations  civil society,  and the private sector, as appropriate, identify and provide options that respect 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 to be used in scaling up development, manufacturing and distribution capacities needed for transparent equitable and timely access to quality, safe, affordable and efficacious diagnostics, therapeutics, medicines, and vaccines for the COVID-19 response taking into account existing mechanisms, tools, and initiatives, such as the Access to COVID-19 Tools (ACT) accelerator, and relevant pledging appeals, such as “The Coronavirus Global Response” pledging campaign, for the consideration of the Governing Bodies; (OP 9.8).  The (ACT) accelerator, announced just last month by European Commission President Ursula Von Leyen, dozens of other countries, WHO, and major global health donors has raised nearly €7.4 billion for a pool of COVID-19 technologies to date.

Another observer, who asked not to be named, described the [EU proposed] text as “tortured and badly written, but not a disaster,” despite nods to industry interests and consultations with the private sector.

However, whether that text can now even gain acceptance over US and other objections remains up in the air.  And if not, EU and other Member State sponsors face two choices.

They can barter away over the weekend at the language of the EU draft, until the US and its allies hopefully agree to a drastically pared-down deal. Or they can submit the EU-sponsored draft to a public vote next week at the full Assembly, presuming that the vast majority of low- and middle-income member states will readily sign onto the deal. But that vote, in and of itself, is likely to be a confusing and chaotic affair due to the fact that the WHA’s 194 members are meeting virtually for the first time ever, on untested and potentially unstable internet platforms.

And ever if a large majority of countries see the current text through to approval, opposition by one powerful state such as the US, would thwart the multi-lateral spirit of the agreement.

Others Thorny Issues – Reproductive Health Rights and WHO Funding
A nurse consults her patient with family planning needs. Sexual and reproductive health has been a controversial issue past UN debates over Universal Health Coverage (UHC).
Photo: Dominic Chavez/World Bank

A number of other thorny issues also exist in the draft proposal, whose other co-sponsors currently include New Zealand, Monaco, Montenegro, North Macedonia and San Marino, which could stall agreement at the last minute.

They include a reference to the importance of maintaining “the continued functioning of the health system in all relevant aspects.. including  by undisrupted vaccination programmes, neglected tropical diseases, noncommunicable diseases, mental health, mother and child health  and sexual and reproductive health and promote improved nutrition for women and children…” (OP 7.5)

References to sexual and reproductive health have often been red-penciled for deletion from international documents by the Administration of US President Donald Trump, which has regarded them as coded references to abortion rights.

The text also makes numerous references to ensuring funding flows to WHO, calling on member states to: provide sustainable funding to the WHO to ensure that can fully respond to public health needs in the global response to COVID-19, leaving no one behind. OP 7.15)”.  Such references, if accepted by the United States, might also hint at a softening of earlier positions by the Trump administration whch had said it was temporarily suspending funding to the organization.  Then again, maybe those will disappear as well.

However, the text also clearly includes some clauses that Washington should be keen to see survive. These include demands that member states “provide WHO timely, accurate and sufficiently detailed public health information related to the COVID-19 pandemic as required by the IHR [International Health Regulations] (OP 7.10).”

Another clause calls on the WHO to work with the World Organization for Animal Health (OIE) and the Food and Agriculture Organization (FAO) to identify the elusive source of the virus, and how it lept from animals to humans, “including through efforts such as scientific and collaborative field missions, which will enable targeted interventions and a research agenda to reduce the risk of similar events as well as to provide guidance on how to prevent SARS-COV2 infection in animals and humans and prevent the establishment of new zoonotic reservoirs,  as well as to reduce further risks of emergence and transmission of zoonotic diseases. (OP 9.6)”

The research would presumably attempt to answer critics, including, but not limited to the White House, who have questioned the Chinese narrative that SARS-COV-2 first reached humans via contact with infected animals at a live market in Wuhan, China.  Some have also suggested that the virus may have somehow escaped from a nearby virology laboratory which was studying coronaviruses.

Evaluation of the COVID-19 Response by WHO – A Stepwise Process

Finally, the draft text contains a proposal, for an “impartial, independent and comprehensive evaluation” of the “WHO-coordinated international health response to COVID-19, including (i) the effectiveness of the mechanisms at WHO’s disposal; (ii) the functioning of the IHR and the status of implementation of the relevant recommendations of the previous IHR Review Committees; (iii) WHO’s contribution to United Nations-wide efforts;…(OP 9.10).”

Such an investigation is politically important to the United States – and also to other countries worldwide that have paid a significant price, both human and economic, as a result of the current pandemic. However, one key refinement is a conditional clause that suggests the investigation should be initiated “at the earliest appropriate moment, and “in consultation with Member States,” as part of a “stepwise process.”

Those small, diplomatic flourishes of “at the appropriate moment, and “stepwise”, in fact, give the global community a diplomatic breathing space to fight the pandemic first – and review the lessons learned once the fires of immediate danger have subsided a little bit more.

If ever the WHA resolution for “COVID-19 Response”, can at least be approved.

Updated 14 May 2020

 

 

Image Credits: FDA/Michael Ermarth, WHO, Dominic Chavez/World Bank, World Health Organization .

Healthcare workers in Nigeria fight to maintain vaccination services during the COVID-19 pandemic.

Life expectancy has increased, particularly in low income countries, but COVID-19 threatens to throw progress off track, according to the World Health Organization’s annual roundup of worldwide disease and mortality trends.

“The good news is that people around the world are living longer and healthier lives. The bad news is the rate of progress is too slow to meet the Sustainable Development Goals and will be further thrown off track by COVID-19,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus of the 2020 World Health Statistics report.

The biggest gains were reported in low-income countries, which saw life expectancy rise 21% or 11 years between 2000 and 2016, compared with an increase of 4% or 3 years in higher income countries.

One driver of progress in lower-income countries was improved access to services to prevent and treat HIV, malaria and tuberculosis, as well as a number of neglected tropical diseases such as guinea worm. Another was better maternal and child healthcare, which led to a halving of child mortality between 2000 and 2018.

However, few gains were made in worldwide immunization coverage, which has remained stagnant at 85% since 2016. And there is still too little attention on non-communicable diseases (NCD) such as heart disease, stroke, diabetes, or cancers, which caused 70% of all deaths in 2016. Some 85% of NCD deaths occurred in low income countries.

But in the context of the COVID-19 pandemic, inequality between and within countries in NCD control and immunization may  grow with the disruption of essential health services, leaving populations more vulnerable to the virus. Gains against HIV, malaria, tuberculosis will likely stagnate or be rolled back if programmes targeting these diseases are disrupted, WHO, UNAIDS, and other NGOs and UN agencies have warned.

Inequality Has Left Some Countries More Vulnerable to COVID-19

Availability of healthcare services in low- and middle-income countries still remains much lower than in wealthier ones, and low- and middle-income countries still have too few healthcare workers, despite the gains in life expectancy. Additionally, many people in lower income countries lack access to safe sanitation and clean water, and live in poor housing facilities that pose additional barriers to preventing COVID-19.

“The COVID-19 pandemic highlights the need to protect people from health emergencies, as well as to promote universal health coverage and healthier populations to keep people from needing health services through multisectoral interventions like improving basic hygiene and sanitation,” said Dr Samira Asma, WHO assistant director-general.

More than 40% of all countries have fewer than 10 medical doctors per 10,000 people. Over 55% of countries have fewer than 40 nursing and midwifery personnel per 10,000 people.

More than half (55%) of the global population was estimated to lack access to safely-managed sanitation services, and more than one quarter (29%) did not have access to safe drinking water in 2017. Two in five households globally (40%) did not have basic hand-washing facilities.

The inability to pay for healthcare is another major challenge. Approximately 1 billion people will be spending at least 10% of their household budgets on health care in 2020, according to WHO estimates. The majority of these people live in lower middle-income countries.

