US Food & Drug Administration Approves New Sedative Product For Emergency Use In Ventilated COVID-19 Patients; Doctors Question Remdesivir Eligibility Criteria 12/05/2020 Grace Ren 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. WHO Repeats Warnings Against ‘Herd Immunity’ Assumptions As Countries Lift Lockdowns & Brace For Resurgence 12/05/2020 Grace Ren 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. Living With Air Pollution In A Post-Coronavirus World 12/05/2020 Jyoti Pande Lavakare 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. ____________________________________________ 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. Taiwan – The Contested Bone Of Global Health Diplomacy Amid Pandemic Mayhem 12/05/2020 Kyra Dupont/Geneva Solutions 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. ____________________________________________ 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. Swelling Bloc Of WHO Member States Proposes Invitation To Taiwan For May 18 World Health Assembly 11/05/2020 Elaine Ruth Fletcher 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. More Research On COVID-19 And Cardiovascular Symptoms Needed, Say WHO Experts 08/05/2020 Grace Ren & Svĕt Lustig Vijay Transmission electron microscope image of SARS-CoV-2, the virus that causes COVID-19 As reports of COVID-19 patients presenting with cardiovascular symptoms continue to surface, World Health Organization experts say more research is needed to understand all of the clinical presentations of the new disease. Still, they underlined that the new coronavirus primarily causes respiratory disease. “It is clear that in a proportion of patients, [COVID-19] is causing a broader inflammatory response, either within the vascular system – that’s the blood carrying system – or in other parts of the body,” said WHO Executive Director of Health Emergencies Mike Ryan. “But when we look at COVID-19, we need to see that obviously as a respiratory disease that’s spread by a respiratory route. It causes a respiratory syndrome.”” Ryan’s comments come just days after The Lancet published a correspondence describing eight young COVID-19 patients who had presented with symptoms similar to Kawasaki’s disease – a pediatric heart condition caused by swelling of the blood vessels. Just a day before, New York City health officials had released an official notice describing 15 similar cases among children 2 to 15 years old, ten of whom were previously exposed to COVID-19. Many of the patients did not present with significant respiratory symptoms. WHO COVID-19 Technical Lead Maria Van Kerkhove again attempted to reassure parents that the syndrome was still rare, and added that WHO would be rolling out a new form tailored specifically to collecting information on the ‘Kawasaki-like’ illness. But so far, it seems like COVID-19 still primarily causes a respiratory illness. Data from rare reports of the virus attacking other parts of the body must be collected systematically in order to determine how frequently these syndromes occur, or whether they are associated with COVID-19 at all. “Very often with new emerging diseases, they don’t always have just one target organ. They tend to cause a much more disseminated disease that may affect multiple organs,” explained Ryan. “We’ve also seen reports of encephalitis or swelling or inflammation of the brain. We’ve seen other reports of other effects of the disease.” “We’re at the very early stages of understanding how this virus affects the body, and how disease progresses,” added Van Kerkhove. “I have to remind myself that we’re in month five of this pandemic.” So far, over 10,000 detailed case reports of COVID-19 patients have been collected using a standardized form co-designed by WHO and the International Severe Acute Respiratory Infection Consortium (ISARIC). Individual hospitals are also collecting data on different clinical presentations of COVID-19, which is how the ‘Kawasaki-like’ illness in pediatric COVID-19 patients was first identified. But WHO is “hoping that more and more case records can be obtained so that we could better understand this [disease],” said Van Kerkhove. Switzerland Will Deploy Official Contact Tracing Application Alongside ‘Old-Fashioned’ Contact Tracing; WHO Emphasizes Finding Active COVID-19 Cases Over Monitoring Virus In Wastewater Meanwhile, in Switzerland, Swiss Parliament adopted a motion to use a contact tracing application in synergy with classical contact tracing, said Swiss Federal Council Alain Berset at a press conference today. The application will be tested in the next few weeks, before being deployed widely. Switzerland has reported 80 new cases over the pas 24 hours, and 30 207 total cases so far according to the Swiss Federal Office of Public Health. In Switzerland, the situation is ‘evolving favorably’ and current measures will be further softened on Monday to open schools and libraries, said Berset. Although Switzerland can be “optimistic” right now as the outbreak calms down, Berset urged citizens to remain ‘prudent’ and ‘pragmatic’ – “The virus is still here,” he warned. Physical distancing measures must be respected and vulnerable populations need to be considered, he said. Switzerland’s focus on contact tracing in its reopening strategy aligns with WHO recommendations that countries ramp up capacity to detect, isolate, and treat every case as countries gradually lift lockdown measures. Early detection and isolation of contacts is crucial, as it can prevent people from transmitting the virus before they themselves present with symptoms. WHO is also exploring other ways of monitoring COVID-19 – including testing for COVID-19 antibodies, or monitoring wastewater for the presence of the virus. Fragments of SARS-CoV-2, the virus that causes COVID-19, have been detected in wastewater, no live or infectious virus has been found in any samples so far. But while environmental monitoring or antibody testing are important for “understanding the long term trajectory of the pandemic,” countries must not neglect core public health strategies, said Mike Ryan. “We seem to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back to where we should have been; finding cases, tracking cases and contacts, testing cases, and isolating people who have tested positive,” said Ryan. Total cases of COVID-19 as of 7:32PM CET 8 May 2020, with active case distribution globally. Numbers change rapidly. 280 Rohingya Refugees Quarantined Offshore Bangladesh ‘As Precaution’; UN appeals for US$ 6.7 billion To Support Vulnerable Populations Some 280 Muslim-majority Rohingya refugees were precautionarily quarantined off the coast of Bangladesh on the Bhasan Char island due to fear of coronavirus spread – a move that sparked criticism by Human Rights Watch. Bangladesh is South East Asia’s second fastest growing pandemic hotspot after India, with over 13 000 cases and almost 800 new cases in the past 24 hours. “Bangladesh faces the tremendous challenge of assisting Rohingya boat people while preventing the spread of Covid-19, but sending them to a dangerously flood-prone island without adequate health care is hardly the solution,” said Brad Adams, Asia director of Human Rights Watch. “Any quarantines need to ensure aid agency access and safety from storms, and a prompt return to their families on the mainland.” Last weekend, a smaller boat with 29 Rohingya refugees was also taken to Bhasan Char island. There are approximately 1 million Rohingya refugees in Bangladesh, most of whom are based in the Capital’s Cox Bazar. The UN appealed for US$ 6.7 billion to fund an updated plan for responding to the COVID-19 pandemic in 63 of world’s most fragile countries, many of which are hosting refugees, the UNHCR said in a statement released Wednesday. The UNHCR called on countries to support vulnerable populations – with explicit reference to the Rohingya. “We call on States in the region to uphold the commitments of the 2016 Bali Declaration as well as ASEAN pledges to protect the most vulnerable and to leave no one behind. Not doing so may jeopardize thousands of lives of smuggled or trafficked persons, including the hundreds of Rohingya currently at sea.” Despite the UN’s call on South East Asian countries to allow vulnerable populations to land on their coasts, South East Asian nations have not followed. Meanwhile, neighboring India’s Asian Infrastructure Investment Bank (AIIB) signed a $500 million “COVID-19 Emergency Response & Health System Preparedness Project” on Friday to help respond to the pandemic and strengthen public health preparedness. India has over 64% of South East Asia’s cases, with almost 54 000 total confirmed cases and 3561 new cases reported over the past 24 hours. South Africa Releases 20 000 Prisoners From Jails And Facilitates Movement Of Civilians Through New Amendment To curb the spread of COVID-19 in jails, South Africa released nearly 20,000 prisoners on Friday, announced South African President Cyril Ramaphosa. Some 45% of Africa’s 35 470 cases are in South Africa, Algeria and Nigeria, and almost 50% of new cases in the past 24 hours were reported in these three countries. South Africa will also allow individuals and businesses to move premises across the country, including citizens who were not able to do so due to the lockdown, said a statement from the South African government from Thursday. Zixuan Yang contributed this story. Image Credits: NIAID-RML, Johns Hopkins CSSE. World Health Assembly Resolution On COVID-19 Response: The Stark Choices Faced In A Polarized World Of Global Health 08/05/2020 Svĕt Lustig Vijay & Elaine Ruth Fletcher The World Health Assembly in Geneva, Switzerland. As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge. But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes. “When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. “Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.” In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.” However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.” However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. K.M. Gopakumar, Legal Advisor for the Third World Network (TWN). The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar. He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador. The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. “Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative. “19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.” Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier Thomas Cueni, director general of the IFPMA There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations. In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important. Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.” Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world. “We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added. Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.” Managing Director of Vital Transformation, Duane Schulthess Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation. Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe. “As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.” “The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).” But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI) “We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. “Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note. “We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? Iranian healthcare workers in personal protective equipment Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.” Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion. And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch. “It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source. “We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers… “We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal. An Investigation of The WHO’s Handling of COVID-19 Is Important – But Not Right Now Frederick Abbott, Professor of International Law at Florida State University. Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott. A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis. While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined: “When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.” Senior Policy Advisor of Health Action International Jaume Vidal Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International. 190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
