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

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

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

Dr Tedros Adhanom Ghebreyesus

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

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

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

Dr Mariangela Simao

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

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

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

Sebastián Piñera

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

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

Image Credits: Government of Chile.

Kawasaki disease is a severe inflammatory disease in children

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

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

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

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

Kawasaki disease incidence has surged since COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: BruceBlaus, The Lancet, Agência Brasília .

Worldwide distribution of people that are undernourished

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

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

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

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

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

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

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

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

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

Celebration of Older Adult Mental Health Awareness Day in the USA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Language on Overriding Patent Rights Was a Key Negotiating Point

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Uniting Behind A People’s Vaccine

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

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

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

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

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

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

 

Image Credits: Jamie.

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.