Coupled with the increasing burden of NCDS in low- and middle-income countries, these inequalities have left low- and middle-income countries even more vulnerable to the pandemic.

“We know now that people living with noncommunicable diseases such as diabetes, heart disease, and kidney disease, as well as people with hypertension and obesity, are at much higher risk of suffering severe complications and dying from COVID-19,” said NCD Alliance CEO Katie Dain. “We must not forget that many of these conditions are preventable. This report reinforces what the current COVID-19 pandemic has already taught us –  that a failure to invest in health is a failure to invest in a country’s own security.”

Addressing these challenges is on the agenda for next week’s 73rd World Health Assembly, to be held online for the first time. The WHA will focus primarily on COVID-19, and Member States will meet from May 18 to 19.

“During the World Health Assembly next week, we will discuss with health leaders from across the world, not only how to defeat COVID-19, but also how we can build back stronger health systems, everywhere,” said Dr Tedros.

“The coronavirus is an unprecedented shock to the world. Through national unity and global solidarity, we can save both lives and livelihoods and ensure that other health services for neglected diseases, child vaccination, HIV, TB and malaria continue to improve…We have a once in a lifetime opportunity to prove that the world is more than just a collection of individual countries with colorful flags.”

Image Credits: Twitter: @WHOAFRO.

Health Policy Watch is the media partner for the Geneva Graduate Institute – Global Health Centre series of World Health Assembly events, running Thursday 14 May to Wednesday 27 May.

The series of events is built around themes relevant to the 73rd session of the WHA, 18-19 May, the first ever Assembly to bring together the World Health Organization’s 194 member states in a virtual session, and focusing largely on a response to the COVID-19 pandemic.

The two-week series of virtual events will feature discussions on a range of critical global health issues such as the COVID-19 response, the role of civil society in global health governance, access to medicines and price transparency; women in the health workforce, as well as the political and commercial determinants of health.  The series, co-sponsored by the WHO, UN Foundation, the civil society movement UHC 2030, and others, brings together panels of scientists, public health professionals and policymakers from WHO, other UN agencies, and civil society.

See the full schedule and links for plugging in online below. Click the event titles for more information.

WORLD HEALTH ASSEMBLY OPEN BRIEFING

14 May, 15:00 The Global Health Centre and UN Foundation announce the annual World Health Assembly (WHA) Open Briefing for delegates, non-state actors, and the general public. This virtual event will introduce how the 73rd Assembly, the first ever to convene online, will work this year, with an update from WHO on the COVID-19 response. A diverse panel of experts will explore key issues emerging in the global response to the pandemic, including resource mobilization and financing, human rights and gender equality, and international cooperation for innovation and access to health technologies.

WALK THE TALK: THE HEALTH FOR ALL CHALLENGE 

17 May, 12:00 CEST | The third edition of the Walk the Talk will offer a global platform to promote well-being for people all over the world. This WHO virtual event will support ongoing efforts to promote ways for people to be healthy at home, and engage in activities that promote good physical and mental health, including healthy diets, hand washing and mental health awareness. People are invited to join in from their homes for a range of online activities (yoga, zumba, meditation and more) presented by athletes. All activities are meant to be enjoyed by all ages, all abilities, alone or with your families.  See More here.

IS SPACE CLOSING FOR CIVIL SOCIETY IN GLOBAL HEALTH?

19 May, 16:00 | With restrictions in many countries on nongovernmental organisations, and sweeping new laws coming into play in response to COVID-19, is space closing for civil society, journalists and other whistleblowers in global health? Who will speak for civil society in the COVID-19 response, and what role –if any– will they play in oversight of the billions to be spent? Do civil society activists on the boards of global health agencies act as a force for accountability, or does being at the table with powerful donors, governments and UN agencies limit what they say? Leading activists  will debate these questions.

EL SUSTO (THE SHOCK): THE POLITICAL AND COMMERCIAL DETERMINANTS OF TYPE 2 DIABETES

20 May, 15:00 | The online screening of El Susto, followed by a discussion with the film director and leading experts, will shed light on the factors that shape the epidemiology of type 2 diabetes. Mexico’s number one killer is not cartels, but type 2 diabetes. Medical textbooks speak of genetics, diet, obesity, lack of physical exercise as the causes, but what are the political and commercial determinants that shape mass lifestyle choices? We will share an online screening of this 75-minute film in advance of this webinar, jointly organised by the Global Health Centre and Saluteglobale.it.

TRANSPARENCY AND ACCESS TO MEDICINES: ONE YEAR AFTER THE WHA RESOLUTION

21 May, 15:00 | In May 2019, a milestone resolution on transparency in pharmaceutical markets was adopted by the 72nd World Health Assembly. One year later, this event will reflect on efforts to implement it at national level, challenges that have arisen and ongoing debates. How does transparency shape innovation and access to medicines and diagnostics? What is the relevance of transparency to the ongoing COVID-19 crisis? Panelists will address these questions from government, civil society, academic and industry perspectives, looking at both national and global levels.

MASKED HEROINES? BUILDING RESILIENCE BEGINS WITH A GENDER-EQUITABLE HEALTH WORKFORCE

Cropped shot of a group of surgeons performing a medical procedure in an operating room

22 May, 15:00 | The COVID-19 pandemic is exposing the deep inequities that undermine global health, especially gender inequities impacting women front line health and care workers. In the Year of the Nurse and Midwife, few health and care workers (many of whom are women) have safe and decent working conditions, appropriate protection and equal and timely pay. How many decision makers in health systems are women? Do we collect sufficient data and evidence to understand the implications of COVID-19 on female health workers? Speakers in this session will share the perspectives of female health workers during this pandemic, and review lessons learnt from previous outbreaks.

TIME TO GET OUR ACT TOGETHER ON HEALTH SECURITY AND UHC

27 May, 14:00 | UHC2030 will launch its updated vision document for health systems strengthening, building on the recent statement from UHC2030 co-chairs which called on world leaders to remember their UHC commitments as they respond to COVID-19. This event proposes to stimulate discussion with stakeholders from across the UHC movement and beyond, immediately after the World Health Assembly, in order to leverage the momentum around the discussions among ministers of health.

A bottle of 10ug/mL propofol, a sedative used for COVID-19 patients on mechanical ventilation

Amidst the global shortage of ventilators, personal protective equipment, and diagnostics; sedatives, used to keep severe COVID-19 patients who require invasive ventilation continuously sedated, are in increasingly short supply around the United States.

The US Food and Drug Administration (FDA) on Monday issued an emergency use authorization (EUA) for Fresenius Propoven 2% (propofol 20 mg/mL) Emulsion 100 mL to maintain sedation via continuous infusion in COVID-19 patients  who require mechanical ventilation in an intensive care unit (ICU) setting. The product is already approved for use in Europe, but only a lower concentration, propofol 10mg/mL drug Diprivan is approved for use in the US.

Sedating patients who are on mechanical ventilation is necessary to keep them calm while the machine supports their breathing, according to guidelines from the American Academy of Surgeons. Patients who are not sedated properly may experience physiological stress and panic, leading to struggling to rip their breathing tubes from their throats.

But continuous sedation is a delicate process, and even a slight miscalculation of anesthetics can lead to death. The US FDA warns multiple times that the higher concentration of propofol in the newly approved Fresenius Propoven Emulsion could lead to unintentional overdose. The product approved under the EUA is only to be used in patients 16 years of age or older, who are not pregnant.

Propofol is the most common drug used to sedate patients on mechanical ventilation, according to the Academy. However, COVID-19 patients require an unusually high level of sedation, and are often on a combination of drugs.

As such, other injectable anesthetic drugs such as ketamine, etomidate, dexmedetomidine, and others are also listed in the US FDA’s Drug Shortage database as facing “current shortages” due to “demand increase for the drug.”