WHO Repeats Warnings Against ‘Herd Immunity’ Assumptions As Countries Lift Lockdowns & Brace For Resurgence 12/05/2020 Grace Ren 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. Living With Air Pollution In A Post-Coronavirus World 12/05/2020 Jyoti Pande Lavakare 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. ____________________________________________ 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. Taiwan – The Contested Bone Of Global Health Diplomacy Amid Pandemic Mayhem 12/05/2020 Kyra Dupont/Geneva Solutions 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. ____________________________________________ 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. Swelling Bloc Of WHO Member States Proposes Invitation To Taiwan For May 18 World Health Assembly 11/05/2020 Elaine Ruth Fletcher 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. More Research On COVID-19 And Cardiovascular Symptoms Needed, Say WHO Experts 08/05/2020 Grace Ren & Svĕt Lustig Vijay Transmission electron microscope image of SARS-CoV-2, the virus that causes COVID-19 As reports of COVID-19 patients presenting with cardiovascular symptoms continue to surface, World Health Organization experts say more research is needed to understand all of the clinical presentations of the new disease. Still, they underlined that the new coronavirus primarily causes respiratory disease. “It is clear that in a proportion of patients, [COVID-19] is causing a broader inflammatory response, either within the vascular system – that’s the blood carrying system – or in other parts of the body,” said WHO Executive Director of Health Emergencies Mike Ryan. “But when we look at COVID-19, we need to see that obviously as a respiratory disease that’s spread by a respiratory route. It causes a respiratory syndrome.”” Ryan’s comments come just days after The Lancet published a correspondence describing eight young COVID-19 patients who had presented with symptoms similar to Kawasaki’s disease – a pediatric heart condition caused by swelling of the blood vessels. Just a day before, New York City health officials had released an official notice describing 15 similar cases among children 2 to 15 years old, ten of whom were previously exposed to COVID-19. Many of the patients did not present with significant respiratory symptoms. WHO COVID-19 Technical Lead Maria Van Kerkhove again attempted to reassure parents that the syndrome was still rare, and added that WHO would be rolling out a new form tailored specifically to collecting information on the ‘Kawasaki-like’ illness. But so far, it seems like COVID-19 still primarily causes a respiratory illness. Data from rare reports of the virus attacking other parts of the body must be collected systematically in order to determine how frequently these syndromes occur, or whether they are associated with COVID-19 at all. “Very often with new emerging diseases, they don’t always have just one target organ. They tend to cause a much more disseminated disease that may affect multiple organs,” explained Ryan. “We’ve also seen reports of encephalitis or swelling or inflammation of the brain. We’ve seen other reports of other effects of the disease.” “We’re at the very early stages of understanding how this virus affects the body, and how disease progresses,” added Van Kerkhove. “I have to remind myself that we’re in month five of this pandemic.” So far, over 10,000 detailed case reports of COVID-19 patients have been collected using a standardized form co-designed by WHO and the International Severe Acute Respiratory Infection Consortium (ISARIC). Individual hospitals are also collecting data on different clinical presentations of COVID-19, which is how the ‘Kawasaki-like’ illness in pediatric COVID-19 patients was first identified. But WHO is “hoping that more and more case records can be obtained so that we could better understand this [disease],” said Van Kerkhove. Switzerland Will Deploy Official Contact Tracing Application Alongside ‘Old-Fashioned’ Contact Tracing; WHO Emphasizes Finding Active COVID-19 Cases Over Monitoring Virus In Wastewater Meanwhile, in Switzerland, Swiss Parliament adopted a motion to use a contact tracing application in synergy with classical contact tracing, said Swiss Federal Council Alain Berset at a press conference today. The application will be tested in the next few weeks, before being deployed widely. Switzerland has reported 80 new cases over the pas 24 hours, and 30 207 total cases so far according to the Swiss Federal Office of Public Health. In Switzerland, the situation is ‘evolving favorably’ and current measures will be further softened on Monday to open schools and libraries, said Berset. Although Switzerland can be “optimistic” right now as the outbreak calms down, Berset urged citizens to remain ‘prudent’ and ‘pragmatic’ – “The virus is still here,” he warned. Physical distancing measures must be respected and vulnerable populations need to be considered, he said. Switzerland’s focus on contact tracing in its reopening strategy aligns with WHO recommendations that countries ramp up capacity to detect, isolate, and treat every case as countries gradually lift lockdown measures. Early detection and isolation of contacts is crucial, as it can prevent people from transmitting the virus before they themselves present with symptoms. WHO is also exploring other ways of monitoring COVID-19 – including testing for COVID-19 antibodies, or monitoring wastewater for the presence of the virus. Fragments of SARS-CoV-2, the virus that causes COVID-19, have been detected in wastewater, no live or infectious virus has been found in any samples so far. But while environmental monitoring or antibody testing are important for “understanding the long term trajectory of the pandemic,” countries must not neglect core public health strategies, said Mike Ryan. “We seem to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back to where we should have been; finding cases, tracking cases and contacts, testing cases, and isolating people who have tested positive,” said Ryan. Total cases of COVID-19 as of 7:32PM CET 8 May 2020, with active case distribution globally. Numbers change rapidly. 280 Rohingya Refugees Quarantined Offshore Bangladesh ‘As Precaution’; UN appeals for US$ 6.7 billion To Support Vulnerable Populations Some 280 Muslim-majority Rohingya refugees were precautionarily quarantined off the coast of Bangladesh on the Bhasan Char island due to fear of coronavirus spread – a move that sparked criticism by Human Rights Watch. Bangladesh is South East Asia’s second fastest growing pandemic hotspot after India, with over 13 000 cases and almost 800 new cases in the past 24 hours. “Bangladesh faces the tremendous challenge of assisting Rohingya boat people while preventing the spread of Covid-19, but sending them to a dangerously flood-prone island without adequate health care is hardly the solution,” said Brad Adams, Asia director of Human Rights Watch. “Any quarantines need to ensure aid agency access and safety from storms, and a prompt return to their families on the mainland.” Last weekend, a smaller boat with 29 Rohingya refugees was also taken to Bhasan Char island. There are approximately 1 million Rohingya refugees in Bangladesh, most of whom are based in the Capital’s Cox Bazar. The UN appealed for US$ 6.7 billion to fund an updated plan for responding to the COVID-19 pandemic in 63 of world’s most fragile countries, many of which are hosting refugees, the UNHCR said in a statement released Wednesday. The UNHCR called on countries to support vulnerable populations – with explicit reference to the Rohingya. “We call on States in the region to uphold the commitments of the 2016 Bali Declaration as well as ASEAN pledges to protect the most vulnerable and to leave no one behind. Not doing so may jeopardize thousands of lives of smuggled or trafficked persons, including the hundreds of Rohingya currently at sea.” Despite the UN’s call on South East Asian countries to allow vulnerable populations to land on their coasts, South East Asian nations have not followed. Meanwhile, neighboring India’s Asian Infrastructure Investment Bank (AIIB) signed a $500 million “COVID-19 Emergency Response & Health System Preparedness Project” on Friday to help respond to the pandemic and strengthen public health preparedness. India has over 64% of South East Asia’s cases, with almost 54 000 total confirmed cases and 3561 new cases reported over the past 24 hours. South Africa Releases 20 000 Prisoners From Jails And Facilitates Movement Of Civilians Through New Amendment To curb the spread of COVID-19 in jails, South Africa released nearly 20,000 prisoners on Friday, announced South African President Cyril Ramaphosa. Some 45% of Africa’s 35 470 cases are in South Africa, Algeria and Nigeria, and almost 50% of new cases in the past 24 hours were reported in these three countries. South Africa will also allow individuals and businesses to move premises across the country, including citizens who were not able to do so due to the lockdown, said a statement from the South African government from Thursday. Zixuan Yang contributed this story. Image Credits: NIAID-RML, Johns Hopkins CSSE. World Health Assembly Resolution On COVID-19 Response: The Stark Choices Faced In A Polarized World Of Global Health 08/05/2020 Svĕt Lustig Vijay & Elaine Ruth Fletcher The World Health Assembly in Geneva, Switzerland. As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge. But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes. “When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. “Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.” In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.” However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.” However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. K.M. Gopakumar, Legal Advisor for the Third World Network (TWN). The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar. He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador. The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. “Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative. “19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.” Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier Thomas Cueni, director general of the IFPMA There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations. In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important. Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.” Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world. “We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added. Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.” Managing Director of Vital Transformation, Duane Schulthess Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation. Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe. “As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.” “The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).” But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI) “We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. “Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note. “We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? Iranian healthcare workers in personal protective equipment Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.” Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion. And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch. “It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source. “We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers… “We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal. An Investigation of The WHO’s Handling of COVID-19 Is Important – But Not Right Now Frederick Abbott, Professor of International Law at Florida State University. Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott. A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis. While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined: “When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.” Senior Policy Advisor of Health Action International Jaume Vidal Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International. 190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