Doctors Question Remdesivir Elligibility Criteria

In a parallel development, physicians are questioning the federal government’s system for doling out remdesivir. After the US FDA issued emergency use authorization for the drug on 1 May, hospitals receiving the government’s drug shipments claim that the limited quantities and unclear guidance still force doctors to make harsh decisions about who gets the treatment.

The US Health and Human Services began shipping the drug in limited quantities to 13 different states on 9 May, after finalizing an agreement with Gilead Sciences, remdesivir’s producer, to provide approximately 607,000 vials of the experimental drug over the next six weeks to treat an estimated 78,000 hospitalized COVID-19 patients.

But doctors are saying that the federal guidance for who should be getting the limited donations is too vague. According to the guidelines, anyone with a room-air blood oxygen level at or below 94% who requires supplemental oxygen is eligible to receive the drug. However, this broad categorization runs the gamut from patients who require just a little extra oxygen, all the way to heavily sedated patients on mechanical ventilation who rely almost entirely on the machine to breathe.

“It’s very broad,” Erin Fox, director of drug information and support services at the University of Utah Medical Center told STAT News. “If you have 20 patients but only two vials, how do you decide which two patients get those vials?”

The drug was granted emergency use authorization following the early termination of a National Institutes of Allergies and Infectious Diseases (NIAID) trial that found patients on remdesivir recovered on average 4 days faster than those who did not receive the drug. Anthony Fauci, leading coronavirus expert on the federal COVID-19 taskforce and director of the NIAID, showed high optimism for the drug’s potential after seeing preliminary trial results.

Image Credits: Flickr: Dustin Hackert.

Shoppers line up outside a flower shop on Mother’s Day after Geneva, Switzerland began a phased re-opening in late April.

As countries cautiously begin to lift lockdown measures, WHO Executive Director for Health Emergencies Mike Ryan has again warned that serological studies were presenting increasing evidence that a ‘herd immunity’ approach to mitigating the effects of further waves of infection would not be effective. 

Herd immunity occurs when a large enough proportion of the population becomes immune to a disease, thus forming a protective ring around those who are still susceptible to disease. In the early days of the coronavirus, a number of countries including the UK and the Netherlands had pursued a “herd immunity” strategy, assuming that once enough people had gotten infected with the virus and generated natural immunity, the spread of the virus would naturally peter out.

Early results from a number of sero-epidemiological studies have shown that the proportion of people who were likely infected in the first wave of the pandemic is anywhere between 5-15%, according to WHO COVID-19 Technical Lead Maria Van Kerkhove. 

For example, only 1 in 10 people had developed antibodies against SARS-CoV-2, the virus that causes COVID-19, in Geneva Switzerland three weeks after the peak of the first wave of infections, according to a study posted on 6 May on the preprint server MedRxiv. Children and teens (5-15 years) were infected at about the same rate as adults aged 20-49 years, the study indicated, although the rate of childhood infection still requires further examination. People over the age of 50 were the least infected. 

The study is also significant insofar as Switzerland was one of the countries with the highest rates of reported COVID-19 cases, per million population.

“Assuming that the presence of…antibodies measured in this study is at least in the short-term associated with immunity, these results highlight that the epidemic is far from burning out simply due to herd immunity,” wrote the authors.

COVID-19 May Be More Lethal Than Assumed – Large Proportion of Population Remains Susceptible

Observed Van Kerkhove, “These studies indicate to us that there’s a large proportion of the population that remains susceptible. And that’s important when you think about what may happen in subsequent waves or what may happen in potential resurgences.

“And so we have a long way to go with this virus, because the virus has more people that can be infected.”

The low rates of people with antibodies to the virus also means that it may be more lethal than some experts have claimed – insofar as there isn’t a huge pool of undetected minor or asymptomatic infections. 

In [the herd immunity] narrative, there was an assumption…that we’re really just seeing these [rare] weird cases and difficult cases. Under [this theory] we’ll demonstrate that most people have been infected [with mild or asymptomatic illness] and then this will all be over. We’ll go back to normal business,” said Ryan.

“Well, the preliminary results from epidemiological studies are showing the opposite. It’s showing that the proportion of people with significant clinical illness is actually a higher proportion of all those who’ve been infected  – because the number of people infected in the total population is probably much lower than we expected.

“This idea that maybe countries who have lacked [public health] measures and will all of a sudden magically reach some herd immunity, and we’ll lose a few old people along the way – this is a really dangerous, dangerous calculation, and not one I believe most Member States are willing to make,” added Ryan.

Svet Lustig Vijay, Tsering Lhamo, and Kyra Dupont/Geneva Solutions contributed to this story

Image Credits: HP-Watch/Svet Lustig Vijay.

The Dhauladhar mountain range of Himachal, visible from 200 km away in Jalandhar (Punjab) after air pollution drops to its lowest level in 30 years

Like the delicate mesh of grandma’s crochet, the SARS-CoV-2 virus that causes COVID-19 is intricately intertwined with air pollution, the two knitted together in a secret code, which research from Italy, Germany and the United States is beginning to unveil. More than ever before, the clear blue skies are telling us that it is time to grasp the opportunity to clean the air we breathe, says Jyoti Pande Lavakare, Delhi-based journalist and co-founder of the Indian non-profit Care for Air. Jyoti’s book Breathing Here is Injurious to Your Health, on the human cost of air pollution, will be published by Hachette India in September 2020.

When I heard American pulmonologist Dr Nicholas Marks in an NPR podcast describe the lungs as “these exquisite machines, containers of air that just kind of blow life-giving oxygen into the blood through a thin wall, a membrane,” I understood immediately what he meant by the “poetry of the lungs”. Almost exactly two years ago, I had watched helplessly as my mother, a trained classical music vocalist, struggled to breathe in the terminal stages of the lung cancer that consumed her. In those moments, breathing – an involuntary, effortless activity I’d always taken for granted – embodied this poetry. In my mother’s case, it became an elegy.

It is the thinness and suppleness of our lung walls that enables them to expand and contract and pass oxygen smoothly and makes breathing so effortless.

“What’s so elegant about it is that the membrane is so thin and delicate,” Dr Marks explained in the podcast. It was this delicate membrane that Dr Marks worried about when he first heard about COVID-19, because what COVID-19 does is inflame that membrane, making the thin, delicate walls of the human lungs very thick.

“Suddenly, the lung gets really stiff. And instead of it being really easy to get enough oxygen in, now, suddenly, it requires tremendous work to do it.” Sometimes that even leads to patients needing a ventilator to breathe for them.

Air Pollution Causes 7 Million Deaths A Year

It’s not just COVID that affects human lungs this way. Many respiratory diseases do – including those triggered by air pollution, like doctors said my mother’s lung cancer was. The only difference is that some of those diseases may not be as immediately lethal as COVID-19 and, more importantly, they don’t spread in bunched up clusters, overwhelming doctors and hospitals at once. But their naturally flatter curve doesn’t mean they kill fewer people. In fact, air pollution kills many more. It is just that the diseases it triggers are non-communicable: cardio-vascular diseases – hypertension, heart-attack, stroke; lung and respiratory diseases; cancers; diabetes; obesity; and cognitive and mental illnesses; among others.

According to World Health Organisation (WHO) estimates, air pollution causes around 7 million premature deaths globally. COVID has caused the deaths of 227,051 individuals as of 30 April. If COVID is a visible, viciously virulent, insanely infectious pandemic, killing swiftly and mercilessly, air pollution is its invisible, non-communicable evil twin, killing unhurriedly, under the radar, but equally ruthlessly. It is a non-communicable disease (NCD) pandemic in slow-motion, matching – if not surpassing – the cataclysmic fury of SARS-CoV-2.

Air pollution affects our lungs insidiously, indirectly, gradually. But its effects are equally horrific, the morbidity and mortality of the diseases it triggers much higher. In fact, even when it doesn’t actually trigger disease, air pollution ends up compromising and weakening the human lungs, making us more vulnerable to respiratory viruses like the SARS, MERS and now the novel coronavirus, SARS-CoV-2, which causes COVID-19.

Mount Everest seen from a house in Singhwahini village, approximately 200 km away, after air pollution levels drop
Exposure to Air Pollution Increases Risk of Dying By COVID-19 

In a first clear link between long-term exposure to pollution and COVID-19 death rates, a new study done by Harvard University’s T.H. Chan School of Public Health has shown that coronavirus patients in areas that had high levels of air pollution before the pandemic were more likely to die from the infection than patients in cleaner parts of the United States. “An increase of 1 μg/m3 in PM2.5 is associated with an 8% increase in the COVID-19 death rate,” the cross-sectional Harvard report said. “Even a small increase in long-term exposure to PM2.5 leads to a large increase in COVID-19 death rate, with the magnitude of increase 20 times that observed for PM2.5 and all-cause mortality. The study results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis,” the report concludes. PM (particulate matter) is a mix of organic and chemical particles that can aggravate respiratory illnesses when inhaled. PM2.5 refers to the size – 2.5 microns or smaller, which can cause graver irreversible health ailments. What is of greater concern for us is that the study was conducted in the U.S., where pollution is nowhere as close to the appallingly high levels that Indian cities experience.

Another paper – by Leonardo Setti of the University of Bologna and his colleagues from universities of Bari, Milan and Trieste (first highlighted by the Economist ) – indicates that reducing air pollution may reduce the rate of infection from the SARS-CoV-2. In this study, Dr Setti and his associates found themselves wondering why (even allowing for time lags caused by its arrival in different places on different dates) SARS-CoV-2 seemed to spread much faster in Italy’s north—specifically in the wide plain that forms the valley of the Po—than in other parts of the country. Their hypothesis? That the catalyst was pollution—specifically, small airborne particles that might carry the virus on their surfaces. These are usually far more abundant in the Po valley than elsewhere. In the paper, the researchers cited previous research that suggested that influenza viruses, respiratory syncytial viruses and measles viruses can all spread by hitching lifts on such micro-particles. And they make a good case that, allowing for a 14-day delay caused by SARS-CoV-2’s incubation period, the daily rates of new infections in the Po valley correlate closely with the level of particulate pollution.

An alternative explanation for this correlation might be that, rather than carrying the virus themselves, airborne particles increase susceptibility to infection in those who encounter the pathogen by some other means. Either way, though, a reduction in airborne-particle levels may be a second way, independent of reduced human contact, in which lockdowns will help stop the virus from spreading. So, yes, reducing air pollution could be another way of reducing the spread of COVID-19, because not only are people living with poor air quality more susceptible to this disease, but also airborne particulate matter can potentially facilitate spreading the virus.

In addition to these studies, more research is emerging which proves that people living in highly polluted cities are likely to have compromised respiratory, cardiac and other systems and are therefore more vulnerable to COVID-19’s impact.

A study that links higher COVID-19 morbidity and mortality to air pollution in northern Italy provides evidence that people living in an area with high levels of pollutants are more prone to developing chronic respiratory conditions that provide fertile ground to any infective agent. This study adds that prolonged exposure to air pollution leads to a chronic inflammatory stimulus, even in young and healthy subjects, and concludes that the high level of pollution in northern Italy should be considered an additional co-factor of the high level of mortality recorded in that area.

Evidence from older studies conducted during the SARS outbreak in China also validates this. One study by researchers at the UCLA’s School of Public Health showed that patients with SARS were more than twice as likely to die from the disease if they came from areas of high pollution. The same seems true of COVID-19: the more dirty air you are exposed to, the sicker you are likely to get.

In short, every day, emerging research shows new linkages between air pollution and respiratory viruses such as SARS-CoV-2, crocheting them together in a denser, tighter web. COVID-19 is a new disease, but recent research already show three direct interlinkages: i) that people are more likely to contract respiratory diseases like COVID if they live in polluted areas (because high levels of pollution lower the body’s natural defenses against airborne viruses); ii) that COVID will affect people more severely if they suffer from pre-existing pollution-triggered diseases (those with heart disease, asthma, chronic obstructive pulmonary disease and diabetes are more likely to get more severely ill, requiring intensive care and intubated ventilation – and thus more likely to die); and iii) that the current levels of air pollution that COVID patients are exposed to will add to the severity of the disease, leading to greater chances of hospitalization and death. A fourth interlinkage – that microparticulates act like tiny Ubers that SARS-CoV-2viruses hitch a ride on to proliferate the spread of the disease – is still in the process of being validated.

In India, Public Health Foundation India president Prof Srinath Reddy told BBC News  “If air pollution has already damaged the airways and lung tissue, there is reduced reserve to cope with the onslaught of coronavirus.” The same BBC report quoted Dr Maria Neira of the WHO as saying that countries with high pollution levels, many in Latin America, Africa and Asia, should ramp up their epidemic response preparations.

On 24 April 2020, the Centre for Research on Energy and Clean Air, registered in Finland, summed up existing research that validates these interlinkages in a compendium even as fresh research continued to trickle in. Air pollution and COVID are interlinked in more ways than one, and the study of these connections remains dynamic – we are likely to discover even more as investigations pick up speed.

Essentially, all emerging research points to air pollution being “one of the most important” contributors to COVID-19 deaths in four countries of Europe with nearly 80 per cent of COVID deaths in 66 administrative regions in France, Spain, Italy and Germany occurring in their most polluted regions.

Kanchenjunga, the third highest mountain in the world, is visible from Alipurduar, approximately 150 km away.
Silver Lining In Clear Skies Over Coronavirus Lockdowns

Meanwhile, there is another brighter, more aesthetic connection between COVID-19 and air pollution. A silver lining, if you will. This one involves stopping the human race on its thoughtless tracks via lockdowns across air sheds, across geographical, political and social boundaries – and it is this.

We’re suddenly seeing clear, blue skies, and breathing clean outdoor air, even in our densest cities and towns; experiencing hidden beauty – spectacular views which were always there, just shrouded in thick, unhealthy smog.

All at once, the air smells fresh, fragrant. Without micropollutants occluding its rays, sunlight dazzles. Birdsong is back. Animals, big and small, rare bird sightings, even fish – dolphin tales abound – all creatures which had retreated due to the relentless advance of man’s economic progress and greed are returning to habitats they were forced to abandon as lockdowns cage humans, limiting their encroachments. Water bodies are turning blue again, rippling clean, without chemicals frothing at their edges, reflecting limpid, cerulean skies. The night sky has turned magical, with faraway stars glittering gloriously, their luminosity unhindered by a haze of pollutants. Across the earth people witnessed the 8 April supermoon, its pink luminescence clearly visible without any telescopic aid, glowing and smiling at an earth that looked like it was healing.

In India, especially, where 13 of the world’s 20 most polluted cities by concentration of particulate matter are in the Indo-Gangetic plains, the near-complete lockdown has succeeded in lifting this malevolent shroud of polluted air.

More specifically, in north India, three weeks of lockdown cleaned the air enough for people in Jalandhar to see for the first time in 30 years the majestic snow-capped peaks of the Dhauladhar mountains, a part of the Himalayan range about 214 kilometres to the north. Astonished residents of this heavily industrialized and congested city took to social media, posting photographs and marveling at the sight on 3 and 4 April. On 4 April, the district recorded an Air Quality Index (AQI) of 52 micrograms per cubic meters, the best it has seen in the past decade, a Punjab Pollution Control Board (PPCB) official said.