Living With Air Pollution In A Post-Coronavirus World 12/05/2020 Jyoti Pande Lavakare 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. ____________________________________________ 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. Taiwan – The Contested Bone Of Global Health Diplomacy Amid Pandemic Mayhem 12/05/2020 Kyra Dupont/Geneva Solutions 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. ____________________________________________ 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. Swelling Bloc Of WHO Member States Proposes Invitation To Taiwan For May 18 World Health Assembly 11/05/2020 Elaine Ruth Fletcher 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. More Research On COVID-19 And Cardiovascular Symptoms Needed, Say WHO Experts 08/05/2020 Grace Ren & Svĕt Lustig Vijay Transmission electron microscope image of SARS-CoV-2, the virus that causes COVID-19 As reports of COVID-19 patients presenting with cardiovascular symptoms continue to surface, World Health Organization experts say more research is needed to understand all of the clinical presentations of the new disease. Still, they underlined that the new coronavirus primarily causes respiratory disease. “It is clear that in a proportion of patients, [COVID-19] is causing a broader inflammatory response, either within the vascular system – that’s the blood carrying system – or in other parts of the body,” said WHO Executive Director of Health Emergencies Mike Ryan. “But when we look at COVID-19, we need to see that obviously as a respiratory disease that’s spread by a respiratory route. It causes a respiratory syndrome.”” Ryan’s comments come just days after The Lancet published a correspondence describing eight young COVID-19 patients who had presented with symptoms similar to Kawasaki’s disease – a pediatric heart condition caused by swelling of the blood vessels. Just a day before, New York City health officials had released an official notice describing 15 similar cases among children 2 to 15 years old, ten of whom were previously exposed to COVID-19. Many of the patients did not present with significant respiratory symptoms. WHO COVID-19 Technical Lead Maria Van Kerkhove again attempted to reassure parents that the syndrome was still rare, and added that WHO would be rolling out a new form tailored specifically to collecting information on the ‘Kawasaki-like’ illness. But so far, it seems like COVID-19 still primarily causes a respiratory illness. Data from rare reports of the virus attacking other parts of the body must be collected systematically in order to determine how frequently these syndromes occur, or whether they are associated with COVID-19 at all. “Very often with new emerging diseases, they don’t always have just one target organ. They tend to cause a much more disseminated disease that may affect multiple organs,” explained Ryan. “We’ve also seen reports of encephalitis or swelling or inflammation of the brain. We’ve seen other reports of other effects of the disease.” “We’re at the very early stages of understanding how this virus affects the body, and how disease progresses,” added Van Kerkhove. “I have to remind myself that we’re in month five of this pandemic.” So far, over 10,000 detailed case reports of COVID-19 patients have been collected using a standardized form co-designed by WHO and the International Severe Acute Respiratory Infection Consortium (ISARIC). Individual hospitals are also collecting data on different clinical presentations of COVID-19, which is how the ‘Kawasaki-like’ illness in pediatric COVID-19 patients was first identified. But WHO is “hoping that more and more case records can be obtained so that we could better understand this [disease],” said Van Kerkhove. Switzerland Will Deploy Official Contact Tracing Application Alongside ‘Old-Fashioned’ Contact Tracing; WHO Emphasizes Finding Active COVID-19 Cases Over Monitoring Virus In Wastewater Meanwhile, in Switzerland, Swiss Parliament adopted a motion to use a contact tracing application in synergy with classical contact tracing, said Swiss Federal Council Alain Berset at a press conference today. The application will be tested in the next few weeks, before being deployed widely. Switzerland has reported 80 new cases over the pas 24 hours, and 30 207 total cases so far according to the Swiss Federal Office of Public Health. In Switzerland, the situation is ‘evolving favorably’ and current measures will be further softened on Monday to open schools and libraries, said Berset. Although Switzerland can be “optimistic” right now as the outbreak calms down, Berset urged citizens to remain ‘prudent’ and ‘pragmatic’ – “The virus is still here,” he warned. Physical distancing measures must be respected and vulnerable populations need to be considered, he said. Switzerland’s focus on contact tracing in its reopening strategy aligns with WHO recommendations that countries ramp up capacity to detect, isolate, and treat every case as countries gradually lift lockdown measures. Early detection and isolation of contacts is crucial, as it can prevent people from transmitting the virus before they themselves present with symptoms. WHO is also exploring other ways of monitoring COVID-19 – including testing for COVID-19 antibodies, or monitoring wastewater for the presence of the virus. Fragments of SARS-CoV-2, the virus that causes COVID-19, have been detected in wastewater, no live or infectious virus has been found in any samples so far. But while environmental monitoring or antibody testing are important for “understanding the long term trajectory of the pandemic,” countries must not neglect core public health strategies, said Mike Ryan. “We seem to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back to where we should have been; finding cases, tracking cases and contacts, testing cases, and isolating people who have tested positive,” said Ryan. Total cases of COVID-19 as of 7:32PM CET 8 May 2020, with active case distribution globally. Numbers change rapidly. 280 Rohingya Refugees Quarantined Offshore Bangladesh ‘As Precaution’; UN appeals for US$ 6.7 billion To Support Vulnerable Populations Some 280 Muslim-majority Rohingya refugees were precautionarily quarantined off the coast of Bangladesh on the Bhasan Char island due to fear of coronavirus spread – a move that sparked criticism by Human Rights Watch. Bangladesh is South East Asia’s second fastest growing pandemic hotspot after India, with over 13 000 cases and almost 800 new cases in the past 24 hours. “Bangladesh faces the tremendous challenge of assisting Rohingya boat people while preventing the spread of Covid-19, but sending them to a dangerously flood-prone island without adequate health care is hardly the solution,” said Brad Adams, Asia director of Human Rights Watch. “Any quarantines need to ensure aid agency access and safety from storms, and a prompt return to their families on the mainland.” Last weekend, a smaller boat with 29 Rohingya refugees was also taken to Bhasan Char island. There are approximately 1 million Rohingya refugees in Bangladesh, most of whom are based in the Capital’s Cox Bazar. The UN appealed for US$ 6.7 billion to fund an updated plan for responding to the COVID-19 pandemic in 63 of world’s most fragile countries, many of which are hosting refugees, the UNHCR said in a statement released Wednesday. The UNHCR called on countries to support vulnerable populations – with explicit reference to the Rohingya. “We call on States in the region to uphold the commitments of the 2016 Bali Declaration as well as ASEAN pledges to protect the most vulnerable and to leave no one behind. Not doing so may jeopardize thousands of lives of smuggled or trafficked persons, including the hundreds of Rohingya currently at sea.” Despite the UN’s call on South East Asian countries to allow vulnerable populations to land on their coasts, South East Asian nations have not followed. Meanwhile, neighboring India’s Asian Infrastructure Investment Bank (AIIB) signed a $500 million “COVID-19 Emergency Response & Health System Preparedness Project” on Friday to help respond to the pandemic and strengthen public health preparedness. India has over 64% of South East Asia’s cases, with almost 54 000 total confirmed cases and 3561 new cases reported over the past 24 hours. South Africa Releases 20 000 Prisoners From Jails And Facilitates Movement Of Civilians Through New Amendment To curb the spread of COVID-19 in jails, South Africa released nearly 20,000 prisoners on Friday, announced South African President Cyril Ramaphosa. Some 45% of Africa’s 35 470 cases are in South Africa, Algeria and Nigeria, and almost 50% of new cases in the past 24 hours were reported in these three countries. South Africa will also allow individuals and businesses to move premises across the country, including citizens who were not able to do so due to the lockdown, said a statement from the South African government from Thursday. Zixuan Yang contributed this story. Image Credits: NIAID-RML, Johns Hopkins CSSE. World Health Assembly Resolution On COVID-19 Response: The Stark Choices Faced In A Polarized World Of Global Health 08/05/2020 Svĕt Lustig Vijay & Elaine Ruth Fletcher The World Health Assembly in Geneva, Switzerland. As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge. But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes. “When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. “Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.” In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.” However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.” However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. K.M. Gopakumar, Legal Advisor for the Third World Network (TWN). The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar. He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador. The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. “Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative. “19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.” Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier Thomas Cueni, director general of the IFPMA There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations. In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important. Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.” Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world. “We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added. Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.” Managing Director of Vital Transformation, Duane Schulthess Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation. Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe. “As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.” “The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).” But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI) “We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. “Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note. “We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? Iranian healthcare workers in personal protective equipment Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.” Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion. And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch. “It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source. “We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers… “We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal. An Investigation of The WHO’s Handling of COVID-19 Is Important – But Not Right Now Frederick Abbott, Professor of International Law at Florida State University. Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott. A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis. While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined: “When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.” Senior Policy Advisor of Health Action International Jaume Vidal Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International. 190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