As recently as 30 April, the dusty, mofussil town of Saharanpur in Uttar Pradesh’s sugar and paper industry belt woke up to the breathtaking sight of the snowy Himalayan peaks of the revered Gangotri glacier over 200 km away as the AQI dipped below 50. (Incidentally, Saharanpur doesn’t have its own air quality monitoring station and has to depend on Muzaffarnagar for it.) Like Jalandhar, stunned Saharanpur residents, an entire generation of which had simply grown up hearing stories of such views from their elders for whom this used to be a common sight, posted admiring pictures on social media. Pictures of the Kanchenjunga peak also emerged from Siliguri, West Bengal on May 1, as did an almost surreal photo of Mount Everest from Singhwahini village 205 km away in Bihar near the Indo-Nepal border, posted by the village gram panchayat mukhiya, Ritu Jaiswal on May 4, making these rare sightings almost commonplace.

Not just the polluted Indo-Gangetic plain, but also across the country others posted equally spectacular pictures and videos of clean lakes, chirping birds, clear, empty roads, postcard-blue skies, buzzing bees, bright green spaces and sparkling rivers, a regenerating planet coming delightfully alive to nature’s divine orchestra and harmonious colours.

Along with revealing nature’s obscured beauty that shimmered beneath, the coronavirus-induced lockdown has proven to even the most vocal deniers and disbelievers of air pollution’s man-made origins that air pollution truly exists and it is almost completely anthropogenic in nature. These are the same people whose sceptical looks and raised eyebrows militate against the over 70,000 scientific studies that link dirty air with disease, disability and death, research that proves that air pollution affects every organ in the human body. Their denial that breathing polluted air kills us faster, accelerating our inevitable demise, ironically doesn’t exempt them from the health harm caused by air pollution. It can’t be emphasized enough that, essentially, if you’re not breathing clean air, you are dying faster.

Delhi’s own pollution level on 22 March, when a day-long nation-wide curfew was imposed by Prime Minister Narendra Modi (nicknamed Janta curfew in an official document), came down by 44 per cent, compelling the Central Pollution Control Board (CPCB) to issue a 20-page report that documented significantly reduced air pollution in at least 85 cities across India in the very first week of the nationwide lockdown beginning March 24. The Press Trust of India (PTI) reported that 92 cities with CPCB monitoring centres recorded minimal air pollution. Whatsapp groups of clean-air evangelists and activists tracking pollution traded PM2.5 numbers as low as 8 in some parts of Delhi, while some in Gurgaon said their low-cost sensors had captured a 1, sending a virtual cheer through the groups. The U.S. space agency National Aeronautics and Space Administration’s (NASA’s) satellite data showed that air pollution over northern India plummeted to a 20-year-low for this time of the year.

The drop in air quality to near-pristine levels in a matter of weeks demonstrates another important fact: that pollution is reversible, and that such a reversal can, in fact, be effected very quickly.

Admittedly, this unintended silver lining of clean, breathable air comes attached to the dark cloud of catastrophic economic, social and mental cost the lockdown has caused. People have been compelled to stay indoors, productivity has plummeted as factories have shut and services frozen. Daily-wage migrant labour has had to reverse-migrate to rural areas as families have slid back into poverty. Supply chains have faltered as the Indian Railways, in an unprecedented move, for the first time in history, has stopped operations around the country. The massive impact on livelihoods and the global economy that these severe restrictions have brought about will likely take years to subside. The question is, however; how do we retain the silver lining even after the COVID-inspired dark cloud rolls away? The only way to sustainably reduce emissions is not through painful lockdowns, but by putting the right energy- and climate-related policies in place.

For those who rarely step out without N-95 or N-99 masks to protect themselves from microparticulate pollution, the irony of finally being able to breathe clean outdoor air without a mask but being forced to stay indoors because of the very lockdown that has cleaned the air isn’t lost. For those who promote wearing masks mainly to make the invisible problem of air pollution visible, the SARS-CoV-2 virus has done more than decades of campaigning could have. Face masks are now ubiquitous.

Kangchenjunga, the third highest mountain in the world, is visible from Siliguri, approximately 150 km away.
The Data Behind Lockdown-Induced Declines In Air Pollution

Importantly, what this lockdown has also done is given air pollution researchers and data scientists an opportunity to monitor, record and parse how air pollution levels have responded to a situation of almost complete stoppage of economic activity and what we can learn from this for the future.

“This is a model scientific experiment,” NASA scientist Robert Levy said about the lockdown and its effects on pollution in the same news report that noted lowest pollution levels in 20 years: “We have a unique opportunity to learn how the atmosphere reacts to sharp and sudden reductions in emissions from certain sectors. This can help us separate how natural and human sources of aerosols affect the atmosphere.”

“The reductions we have seen correspond to the cessation of vehicular traffic, construction activity, industrial activity and brick kiln operations, but for the first time we also have an opportunity to study India’s background levels of PM and other gases, and the influence of meteorological factors,” climate change media portal CarbonCopy quoted Dr Sagnik Dey, associate professor at the Centre for Atmospheric Sciences, IIT Delhi, as saying.

Air pollution scientist and Care for Air adviser Dr Sarath Guttikunda, who runs 3-day pollution forecasts via his UrbanEmissions research group blog analysed measurements of individual pollutants that make up India’s AQI on the first day of the extended period of the lockdown (15 April to 2 May 2020), to understand what caused these changes. Each of the pollutants has a unique story to tell, he writes – local PM2.5 levels proving that at least 70% of pollution is locally generated, the dramatic fall in NO2 reflecting that its main source is vehicular exhaust, its sharp fall in turn allowing ozone levels to rise, since NOx “eats” Ozone….

But more than the blue skies and spectacular views, more than a chance to prove that pollution is anthropogenic and reversible or conduct model scientific experiments on interlinkages between air pollution and COVID-19, what the lockdown has proven beyond the shadow of a doubt is that, if the government truly has intent, it is fully capable of reducing air pollution in India by a large margin. From the recorded audio-messaging that played on every mobile phone before the ring-tone in the early days of the SARS-CoV-2 spread, to using technology and its enormous muscle to track and trace individuals all over the country, the Indian government has demonstrated that it has every tool in place and –  with similar intent – is capable of not just spreading awareness, but also lowering emissions at source, encouraging behavioural changes and penalizing polluters at both the individual and industry levels.

The effectiveness of the government’s measures on the COVID-19 public health disaster was validated by a recent telephone survey by India’s NCAER National Data Innovation Center, which showed a high understanding of social distancing and support for the lockdown despite considerable hardships. The government’s use of science and evidence-backed information as the backbone, and mobile and data technology as tools to spread awareness in a targeted way, made lockdowns more effective in India’s model of democratic, decentralized governance. Going forward, these same tools can easily be used to tackle air pollution, especially now that we know that the lethality of dirty air can extend to communicable diseases like COVID-19, exacerbating its spread and severity.

But that will depend on the government’s intention.

Reopening Into a Climate-Friendly Future

As the government prepares a stimulus package to reinvigorate a stalled economy, this is the time for all decision-makers – legislative, corporate, elective, political executive – to reimagine and redefine a greener and more sustainable path towards economic growth. This is the time to course-correct, to collectively grasp the opportunity of re-prioritizing the sort of growth and progress that is truly important for our nation and its people, one that is in harmony with our environment, rectifying earlier mistakes.

“The big question is whether government stimulus measures lead to pollution levels rebounding above the levels before the crisis, like it happened after the 2008 financial crisis,” says Lauri Myllyvirta, lead analyst at CREA. The report quoting him in the Guardian also says that signs from China, which is coming out of the other side of the coronavirus outbreak and where lockdowns are loosening up, are not positive.. “For the first four weeks after the Chinese new year holiday in late January, when the coronavirus outbreak was at its worst, pollution levels fell 25% across the country. But since early March, levels of nitrogen dioxide pollution have begun to inch back up as the country gets back to work with factories, businesses and power plants re-opening and traffic returning…Indeed, the fear among environmentalists and residents is that, rather than attempting to maintain the low levels of pollution in the world’s biggest capitals, when industry and cars kick back into action post-lockdown, the situation will go back to square one, and perhaps even worsen, as people and industry attempt to make up for the lost months,” it reports.

But thankfully, that may not be the only truth.

Europe, U.K., Japan and other enlightened cities and countries are making a push for a greener revival.

Early opinion polls and pledges to dramatically reduce the footprints of cars by some of Europe’s top city mayors suggest this time, it may be different. Public opinion in Britain appears to want a radical response to climate change, one implemented with the same urgency as that given to the fight against COVID-19. British research company Opinium recently polled 48 per cent of the public agreeing that the government should respond “with the same urgency to climate change as it has [to] COVID-19.” Already, Guiseppe Sala, the mayor of Milan has led a call for stimulus spending to navigate a more sustainable path towards economic growth as hard-hit Italian cities recover from the blow of the COVID-19 pandemic. “If designed properly, using shared knowledge and expertise from cities across the globe, these stimulus packages can foster resilience within our economic and financial systems, while also creating truly sustainable means of protecting public health, reducing inequality, and preserving the global ecosystems we all depend on,” he said. Milan has also announced one of Europe’s most ambitious schemes, reallocating street space from cars to cycling and walking, in response to the coronavirus crisis.

Paris mayor Anne Hidalgo has been even more emphatic, vowing that returning to a Paris dominated by cars after lockdown ends 11 May is “out of the question”. Hidalgo has been leading a radical overhaul of the city’s mobility culture since taking office in 2014 and sounds even more determined to maintain her anti-pollution and anti-congestion measures even as cities rethink transportation policies to avoid COVID-19 transmission. “I say in all firmness that it is out of the question that we allow ourselves to be invaded by cars, and by pollution. It will make the health crisis worse. Pollution is already in itself a health crisis and a danger — and pollution joined up with coronavirus is a particularly dangerous cocktail,” she told the Paris City Council on 28 April.

Denmark and Holland, already criss-crossed by vast networks of bike lanes, are inspiring other European cities seeking to get their economies back on track after the devastation caused by the COVID-19 pandemic. Bike use is being encouraged as a way to avoid unsafe crowding on trains, buses and other shared public transport. Cycling activists from Germany to Peru are trying to use the moment to get more bike lanes or widen existing ones.

Japan has gone a step further, with its environment minister Koizumi Shinjiro reaffirming his country’s allegiance to the United Nation’s Paris agreement on climate change, promising a green recovery from the COVID pandemic with renewed focus on electric mobility and solar power.

“Now is the time to unite, to save lives, save the Paris agreement, and save our planet,” he said.

The Gangotri glacier, visible from Saharanpur in Uttar Pradesh
India Considers Rolling Back Environmental Protections Post-Pandemic

This is exactly the sort of environmental priority that Indian leadership, local, state and central, ought to be aiming for.

In fact, even before choosing a greener path, (and independent of the spread or containment of COVID-19) the first thing we must do is hold our government accountable to existing environmental norms. Unfortunately, even that doesn’t seem to be happening, as the Indian government, in its zeal to revive the economy, is proposing watering down its own environmental norms.

India cannot, under any circumstance, roll back on existing environmental protective measures. Civil society must ensure that the government does not use the pandemic as an excuse to relax hard-won rules and enforcements that lower emissions at source. Activists are already concerned about the government’s proposal to amend its Environmental Impact Assessment (EIA) notification during the course of the lockdown, when it won’t lend itself to adequate public scrutiny. At a time when we should be doing more to take care of the environment and strengthen environmental laws, the Ministry of Environment, Forests and Climate Change has released a draft EIA Notification 2020 that weakens its more stringent 2006 rules. It is open for comments from citizens only until 23 May, a narrow window right in the midst of the biggest pandemic we’re witnessing, when people’s engagement with it may be enervated, inert.

The EIA has far-reaching effects on India’s forest and environment protection and current proposals include shortening timelines for environmental clearances, increasing validity of mining and riverbed related projects, and expanding the list of projects exempted from getting environmental clearances or no longer requiring public consultation. The proposed notification also suggests post-facto approval of projects begun without environmental clearances, doing away with individual environmental clearances for projects within industrial complexes, all of which will only lead to poorer compliance and adherence to environmental standards. It also makes no mention of individual accountability, which will inevitably increase the chances of environmental violations and degradation.

A year-long investigation by IndiaSpend has revealed how India is ripping apart its environment for business, opening up wildlife sanctuaries and national parks to roads, railways, mines and industries by weakening its own regulations. The report analyses data that shows India has approved over 270 projects in and around its most protected areas including biodiversity hotspots, in the six years since July 2014. “At the same time, the Centre has watered down environmental safeguards, prompting stakeholders to warn that such interference not only imperils  habitat and ecosystems, but also endangers public health,” the IndiaSpend analysis says.

The WHO has been warning for years that habitat destruction is changing the patterns of infectious diseases, including a growing number of zoonotic diseases like COVID-19. “The chance of coming in contact with zoonotic diseases increases when humans enter biodiversity hotspots,” IndiaSpend warns.

Other more recent approvals too have been made in haste, disregarding environmental impact, like the April environmental clearances for infrastructure projects in 11 states that were hurried through via videoconferencing. The usual route of direct meetings allows officials to scrutinize maps and locations, and clarify details in real time, but there has been no scope for such careful consideration in this decision. An environment ministry panel has also recommended an automatic extension of forest clearance for government-owned mines, whose lease period got a 20-year extension. Perhaps the fact that India’s environment minister also holds charge of the ministry of heavy industries and public enterprises may have something to do with this?

Even the courts have proved complicit – the Supreme Court recently extended the deadline for selling leftover stock of cars with BS-4 engines, which are more polluting than vehicles equipped with the cleaner BS-6 engines, and were to be phased out by March 31. The pandemic may have worsened the automobile sector’s troubles in the midst of transitioning to stricter emission norms from 1 April this year, but that does not warrant that emission norms be relaxed.

Fears that this virus will make people perceive public transport as unsafe and cause a behavioural shift towards private vehicle ownership may counter falling demand to some extent, but the same fear will limit the demand for buses, trams and other public and shared mobility like Ubers. Instead, the pandemic should serve as a point to embark on a path to cleaner urban transport, whether private or public, bicycles or electric cars. The AQI numbers during lockdown, accompanied by clear blue skies make a compelling case for cleaner transport, and should finally settle the debate between electric mobility and conventional internal combustion engine vehicles. Struggling automakers are sure to make a strong case for an industry-specific fiscal stimulus despite the writing that has been on the wall for years. This is the time to choose an even faster transition to e-mobility and work out a plan to fund the re-skilling of workers towards the manufacturing of electric vehicles (EVs).

At the same time, the government must accelerate the switch from thermal to renewable energy, especially as the latter continues to become relatively more economical. With the current demand for power at an all-time low, this is the best time to close down old thermal power plants that do not meet emission standards. Experts believe shutting down such plants would largely improve air quality. But the government’s ongoing indecision has confounded activists and industry. Despite increasing evidence that coal continues to remain more expensive relative to renewables, the government continues to subsidize it. A report published by Carbon Tracker in mid-April states that 51 percent of the country’s coal power costs more to run than building new renewables and that almost a quarter of the planned 66 GW thermal power capacity will enter the market with negative cash flow.

Now that everyone has experienced for themselves what clear blue skies look, feel and smell like, and how polluted areas could see higher additional deaths due to COVID-19, there should be even greater motivation to find and implement solutions that keep emissions under control.