Taiwan – The Contested Bone Of Global Health Diplomacy Amid Pandemic Mayhem 12/05/2020 Kyra Dupont/Geneva Solutions 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. ____________________________________________ 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. Swelling Bloc Of WHO Member States Proposes Invitation To Taiwan For May 18 World Health Assembly 11/05/2020 Elaine Ruth Fletcher 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. More Research On COVID-19 And Cardiovascular Symptoms Needed, Say WHO Experts 08/05/2020 Grace Ren & Svĕt Lustig Vijay Transmission electron microscope image of SARS-CoV-2, the virus that causes COVID-19 As reports of COVID-19 patients presenting with cardiovascular symptoms continue to surface, World Health Organization experts say more research is needed to understand all of the clinical presentations of the new disease. Still, they underlined that the new coronavirus primarily causes respiratory disease. “It is clear that in a proportion of patients, [COVID-19] is causing a broader inflammatory response, either within the vascular system – that’s the blood carrying system – or in other parts of the body,” said WHO Executive Director of Health Emergencies Mike Ryan. “But when we look at COVID-19, we need to see that obviously as a respiratory disease that’s spread by a respiratory route. It causes a respiratory syndrome.”” Ryan’s comments come just days after The Lancet published a correspondence describing eight young COVID-19 patients who had presented with symptoms similar to Kawasaki’s disease – a pediatric heart condition caused by swelling of the blood vessels. Just a day before, New York City health officials had released an official notice describing 15 similar cases among children 2 to 15 years old, ten of whom were previously exposed to COVID-19. Many of the patients did not present with significant respiratory symptoms. WHO COVID-19 Technical Lead Maria Van Kerkhove again attempted to reassure parents that the syndrome was still rare, and added that WHO would be rolling out a new form tailored specifically to collecting information on the ‘Kawasaki-like’ illness. But so far, it seems like COVID-19 still primarily causes a respiratory illness. Data from rare reports of the virus attacking other parts of the body must be collected systematically in order to determine how frequently these syndromes occur, or whether they are associated with COVID-19 at all. “Very often with new emerging diseases, they don’t always have just one target organ. They tend to cause a much more disseminated disease that may affect multiple organs,” explained Ryan. “We’ve also seen reports of encephalitis or swelling or inflammation of the brain. We’ve seen other reports of other effects of the disease.” “We’re at the very early stages of understanding how this virus affects the body, and how disease progresses,” added Van Kerkhove. “I have to remind myself that we’re in month five of this pandemic.” So far, over 10,000 detailed case reports of COVID-19 patients have been collected using a standardized form co-designed by WHO and the International Severe Acute Respiratory Infection Consortium (ISARIC). Individual hospitals are also collecting data on different clinical presentations of COVID-19, which is how the ‘Kawasaki-like’ illness in pediatric COVID-19 patients was first identified. But WHO is “hoping that more and more case records can be obtained so that we could better understand this [disease],” said Van Kerkhove. Switzerland Will Deploy Official Contact Tracing Application Alongside ‘Old-Fashioned’ Contact Tracing; WHO Emphasizes Finding Active COVID-19 Cases Over Monitoring Virus In Wastewater Meanwhile, in Switzerland, Swiss Parliament adopted a motion to use a contact tracing application in synergy with classical contact tracing, said Swiss Federal Council Alain Berset at a press conference today. The application will be tested in the next few weeks, before being deployed widely. Switzerland has reported 80 new cases over the pas 24 hours, and 30 207 total cases so far according to the Swiss Federal Office of Public Health. In Switzerland, the situation is ‘evolving favorably’ and current measures will be further softened on Monday to open schools and libraries, said Berset. Although Switzerland can be “optimistic” right now as the outbreak calms down, Berset urged citizens to remain ‘prudent’ and ‘pragmatic’ – “The virus is still here,” he warned. Physical distancing measures must be respected and vulnerable populations need to be considered, he said. Switzerland’s focus on contact tracing in its reopening strategy aligns with WHO recommendations that countries ramp up capacity to detect, isolate, and treat every case as countries gradually lift lockdown measures. Early detection and isolation of contacts is crucial, as it can prevent people from transmitting the virus before they themselves present with symptoms. WHO is also exploring other ways of monitoring COVID-19 – including testing for COVID-19 antibodies, or monitoring wastewater for the presence of the virus. Fragments of SARS-CoV-2, the virus that causes COVID-19, have been detected in wastewater, no live or infectious virus has been found in any samples so far. But while environmental monitoring or antibody testing are important for “understanding the long term trajectory of the pandemic,” countries must not neglect core public health strategies, said Mike Ryan. “We seem to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back to where we should have been; finding cases, tracking cases and contacts, testing cases, and isolating people who have tested positive,” said Ryan. Total cases of COVID-19 as of 7:32PM CET 8 May 2020, with active case distribution globally. Numbers change rapidly. 280 Rohingya Refugees Quarantined Offshore Bangladesh ‘As Precaution’; UN appeals for US$ 6.7 billion To Support Vulnerable Populations Some 280 Muslim-majority Rohingya refugees were precautionarily quarantined off the coast of Bangladesh on the Bhasan Char island due to fear of coronavirus spread – a move that sparked criticism by Human Rights Watch. Bangladesh is South East Asia’s second fastest growing pandemic hotspot after India, with over 13 000 cases and almost 800 new cases in the past 24 hours. “Bangladesh faces the tremendous challenge of assisting Rohingya boat people while preventing the spread of Covid-19, but sending them to a dangerously flood-prone island without adequate health care is hardly the solution,” said Brad Adams, Asia director of Human Rights Watch. “Any quarantines need to ensure aid agency access and safety from storms, and a prompt return to their families on the mainland.” Last weekend, a smaller boat with 29 Rohingya refugees was also taken to Bhasan Char island. There are approximately 1 million Rohingya refugees in Bangladesh, most of whom are based in the Capital’s Cox Bazar. The UN appealed for US$ 6.7 billion to fund an updated plan for responding to the COVID-19 pandemic in 63 of world’s most fragile countries, many of which are hosting refugees, the UNHCR said in a statement released Wednesday. The UNHCR called on countries to support vulnerable populations – with explicit reference to the Rohingya. “We call on States in the region to uphold the commitments of the 2016 Bali Declaration as well as ASEAN pledges to protect the most vulnerable and to leave no one behind. Not doing so may jeopardize thousands of lives of smuggled or trafficked persons, including the hundreds of Rohingya currently at sea.” Despite the UN’s call on South East Asian countries to allow vulnerable populations to land on their coasts, South East Asian nations have not followed. Meanwhile, neighboring India’s Asian Infrastructure Investment Bank (AIIB) signed a $500 million “COVID-19 Emergency Response & Health System Preparedness Project” on Friday to help respond to the pandemic and strengthen public health preparedness. India has over 64% of South East Asia’s cases, with almost 54 000 total confirmed cases and 3561 new cases reported over the past 24 hours. South Africa Releases 20 000 Prisoners From Jails And Facilitates Movement Of Civilians Through New Amendment To curb the spread of COVID-19 in jails, South Africa released nearly 20,000 prisoners on Friday, announced South African President Cyril Ramaphosa. Some 45% of Africa’s 35 470 cases are in South Africa, Algeria and Nigeria, and almost 50% of new cases in the past 24 hours were reported in these three countries. South Africa will also allow individuals and businesses to move premises across the country, including citizens who were not able to do so due to the lockdown, said a statement from the South African government from Thursday. Zixuan Yang contributed this story. Image Credits: NIAID-RML, Johns Hopkins CSSE. World Health Assembly Resolution On COVID-19 Response: The Stark Choices Faced In A Polarized World Of Global Health 08/05/2020 Svĕt Lustig Vijay & Elaine Ruth Fletcher The World Health Assembly in Geneva, Switzerland. As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge. But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes. “When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. “Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.” In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.” However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.” However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. K.M. Gopakumar, Legal Advisor for the Third World Network (TWN). The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar. He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador. The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. “Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative. “19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.” Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier Thomas Cueni, director general of the IFPMA There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations. In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important. Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.” Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world. “We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added. Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.” Managing Director of Vital Transformation, Duane Schulthess Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation. Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe. “As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.” “The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).” But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI) “We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. “Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note. “We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? Iranian healthcare workers in personal protective equipment Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.” Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion. And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch. “It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source. “We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers… “We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal. An Investigation of The WHO’s Handling of COVID-19 Is Important – But Not Right Now Frederick Abbott, Professor of International Law at Florida State University. Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott. A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis. While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined: “When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.” Senior Policy Advisor of Health Action International Jaume Vidal Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International. 190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
Swelling Bloc Of WHO Member States Proposes Invitation To Taiwan For May 18 World Health Assembly 11/05/2020 Elaine Ruth Fletcher 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. More Research On COVID-19 And Cardiovascular Symptoms Needed, Say WHO Experts 08/05/2020 Grace Ren & Svĕt Lustig Vijay Transmission electron microscope image of SARS-CoV-2, the virus that causes COVID-19 As reports of COVID-19 patients presenting with cardiovascular symptoms continue to surface, World Health Organization experts say more research is needed to understand all of the clinical presentations of the new disease. Still, they underlined that the new coronavirus primarily causes respiratory disease. “It is clear that in a proportion of patients, [COVID-19] is causing a broader inflammatory response, either within the vascular system – that’s the blood carrying system – or in other parts of the body,” said WHO Executive Director of Health Emergencies Mike Ryan. “But when we look at COVID-19, we need to see that obviously as a respiratory disease that’s spread by a respiratory route. It causes a respiratory syndrome.”” Ryan’s comments come just days after The Lancet published a correspondence describing eight young COVID-19 patients who had presented with symptoms similar to Kawasaki’s disease – a pediatric heart condition caused by swelling of the blood vessels. Just a day before, New York City health officials had released an official notice describing 15 similar cases among children 2 to 15 years old, ten of whom were previously exposed to COVID-19. Many of the patients did not present with significant respiratory symptoms. WHO COVID-19 Technical Lead Maria Van Kerkhove again attempted to reassure parents that the syndrome was still rare, and added that WHO would be rolling out a new form tailored specifically to collecting information on the ‘Kawasaki-like’ illness. But so far, it seems like COVID-19 still primarily causes a respiratory illness. Data from rare reports of the virus attacking other parts of the body must be collected systematically in order to determine how frequently these syndromes occur, or whether they are associated with COVID-19 at all. “Very often with new emerging diseases, they don’t always have just one target organ. They tend to cause a much more disseminated disease that may affect multiple organs,” explained Ryan. “We’ve also seen reports of encephalitis or swelling or inflammation of the brain. We’ve seen other reports of other effects of the disease.” “We’re at the very early stages of understanding how this virus affects the body, and how disease progresses,” added Van Kerkhove. “I have to remind myself that we’re in month five of this pandemic.” So far, over 10,000 detailed case reports of COVID-19 patients have been collected using a standardized form co-designed by WHO and the International Severe Acute Respiratory Infection Consortium (ISARIC). Individual hospitals are also collecting data on different clinical presentations of COVID-19, which is how the ‘Kawasaki-like’ illness in pediatric COVID-19 patients was first identified. But WHO is “hoping that more and more case records can be obtained so that we could better understand this [disease],” said Van Kerkhove. Switzerland Will Deploy Official Contact Tracing Application Alongside ‘Old-Fashioned’ Contact Tracing; WHO Emphasizes Finding Active COVID-19 Cases Over Monitoring Virus In Wastewater Meanwhile, in Switzerland, Swiss Parliament adopted a motion to use a contact tracing application in synergy with classical contact tracing, said Swiss Federal Council Alain Berset at a press conference today. The application will be tested in the next few weeks, before being deployed widely. Switzerland has reported 80 new cases over the pas 24 hours, and 30 207 total cases so far according to the Swiss Federal Office of Public Health. In Switzerland, the situation is ‘evolving favorably’ and current measures will be further softened on Monday to open schools and libraries, said Berset. Although Switzerland can be “optimistic” right now as the outbreak calms down, Berset urged citizens to remain ‘prudent’ and ‘pragmatic’ – “The virus is still here,” he warned. Physical distancing measures must be respected and vulnerable populations need to be considered, he said. Switzerland’s focus on contact tracing in its reopening strategy aligns with WHO recommendations that countries ramp up capacity to detect, isolate, and treat every case as countries gradually lift lockdown measures. Early detection and isolation of contacts is crucial, as it can prevent people from transmitting the virus before they themselves present with symptoms. WHO is also exploring other ways of monitoring COVID-19 – including testing for COVID-19 antibodies, or monitoring wastewater for the presence of the virus. Fragments of SARS-CoV-2, the virus that causes COVID-19, have been detected in wastewater, no live or infectious virus has been found in any samples so far. But while environmental monitoring or antibody testing are important for “understanding the long term trajectory of the pandemic,” countries must not neglect core public health strategies, said Mike Ryan. “We seem to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back to where we should have been; finding cases, tracking cases and contacts, testing cases, and isolating people who have tested positive,” said Ryan. Total cases of COVID-19 as of 7:32PM CET 8 May 2020, with active case distribution globally. Numbers change rapidly. 280 Rohingya Refugees Quarantined Offshore Bangladesh ‘As Precaution’; UN appeals for US$ 6.7 billion To Support Vulnerable Populations Some 280 Muslim-majority Rohingya refugees were precautionarily quarantined off the coast of Bangladesh on the Bhasan Char island due to fear of coronavirus spread – a move that sparked criticism by Human Rights Watch. Bangladesh is South East Asia’s second fastest growing pandemic hotspot after India, with over 13 000 cases and almost 800 new cases in the past 24 hours. “Bangladesh faces the tremendous challenge of assisting Rohingya boat people while preventing the spread of Covid-19, but sending them to a dangerously flood-prone island without adequate health care is hardly the solution,” said Brad Adams, Asia director of Human Rights Watch. “Any quarantines need to ensure aid agency access and safety from storms, and a prompt return to their families on the mainland.” Last weekend, a smaller boat with 29 Rohingya refugees was also taken to Bhasan Char island. There are approximately 1 million Rohingya refugees in Bangladesh, most of whom are based in the Capital’s Cox Bazar. The UN appealed for US$ 6.7 billion to fund an updated plan for responding to the COVID-19 pandemic in 63 of world’s most fragile countries, many of which are hosting refugees, the UNHCR said in a statement released Wednesday. The UNHCR called on countries to support vulnerable populations – with explicit reference to the Rohingya. “We call on States in the region to uphold the commitments of the 2016 Bali Declaration as well as ASEAN pledges to protect the most vulnerable and to leave no one behind. Not doing so may jeopardize thousands of lives of smuggled or trafficked persons, including the hundreds of Rohingya currently at sea.” Despite the UN’s call on South East Asian countries to allow vulnerable populations to land on their coasts, South East Asian nations have not followed. Meanwhile, neighboring India’s Asian Infrastructure Investment Bank (AIIB) signed a $500 million “COVID-19 Emergency Response & Health System Preparedness Project” on Friday to help respond to the pandemic and strengthen public health preparedness. India has over 64% of South East Asia’s cases, with almost 54 000 total confirmed cases and 3561 new cases reported over the past 24 hours. South Africa Releases 20 000 Prisoners From Jails And Facilitates Movement Of Civilians Through New Amendment To curb the spread of COVID-19 in jails, South Africa released nearly 20,000 prisoners on Friday, announced South African President Cyril Ramaphosa. Some 45% of Africa’s 35 470 cases are in South Africa, Algeria and Nigeria, and almost 50% of new cases in the past 24 hours were reported in these three countries. South Africa will also allow individuals and businesses to move premises across the country, including citizens who were not able to do so due to the lockdown, said a statement from the South African government from Thursday. Zixuan Yang contributed this story. Image Credits: NIAID-RML, Johns Hopkins CSSE. World Health Assembly Resolution On COVID-19 Response: The Stark Choices Faced In A Polarized World Of Global Health 08/05/2020 Svĕt Lustig Vijay & Elaine Ruth Fletcher The World Health Assembly in Geneva, Switzerland. As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge. But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes. “When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. “Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.” In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.” However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.” However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. K.M. Gopakumar, Legal Advisor for the Third World Network (TWN). The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar. He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador. The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. “Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative. “19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.” Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier Thomas Cueni, director general of the IFPMA There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations. In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important. Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.” Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world. “We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added. Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.” Managing Director of Vital Transformation, Duane Schulthess Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation. Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe. “As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.” “The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).” But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI) “We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. “Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note. “We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? Iranian healthcare workers in personal protective equipment Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.” Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion. And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch. “It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source. “We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers… “We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal. An Investigation of The WHO’s Handling of COVID-19 Is Important – But Not Right Now Frederick Abbott, Professor of International Law at Florida State University. Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott. A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis. While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined: “When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.” Senior Policy Advisor of Health Action International Jaume Vidal Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International. 190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