Campaigners and environmentalists are concerned about which way things will go. Will we slip back to old, polluting habits? Will we start burning more coal, buying more conventional cars, constructing more buildings, ploughing through our natural resources once again after the pandemic recedes because we have to revive the economy and catch up on our GDP targets? Or will we be able to course-correct, carve out a new normal where the air we breathe isn’t taken for granted, and policies like the National Clean Air Programme (NCAP) are implemented successfully even while the government partners with industry to bring the economy back on track.

View of the Himalayas
Can We Choose a Greener Post-COVID-19 Path?

Coming back to the silver lining, the significant drop in pollution levels is now undeniable and visible for all to see, even the stolid naysayers. While the abrupt economic shutdown that it has taken to achieve this can never be a substitute for a concrete, thought-through plan to lower emissions from all sources, experiencing clean air, breathing, seeing and smelling it, should make it everyone’s new, desirable aspiration. In fact, the COVID-19 pandemic demonstrates that the NCAP shouldn’t just be seen as an environmental policy aimed at improving living conditions, but a mission of national importance aimed at improving public health and thus the overall productivity of the country.

Devising policies that stimulate robust economic activity while also coordinating real action to clean India’s air won’t be easy. This sort of sustainable growth path will require coordination between and within all the states, as well as several levels and agencies of the government and civil society. It will require mindful economic restructuring and thinking out of the box, incorporating the ideas of fairness and restorative and regenerative justice. If there’s one lesson that the response to the COVID-19 pandemic has left us with, it is that even the most extreme measures fall firmly within the realms of possibility if they can inspire both political will and public support. Political will bends to public demand – and, henceforth, a more aware public is more likely to demand better healthcare, which includes cleaner air and water, along with economic growth.

COVID-19 has brought with it an unprecedented threat to human existence and our lives, at once delicate as gossamer and strongly resilient. But it also presents an extraordinary opportunity, a chance to thrive, instead of merely survive. As we wait in this liminal bardo-like state between the earth’s exhalation and inhalation, between the pre-corona and post-corona world, the past and the future, in collective, indefinite limbo for a rebirth into a new normal, we have a chance for a fresh awakening, re-calibrating to a better, fairer, more balanced world. Like the Zoom waiting room, our current bardo has forced us into contemplation, an invaluable gift, if we use it well, to listen to our inner voice.

The lockdown-caused blue skies have shown us that we may yet have another chance to repair the damage we have done to our environment. We must ensure that the growth path we choose this time is greener, fairer and more climate-friendly. It is imperative to choose sustainable development over pure economic growth. We cannot mortgage the future of our young. But if the young themselves don’t make the right choices, voting with their wallets as well as their ballots, demanding to balance healthy profits with a healthy planet and healthy people, this second chance will be lost and future generations will be forced to pay the compounded price for past follies.

If we don’t grasp this opportunity to reimagine growth, reset to a new normal, rebuild climate-smart, healthier and more equitable cities, and take a more sustainable path to growth, we will have lost our last chance to make amends with nature and be forever doomed to suffer ill-health and perhaps a final apocalypse, whether it is through nature’s fury – earthquakes, floods, wildfires, famine – or an even more viciously virulent virus than SARS-CoV-2. And, this time, the poetry of our lungs, will become its own final requiem, just as it did for my mother.

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Jyoti Pande Lavakare is an independent financial journalist, author and clean air evangelist. She started as a radio journalist in 1985 while still in college and began her professional life as a reporter with The Economic Times in 1990, moving to Dow Jones Newswires in 1995. She switched to writing columns for  national and international newspapers after moving to California in 2006. She wrote on start-ups and entrepreneurship for The Business Standard and India Ink after moving back to India and currently writes on air pollution. She also writes fiction and creative non-fiction and her first book, a personalised non-fiction narrative on the human cost of air pollution called “Breathing Here is Injurious To Your Health” is due to be published by Hachette in 2020. 
As a clean air evangelist, she has co-founded Care for Air, which works in bringing awareness of the health harms of air pollution and advocating for clean air for all. As a two-term President of the Sanskriti School PTA and a mother of two, she has also written on parenting issues. Jyoti lived in Palo Alto, California and moved back to Delhi to raise her children in her home country with a stronger sense of their cultural and regional heritage and identity. She is a trained Hindustani classical musician and lives in Delhi in the hope that she won’t be forced to become a pollution migrant.

Image Credits: Twitter: @Deewalia, Twitter: @activistritu, Twitter: @bsouradip, Twitter: @mundhrashish, Dushyant Kumar/Times of India, Esquire Middle East.

A factory worker Taoyuan, Taiwan wears a mask of the national flag during a visit of President Tsai Ing-wen.

Over a dozen World Health Organization Member States have proposed inviting Taiwan as an observer to the upcoming World Health Assembly (WHA), taking place virtually on May 18 and 19. The US-inspired move is formally led by a number of small countries and island states in Africa, central America, the Caribbean, and the Western Pacific. But along with the US, it is supported from the wings by much bigger powers, including Canada, Australia, New Zealand and Japan – all keen to contain Chinese ambitions in the Pacific region. Taiwan, with a population of 23 million and a democratically-elected government, has stood out a model of coronavirus control with 460 cases and seven deaths only to date.

The proposal comes amid increased tensions between China and the United States over the handling of the COVID-19 pandemic, which US President Donald Trump blames on Beijing. The US administration, now at the pandemic epicentre, has also blamed the WHO for “China-centric” policies that failed to contain the virus in its early days.

China, on the other hand, regards Taiwan’s as an island province, led by a rogue government, and perceives any foreign expressions of support for Taipei as intervention in its own internal affairs.

Taiwan and the UN

The UN Membership: Resolution 2758, approved in 1971 paved the way for the official of exclusion of Taiwan, the Republic of China, from the club of UN member states. The resolution, approved by UN member states determined that thereby only one seat to represent China, and that seat is currently occupied by the People’s Republic of China.

Gian Luca Burci

WHO’s position: Taiwan is not a separate state by UN definitions, and that is a policy the WHO Secretariat has to follow. But the doors are not totally closed to technical contacts and information flow via informal bilateral channels, notes Geneva Graduate Institute Professor Gian Luca Burci, former chief WHO legal counsel. “WHO is probably the only organization in the UN system that has contacts with Taiwan. Most of them have absolutely closed doors,” said Burci.

Observer Status: Former WHO Director General, Margaret Chan, invited Taiwan as an observer to the World Health Assembly between 2009 and 2016. Significantly, however, she did not issue an invitation to the last WHA in May 2017 over which she also presided. What changed in 2017? Firstly, in January, Tsai Ing-wen, a Beijing skeptic, was elected as president of Taiwan. Then, the May World Health Assembly also saw the election of Africa’s first WHO head, Dr Tedros Adhanom Ghebreyesus, a former Ethiopian Health Minister. After assuming his post, DG Tedros Ghebreyesus also did not renew the invitation to Taiwan to participate in annual meetings of the WHA, WHO’s member state decision-making body.

WHO’s New Director-General and Taiwan

Is it because China supported Dr Tedros’ election? It’s a question that many are asking.

But, “one needs to be careful with these associations,” warns Burci. “When Taiwan was invited, the [Taiwanese] Kuomintang party, friendly to China, was in power. There was a more conciliatory tone. Almost like a reward to Taiwan, the invitation was [issued] on the basis of this understanding and all the key countries were very happy with these arrangements.”

Since Tsai Ing-wen’s election, the conciliatory tone between China and Taiwan has changed. The window of dialogue has closed.

“The DG is not in a position to invite Taipei anymore. It’s as if the canton of Schauffausen were invited to attend the [World Health] Assembly without the consent of the Swiss Federal government,” said Burci.

Procedure: Under WHO’s constitution, there are two ways to invite a government [usually in dispute] to attend as a WHA observer – after a proposal is sent by member states to the WHO:

The Director General can issue an invitation personally, or the issue can be placed on the WHA agenda for a vote by the 194 Member States. But first, this has to be decided by the WHA General Committee, which determines the final order of business. In the past three years, an “elegant solution” was reached whereby just two Committee members would submit the request for Taiwan to participate as an observer, two would oppose it, and the rest abstained. And thus it wouldn’t go on the full WHA agenda at all.

“It’s a complicated choreography… Every year there has been a resolution with this request but there has always been an agreement with two countries in favor and two against,” explained Burci.

What’s the Problem this Year?

For the first time in its history, the Assembly will be virtual.

The WHA agenda is supposed to be restricted to two topics: COVID-19 and the election of 10 new members to the WHO Executive Board, the 34- member WHO governing body. .

There is no broad consensus to support Taiwan’s status as an observer and the Director General will therefore not extend a personal invitation. There is also no unspoken deal this year either among Member States’ side to avoid a vote on Taiwan in the plenary. And with the pandemic, it is not possible for diplomats to see each other as usual. So, without a political agreement beforehand, the China-Taiwan divide will likely be aired publicly, live over the internet, something member states try to avoid. Says Burci it could be “a mess.”

“Imagine the Assembly opening with 194 Member States connected by Zoom. Connection will be terrible, it will be chaotic. And on top of that, the [WHA] president introduces this proposal. If there is opposition, the Assembly will have to vote, and [if] it is impossible to vote, this could be an element of paralysis and confusion right at the beginning. It could be a mess, a catastrophic failure of the Assembly,” he added.

This is certainly an image the WHA does not want to create before the world in the middle of a pandemic, so a great deal of diplomacy is underway right now in Geneva to mediate between the US and China.

Taiwanese President Tsai Ing-wen
Who’s Blackmails Who?

China’s viewpoint: Taiwan backed by the US is capitalizing on a moment of panic to score political points.

The US viewpoint: The US would never support Taiwan’s membership but always supported Taiwan’s participation as an observer. “There is a big pro Taiwan lobby in Washington up to a point. But with the Trump administration the bilateral situation with China is such that WHO is the collateral damage,” said Burci.

Taiwan’s position: Exclusion of Taipei from important UN agencies like the WHO poses real security and health threats. And this happened once before already, during the SARS epidemic in 2003, which also hindered response. Taiwan can also contribute to WHO and United Nations global health goals. What if the WHO had listened more carefully to the Chinese Republic’s early warnings in the very early days?

Game score: “You can argue either way,” said Burci. Despite early warnings about the seriousness of COVID-19 and its successful management of the epidemic, Taiwan has been largely sidelined during this crisis; its expertise and role not been recognized. But…. if you look in other direction, it’s also not the time to score political points.

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Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates.

Image Credits: Republished from our partner publication — Geneva Solutions.© Keystone: Ritchie B. Tongo , Wang Yu Ching / Taiwan Office of the President.

Taiwanese president Tsai Ing-wen inspects COVID-19 prevention measures at Taoyuan Airport on April 7.

Some 13 Member States have now submitted a formal proposal to the World Health Assembly (WHA) to extend an invitation to Taiwan to attend the Assembly as an observer – a status that it has not held since 2016, according to WHO documents. 

The move, while initiated by the Central American state of Belize, essentially represents as US-led pushback to China’s attempts to squeeze Taiwan out of the diplomatic space in the global health domain – building on mounting frustration with the size and scope of the COVID-19 pandemic that has stalled global economic activity and thrown much of the world’s population into lockdowns. 

Taiwan also has gained media attention with its claims that WHO had ignored early warnings of human-to-human transmission from Taiwan due to its non-State status and exclusion from formal member state meetings – although WHO has said that is in fact a member state decision.

Raising the ante, US Secretary of State Mike Pompeo last week pointedly stated that Taiwan should be extended a personal invitation from World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus to attend the WHA. 

“I want to call upon all nations, including those in Europe, to support Taiwan’s participation as an observer at the World Health Assembly and in other relevant United Nations venues,” Pompeo said in a press release last Wednesday. “I also call upon WHO Director General Dr. Tedros to invite Taiwan to observe this month’s WHA as he has the power to do and as his predecessors have done on multiple occasions,”  Pompeo’s call was later echoed by Canada – albeit in more indirect, and diplomatic language.

On the same day, a proposal for a vote on the issue by member states at the upcoming Assembly was submitted to WHO by the Central American country of Belize. A swelling list of other sponsors have now formally added their names to the call, including the central American countries of Nicaragua, Honduras, Guatemala and Paraguay; the Caribbean islands of Haiti, St. Lucia, Saint Kitts and Nevis; Eswatini in southern Africa; and the Pacific small island states of The Marshall Islands, Palau, Republic of Nauru, and Tuvalu.  

The move by Western Pacific states, in particular, reflects the growing jitters in the region about China’s ambitions and expanding influence. While not formally signatories to WHO appeals, New Zealand’s foreign minister also told reporters last week that Taiwan should be included as a WHA observer, following the lead of Australia, which had made a  public statement just days earlier. Already in late January, Japan had issued a similar call.

Support by other Latin American, Caribbean and African states comes from vulnerable states that have benefitted from generous Taiwanese technical assistance in the COVID-19 crisis.

WHO Legal Counsel Insists that Director General Does Not Mandate to Invite Taiwan

In a press briefing Monday, WHO legal counsel Steven Solomon confirmed a proposal had been made “to the assembly itself to make a decision on an invitation [to Taiwan].”

“That is procedurally how it is supposed to work under the Constitution. All 194 Member States can consider the issue collectively, in accordance with the rules of procedure,” said Solomon. “Success depends on political will and political engagement, which underscores the point that this is a political issue that is properly in the hands of Member States.” 

The motion asks for all 194 WHA member states to vote directly on granting Taiwan observer status at the annual meeting, which is supposed to be focused on COVID-19 pandemic response. While observer status would not give Taiwan the right to vote on any WHA resolutions, it does give the Taiwanese government the ability to send a representative to speak at the Assembly. 

This is not the first time in recent memory that Taiwan has been allowed to attend the WHA.  It held Observer status at the WHA from 2009 to 2016 as ‘Chinese Taipei’ – attending at the personal invitation of then director general Dr Margaret Chan, herself a former Hong Kong health official. 

However, Chan’s invitation to Taiwan to attend the  World Health Assembly in May, 2017 was suddenly cancelled – just as Chan was finishing her term, to be replaced by Dr Tedros who was elected at that year’s meeting in the first-ever secret ballot by the full Assembly. There has been speculation that the invitations ceased in 2017 and thereafter, as a result of China’s support for the election of Dr Tedros, also the first WHO Director General from an African nation. However, WHO has pushed back saying that it is member state consensus that drives the invitation.  

Regardless of this precedent, under the WHA’s current operating procedures, the WHO Director-General cannot extend an invitation to Taiwan to observe the Assembly without consensus from all Member States, Solomon stressed at the briefing, responding to Pompeo’s call for a personal invitation from Dr Tedros, regardless of prevailing member state sentiments.

To put it in crisply, the Director General only extends invitations when it’s clear that all Member States support doing so,” said Solomon. 

He stressed that in the 2009 to 2016 period Taiwan was only invited to attend the WHA as an Observer after a ‘diplomatically agreeable solution’ had been found that won the support of all Member States.

“However, the situation is not the same [now],” said Solomon. “Instead of clear support, there are divergent issues among Member States, and therefore no mandate for the Director-General to extend an invitation.”

What remains now to be seen is whether the two-day virtual WHA, which is supposed to be devoted to uniting member states around a strategy for global COVID-19 pandemic response will instead become a divided platform over China’s claims to Taiwan.

Svet Lustig Vijay, Tsering Lhamo, and Heidi News Service/Geneva Solutions contributed to this story.

Image Credits: 總統府 / Wang Yu Ching.