More Research On COVID-19 And Cardiovascular Symptoms Needed, Say WHO Experts 08/05/2020 Grace Ren & Svĕt Lustig Vijay Transmission electron microscope image of SARS-CoV-2, the virus that causes COVID-19 As reports of COVID-19 patients presenting with cardiovascular symptoms continue to surface, World Health Organization experts say more research is needed to understand all of the clinical presentations of the new disease. Still, they underlined that the new coronavirus primarily causes respiratory disease. “It is clear that in a proportion of patients, [COVID-19] is causing a broader inflammatory response, either within the vascular system – that’s the blood carrying system – or in other parts of the body,” said WHO Executive Director of Health Emergencies Mike Ryan. “But when we look at COVID-19, we need to see that obviously as a respiratory disease that’s spread by a respiratory route. It causes a respiratory syndrome.”” Ryan’s comments come just days after The Lancet published a correspondence describing eight young COVID-19 patients who had presented with symptoms similar to Kawasaki’s disease – a pediatric heart condition caused by swelling of the blood vessels. Just a day before, New York City health officials had released an official notice describing 15 similar cases among children 2 to 15 years old, ten of whom were previously exposed to COVID-19. Many of the patients did not present with significant respiratory symptoms. WHO COVID-19 Technical Lead Maria Van Kerkhove again attempted to reassure parents that the syndrome was still rare, and added that WHO would be rolling out a new form tailored specifically to collecting information on the ‘Kawasaki-like’ illness. But so far, it seems like COVID-19 still primarily causes a respiratory illness. Data from rare reports of the virus attacking other parts of the body must be collected systematically in order to determine how frequently these syndromes occur, or whether they are associated with COVID-19 at all. “Very often with new emerging diseases, they don’t always have just one target organ. They tend to cause a much more disseminated disease that may affect multiple organs,” explained Ryan. “We’ve also seen reports of encephalitis or swelling or inflammation of the brain. We’ve seen other reports of other effects of the disease.” “We’re at the very early stages of understanding how this virus affects the body, and how disease progresses,” added Van Kerkhove. “I have to remind myself that we’re in month five of this pandemic.” So far, over 10,000 detailed case reports of COVID-19 patients have been collected using a standardized form co-designed by WHO and the International Severe Acute Respiratory Infection Consortium (ISARIC). Individual hospitals are also collecting data on different clinical presentations of COVID-19, which is how the ‘Kawasaki-like’ illness in pediatric COVID-19 patients was first identified. But WHO is “hoping that more and more case records can be obtained so that we could better understand this [disease],” said Van Kerkhove. Switzerland Will Deploy Official Contact Tracing Application Alongside ‘Old-Fashioned’ Contact Tracing; WHO Emphasizes Finding Active COVID-19 Cases Over Monitoring Virus In Wastewater Meanwhile, in Switzerland, Swiss Parliament adopted a motion to use a contact tracing application in synergy with classical contact tracing, said Swiss Federal Council Alain Berset at a press conference today. The application will be tested in the next few weeks, before being deployed widely. Switzerland has reported 80 new cases over the pas 24 hours, and 30 207 total cases so far according to the Swiss Federal Office of Public Health. In Switzerland, the situation is ‘evolving favorably’ and current measures will be further softened on Monday to open schools and libraries, said Berset. Although Switzerland can be “optimistic” right now as the outbreak calms down, Berset urged citizens to remain ‘prudent’ and ‘pragmatic’ – “The virus is still here,” he warned. Physical distancing measures must be respected and vulnerable populations need to be considered, he said. Switzerland’s focus on contact tracing in its reopening strategy aligns with WHO recommendations that countries ramp up capacity to detect, isolate, and treat every case as countries gradually lift lockdown measures. Early detection and isolation of contacts is crucial, as it can prevent people from transmitting the virus before they themselves present with symptoms. WHO is also exploring other ways of monitoring COVID-19 – including testing for COVID-19 antibodies, or monitoring wastewater for the presence of the virus. Fragments of SARS-CoV-2, the virus that causes COVID-19, have been detected in wastewater, no live or infectious virus has been found in any samples so far. But while environmental monitoring or antibody testing are important for “understanding the long term trajectory of the pandemic,” countries must not neglect core public health strategies, said Mike Ryan. “We seem to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back to where we should have been; finding cases, tracking cases and contacts, testing cases, and isolating people who have tested positive,” said Ryan. Total cases of COVID-19 as of 7:32PM CET 8 May 2020, with active case distribution globally. Numbers change rapidly. 280 Rohingya Refugees Quarantined Offshore Bangladesh ‘As Precaution’; UN appeals for US$ 6.7 billion To Support Vulnerable Populations Some 280 Muslim-majority Rohingya refugees were precautionarily quarantined off the coast of Bangladesh on the Bhasan Char island due to fear of coronavirus spread – a move that sparked criticism by Human Rights Watch. Bangladesh is South East Asia’s second fastest growing pandemic hotspot after India, with over 13 000 cases and almost 800 new cases in the past 24 hours. “Bangladesh faces the tremendous challenge of assisting Rohingya boat people while preventing the spread of Covid-19, but sending them to a dangerously flood-prone island without adequate health care is hardly the solution,” said Brad Adams, Asia director of Human Rights Watch. “Any quarantines need to ensure aid agency access and safety from storms, and a prompt return to their families on the mainland.” Last weekend, a smaller boat with 29 Rohingya refugees was also taken to Bhasan Char island. There are approximately 1 million Rohingya refugees in Bangladesh, most of whom are based in the Capital’s Cox Bazar. The UN appealed for US$ 6.7 billion to fund an updated plan for responding to the COVID-19 pandemic in 63 of world’s most fragile countries, many of which are hosting refugees, the UNHCR said in a statement released Wednesday. The UNHCR called on countries to support vulnerable populations – with explicit reference to the Rohingya. “We call on States in the region to uphold the commitments of the 2016 Bali Declaration as well as ASEAN pledges to protect the most vulnerable and to leave no one behind. Not doing so may jeopardize thousands of lives of smuggled or trafficked persons, including the hundreds of Rohingya currently at sea.” Despite the UN’s call on South East Asian countries to allow vulnerable populations to land on their coasts, South East Asian nations have not followed. Meanwhile, neighboring India’s Asian Infrastructure Investment Bank (AIIB) signed a $500 million “COVID-19 Emergency Response & Health System Preparedness Project” on Friday to help respond to the pandemic and strengthen public health preparedness. India has over 64% of South East Asia’s cases, with almost 54 000 total confirmed cases and 3561 new cases reported over the past 24 hours. South Africa Releases 20 000 Prisoners From Jails And Facilitates Movement Of Civilians Through New Amendment To curb the spread of COVID-19 in jails, South Africa released nearly 20,000 prisoners on Friday, announced South African President Cyril Ramaphosa. Some 45% of Africa’s 35 470 cases are in South Africa, Algeria and Nigeria, and almost 50% of new cases in the past 24 hours were reported in these three countries. South Africa will also allow individuals and businesses to move premises across the country, including citizens who were not able to do so due to the lockdown, said a statement from the South African government from Thursday. Zixuan Yang contributed this story. Image Credits: NIAID-RML, Johns Hopkins CSSE. World Health Assembly Resolution On COVID-19 Response: The Stark Choices Faced In A Polarized World Of Global Health 08/05/2020 Svĕt Lustig Vijay & Elaine Ruth Fletcher The World Health Assembly in Geneva, Switzerland. As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge. But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes. “When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. “Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.” In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.” However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.” However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. K.M. Gopakumar, Legal Advisor for the Third World Network (TWN). The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar. He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador. The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. “Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative. “19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.” Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier Thomas Cueni, director general of the IFPMA There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations. In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important. Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.” Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world. “We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added. Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.” Managing Director of Vital Transformation, Duane Schulthess Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation. Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe. “As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.” “The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).” But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI) “We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. “Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note. “We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? Iranian healthcare workers in personal protective equipment Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.” Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion. And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch. “It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source. “We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers… “We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal. An Investigation of The WHO’s Handling of COVID-19 Is Important – But Not Right Now Frederick Abbott, Professor of International Law at Florida State University. Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott. A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis. While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined: “When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.” Senior Policy Advisor of Health Action International Jaume Vidal Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International. 190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
World Health Assembly Resolution On COVID-19 Response: The Stark Choices Faced In A Polarized World Of Global Health 08/05/2020 Svĕt Lustig Vijay & Elaine Ruth Fletcher The World Health Assembly in Geneva, Switzerland. As the 73rd World Health Assembly approaches, the European Union-sponsored draft resolution on the COVID-19 response is gathering steam and storm as it rolls closer to the planned opening of the Assembly on 18 May – with far less clarity about how it might actually hit the shores of the public debate. The resolution aims to show unity in the face of a global pandemic – ensuring more equitable access for existing diagnostics and medical equipment as well as potential treatments. But hidden in the layers of diplomatic doublespeak are also multiple nuances, as well as minefields, that could befoul the whole negotiations. Strikingly, the resolution also aims to address obvious weaknesses in the international pandemic response frameworks, and address criticism of the World Health Organization’s own response, by calling for an “independent evaluation…to review lessons learnt” about the WHO-coordinated response, as well as the “effectiveness” of mechanisms at its disposal – namely the 2005 International Health Regulations. The proposal for independent evaluation apparently has wide support. Although it remains to be seen if such a review can be undertaken in a way that satisfies very different blocs and political agendas – including the United States, which has been bitterly critical of WHO, and European countries that would likely see a stronger international order emerge. But some observers, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have said that such an investigation should be postponed until after the pandemic wanes. “When we emerge from this global crisis, it will be important to look back and build upon the lessons learned from multi-stakeholder collaboration around COVID-19 in order to strengthen future pandemic preparedness and truly enhance global health security,” Thomas Cueni, IFPMA Director-General told Health Policy Watch. “But for now, the most important thing to do is to knuckle down and tackle what is potentially one of the biggest public health, social and economic crisis we have faced in 100 years. “Coordinated, inclusive, and multi-stakeholder action is the only possible solution to mitigate the impact of this unprecedented global health emergency. Multilateral organizations such as the World Health Organization (WHO) have an important role to play in these global efforts and in supporting the most vulnerable populations. International cooperation is critical to maintain global supply chains, to avoid shortages and to ensure effective surveillance mechanisms.” In terms of the mechanics of response, the key debate here for medicines access advocates is whether the resolution can really ensure more equitable distribution of COVID-19 treatments. For that to happen, they argue that there needs to be an explicit reference to existing “TRIPS flexibilities” – the legal World Trade Organization framework that allows countries to legally override patent laws when a clear national health interest is at stake. Right now, the text makes only general reference to this: “using fully the provisions of international legal treaties.” However, there could be new blocs of allies and opponents forming around the access issue – which traditionally divided roughly along lines of global north and south. Recently, for instance, the United States moved to issue an emergency use authorization for remdesivir, the drug produced by Gilead Sciences that has shown some initial efficacy against the SARS-CoV-2 virus that causes COVID-19. That has led to worries in European circles that an “America-first” approach could cut off access to the drug – including in other high-income European countries that have also been at the virus epidemic. As for the ins- and outs of the debate, Health Policy Watch interviewed half a dozen observers of the negotiations; to see what else they had to say. Explicit Reference To IP “Flexibilities” In WHA Draft Resolution: A Hot Topic For Debate The May 4 draft resolution has called for “equitable access to and fair distribution to all countries” to COVID-19 technologies, “including through using fully the provisions of international treaties…. Required in the response to the COVID-19 pandemic.” However, these drafts, and even alternative language so far proposed, makes no specific reference to the foundational World Trade Organization treaty and agreements enabling intellectual property barriers to be temporarily lifted under emergency conditions. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) saw IP flexibilities for public health needs further affirmed by the 2001 Doha Declaration on the TRIPS Agreement and Public Health. Lack of reference to TRIPS flexibilities is “strange” because “it ignores a great deal of history and the global efforts that were needed to facilitate equitable access to health technologies, products and services” like vaccines or PPE, said Frederick Abbott, Professor of International Law at Florida State University. K.M. Gopakumar, Legal Advisor for the Third World Network (TWN). The draft resolution’s silence is a “double standard” given that some EU members have already taken steps to make use of TRIPS flexibilities, said Legal Advisor for the Third World Network (TWN) K.M Gopakumar. He referred to recent instances when the European Commission reportedly pressured Roche Pharmaceuticals to disclose the critical recipe for a reagent in a patented diagnostic. Germany has meanwhile amended its patent law to fast-track the issuing of compulsory licenses to override patents on health products, should there be a need. Other countries to have taken similar steps include Israel, Canada, Indonesia, Chile, Colombia and Ecuador. The silence of the EU-sponsored resolution could nonetheless be explained by the region’s strong pharma industry base, he added. Some advocates have pointed their finger squarely at the Member State diplomats engaged in the WHA negotiations as failing to pick up the gauntlet – despite the fact that the international community affirmed the use of such measures through the WTO Doha agreement nearly two decades ago. “Member state diplomats who are negotiating at the WHA need to step up to the plate,” said Thiru Balasubramaniam, Knowledge Ecology International’s Geneva representative. “19 years later after Doha, it is disheartening that WHO delegates tasked with the mandate to protect public health cannot muster the courage to make explicit references [in the draft resolution] to TRIPS public health safeguards amidst a pandemic.” Even so, negotiations are still ongoing – and a reference to TRIPS may yet appear in later drafts, said Jaume Vidal, Senior Policy Advisor of Health Action International. Intellectual Property Rights May Not Be The Issue – Compulsory Licences Could Be Innovation Barrier Thomas Cueni, director general of the IFPMA There are also concerns, however, that opening the floodgates to a practice of very widespread compulsory licensing could upend the status quo of patent-driven R&D, at a critical moment when private investment in research is needed now, more than ever – alongside the public sector grants and donations. In an interview with Health Policy Watch, Francis Gurry, Director General of The World Intellectual Property Organization (WIPO) pointedly noted that patent rights is not the main barrier accessing treatments right now; in fact the main barrier is the lack of treatments, for which private sector investment is important. Those sentiments are echoed by IFPMA’s Cueni, who has been highly supportive of recent UN and global moves to expand public funding for drug development and ensure broad access; “IP is not a hindrance to developing COVID-19 treatments or vaccines, indeed quite the opposite,” Cueni said. “The main policy challenge is to encourage the innovation that may lead to COVID-19 vaccines, treatments and cures, as well as innovation that assists in managing the coronavirus crisis.” Added Cueni, “There is no evidence that IP has been or will be an impediment to the research, development and testing of potential COVID-19 treatments and vaccines or to the many research partnerships underway between companies and institutions around the world. “We can only overcome this through a coordinated, inclusive, and multi-stakeholder response,” he added. Referring to a recent UN General Assembly resolution on COVID-19 response, which received broad industry blessing, he said, “We hope WHO member states will be able to build on this momentum and approve a truly inclusive text that recognizes that the expertise of the private sector is central in fighting this pandemic.” Managing Director of Vital Transformation, Duane Schulthess Lifting intellectual property protections could have long-term repercussions on innovation, warns Duane Schulthess, a health consultant and Managing Director of the Belgium-based consultancy firm, Vital Transformation. Compulsory licenses will make it “hugely expensive and risky to produce at scale for any commercial enterprise,” said Shutlthess, who works with both public and private sectors in Europe. “As an investor and consultant to many international biotech firms and biopharma supporting governments, I think that a compulsory license is a REALLY bad idea in this case.” Issuing compulsory licenses for new therapies that are typically more costly to development, such as vaccines or monoclonal antibody treatments “may seem like a good idea in the short-term”, but would become “a huge barrier against anyone taking on risk for vaccine or monoclonal antibody development.” Given the high safety standards required for vaccines, as well as debate over the actual fatality rate for COVID-19, any company willing to invest “multiples of billions of Euros” to develop and manufacture a vaccine or monoclonal antidote at scale will be “extremely concerned.” “The up-front costs of development will be astronomical due to the need to simultaneously invest in manufacturing capacity”, as well as the need for high safety standards, he said. Voluntary Patent Pools Offer A Third Way – But Some Not So Sure It will Work There has been widespread support by countries, as well as by WHO, for a voluntary “patent pool” – whereby industry would offer licenses to other countries to manufacture their products. This would build upon the successful model of the Medicines Patents Pool, which has succeeded in bringing affordable treatments for HIV/AIDS and Hepatitis C to billions in Africa and elsewhere. Indeed, the most recent drafts of the EU resolution call for member states to “work collaboratively at all levels, including through existing mechanisms, for voluntary pooling of patents, and licensing of medicines and vaccines to facilitate equitable and affordable access (OP 7.2).” But not everyone is convinced such schemes will really work for the challenges posed by COVID-19. Michelle Childs, Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDI) “We need to hope for the best and prepare for the worst,” said Head of Policy Advocacy for Drugs for Neglected Diseases Initiative (DNDi) Michelle Childs. “Everyone would prefer if there were no intellectual property barriers and for innovators to waive their rights through a voluntary patent pool, but we need to have all tools in our toolbox just in case that doesn’t happen. Countries should have all options available to them, such as compulsory licensing.” Said Vidal, “the patent pool is a unique mechanism to operationalise voluntary licensing. Within its constraints, it is an effective instrument to improve access conditions. It is not, and was not, designed to be a remedy for the anticompetitive practices of patent holders, nor can it compensate the excesses of monopolies worldwide. Support for the Medicines Patent Pool does not invalidate the need to promote a widespread and intensive use of Compulsory Licensing, beyond COVID-19.” Already during the COVID-19 pandemic, the world has observed some countries halting export of certain drugs or personal protective equipment (PPE) so as to insure domestic supplies, other observers note. The irony is that while past outbreaks or pandemics have seen northern countries pitted against the south, here the fault lines may shape up around the Atlantic – between the United States and European countries nervous that they might not get access to new therapies such as remdesivir, developed or manufactured elsewhere, other observers note. “We need to deal with equitable access issues in advance – when push comes to shove, people end up panicking, and we’ve seen countries hoard things like PPE,” said one source. Prioritizing Access – Will Health Workers, Older People & Those With Pre-existing Conditions Really Come First? Iranian healthcare workers in personal protective equipment Presuming that some international mechanism is created, voluntary or compulsory, to ensure widespread access to new treatments or vaccines – agreement on what groups might be prioritized will be another minefield in any process. Most experts would agree that in the case of COVID-19, healthcare workers, older people and those with pre-existing conditions are those most in need of any forthcoming treatments and vaccines. But while the preamble (PP11) of the draft resolution emphasizes the need to protect key populations like ‘people with pre-existing conditions…older persons and healthcare professionals,” there is no explicit reference to those groups as priorities for being the first to receive new drugs or interventions in the operative sections of the draft. Rather, there is a general call for governments to: “Put in place…measures across government sectors against COVID-19; ensuring respect for human rights and fundamental freedoms, and paying particular attention to the needs of vulnerable groups and people in vulnerable situations; promoting social cohesion, taking necessary measures to ensure social protection and prevent discrimination and marginalization.” Even that language may somehow become tied up in traditional disputes over a) sanctions, such as those currently applied by the US against Iran and b) language that refers to sexual and reproductive rights in the healthcare context – something that has been hotly opposed by the US administration in recent years due to fears that it could be somehow interpreted as legitimizing abortion. And…. Even if a Resolution is Passed – Enforcement Will Be A Challenge A United Nations Solidarity Flight lands in Brazzaville, Republic of the Congo with PPE and diagnostics supplies Even if widespread access to treatment by the groups most in need was enshrined in the final WHA resolution – enforcing such provisions would be another matter altogether. International agreements are critical, but they are insufficient if they are not enforced, sources underlined to Health Policy Watch. “It’s not just about intellectual property… we need international agreements about how drugs and other technologies will be used,” said the source. “We’ve seen very good statements about what countries want to achieve but they need to follow that…They’re trying to outsource some of [access] questions to initiatives like WHO’s Access to COVID-19 Tools (ACT) Accelerator (ACT). There are no easy answers… “We cannot leave this to the [international] agencies. Countries have to do this work themselves and follow what they have publicly committed to do.” Equitable access will also depend on a range of other factors, as well, including scaling up manufacturing capabilities and securing supply mechanisms within health systems, said Vidal. An Investigation of The WHO’s Handling of COVID-19 Is Important – But Not Right Now Frederick Abbott, Professor of International Law at Florida State University. Regarding the independent examination of investigation of COVID-19 management, there appears to be agreement across the classic fault lines of industry, academia and civil society that the timing is not right for this now. Says Abbott: “Conducting a review as soon as possible is likely to be a drain on internal WHO resources that are vitally needed to coordinate the global response. There are external political pressures underlying the demand for immediate initiation of a review, and this exacerbates the risks of politicizing the endeavor.” It will also be vital to assure the objective integrity of the review process and not to succumb to external politics that have pressured the review to be undertaken as soon as possible, said Abott. A review of the WHO’s efforts will be important after we emerge from this global crisis, underlines Cueni, which has also publicly backed the WHO co-sponsored Access to Covid-19 Tools Accelerator that just raised nearly US$ 7.4 billion this week for drug research, manufacture and distribution. However, the “most important thing to do” right know is is to “knuckle down and tackle” the crisis. While accountability is good for transparency and governance within international organisations, the WHO ‘cannot be a chip in a power game’ between certain Member States, says Vidal. And he adds, suggestively, that WHO is not the only entity that should be examined: “When we scrutinise WHO handling of the pandemic we should also look into the actions (or indeed inaction) of some Member States, experts and political figures.” Senior Policy Advisor of Health Action International Jaume Vidal Image Credits: WHO, K.M Gopakumar, IFPMA , Duane Schulthess, Michelle Childs, Twitter: @WHOEMRO, Matshidiso Moeti, Health Policy International. 190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
190 000 Africans Could Die If COVID-19 Outbreak Is Not Controlled; It Is ‘Ever More Crucial’ To Promote Effective Containment Measures Now 08/05/2020 Svĕt Lustig Vijay Matshidiso Moeti, WHO Regional Director for Africa at regular press conference Up to 190 000 Africans could die of COVID-19 within the first year of the pandemic if containment measures fail. And up to 44 million Africans, or 26% of the African population, could be infected by the virus, according to a new modelling study by the World Health Organization Regional Office for Africa. A proactive approach needs to be taken now, or health systems will not be able to cope with an outbreak that could last for years, said WHO Regional Director for Africa Matshidiso Moeti at a press briefing on Thursday. The number of patients requiring hospitalization and intensive care due to COVID-19 will “severely strain” the health capacities of countries, she added. The study predicts 3.6 million to 5.5 million COVID-19 hospitalizations, of which 82 000–167 000 would be severe cases requiring oxygen treatment, and 52 000–107 000 would be critical cases requiring more advanced breathing support. African countries have a ‘woefully inadequate’ intensive care bed capacity – about 13 times lower than in Europe, she added. In Africa, there is, on average, nine intensive care unit beds per one million people, based on self-reports by 47 countries to the WHO. In contrast, European countries have on average 11.5 critical care beds per 100 000 people. Africa – The Continent With The Lowest Hospital Bed Capacity In The World Although the modelling study anticipates a slower pace of virus transmission in Africa, as compared to other parts of the world, taking proactive and preventative measures now will be cheaper than dealing with the aftershocks of an outbreak that could last ‘a few years’, said Moeti: “While COVID-19 likely won’t spread as exponentially in Africa, as it has elsewhere in the world; it likely will smoulder in transmission hotspots,” said Dr Moeti. “The importance of promoting effective containment measures is ever more crucial, as sustained and widespread transmission of the virus could severely overwhelm our health systems.” “Curbing a large-scale outbreak is far costlier than the ongoing preventive measures governments are undertaking to contain the spread of the virus.” The research, which is based on prediction modelling, looked at 47 countries in the WHO African Region with a total population of one billion people. The predictive model was adjusted for differences between countries in disease severity and transmission, taking into account those country-specific variables. In a related move, the United Nations launched a global funding appeal for humaitarian aid to protect millions of people and stem the spread of the coronavirus in fragile countries. Image Credits: Our World In Data, OECD, Eurostat, World Bank, National Government Records . Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
Breakthrough Microbe Can Prevent Mosquitoes From Infection By Malaria Parasites 06/05/2020 Gauri Saxena icipe scientists study malaria in Kenya A newly identified microbe, named Microsporidia MB, can prevent mosquitoes from being infected by malaria parasites. This microbe could be used to block the transmission of malaria parasites from mosquito vectors to humans, according to new research published by researchers from the International Centre of Insect Physiology and Ecology (icipe) in Kenya and the University of Glasgow in the United Kingdom. This breakthrough comes at a time when the World Health Organisation (WHO) has warned that the current COVID-19 outbreak could increase deaths from malaria as focus shifts towards the coronavirus, and called for continued research and advancements in this area. “Healthy insects often have microbial symbionts inside their bodies and cells, which can have major effects on the biology of their hosts,” explained Jeremy Herren, lead researcher on the study, in a press release. “At icipe, my team’s research is focused on this type of microbial symbiont, especially when they may be interfering with transmission of diseases by insects.” Fluorescence microscopy image shows Microsporidia MB entering the ovaries of a female Anopheles mosquito. Scientists reported that mosquitos carrying the microbial symbiont Microsporidia MB could not be infected with Plasmodium falciparum, the most common malaria parasite in Africa, after experimental infection with the microbe in laboratories. The results hold in nature as well – low levels of the microbe naturally occur in mosquitoes in Kenya, preventing some mosquitos from carrying the malaria parasite. Since Plasmodium falciparum must be transmitted between mosquitoes and humans to fulfill its full life cycle, protecting mosquitoes from infection by the parasite could break the chain of transmission. So far, most malaria interventions have only focused on preventing humans from being infected. The research, which has been published in Nature Communications, details the findings of studies conducted along the shores of Lake Victoria in Kenya, a natural habitat of the Anopheles mosquitoes that serve as malaria vectors. Africa, where malaria kills over 400,000 people a year, contributed to more than 90% of the global deaths from the disease in 2017 alone. While use of cost-effective interventions like insecticide-treated nets have reduced malaria cases by 40% in 2015, progress has since stagnated partly due to increased resistance to insecticide and antimalarial medications. New tools are desperately needed in order to continue making gains against the disease. The study also found that Microsporidia MB can be passed from female mosquitoes to offspring without causing any obvious ecological harm, making it an even more attractive potential tool for malaria control. Researchers agree that further studies will be needed to determine the exact mechanisms by which the microbe can be used to control malaria transmission. The next phase of the research will investigate the dynamics of the microbes in large mosquito populations in screen house ‘semi-field’ facilities. There have been few examples of microbes affecting malaria transmission in mosquitoes, but similar research exists in dengue. Professor Steven Sinkins from the MRC-University of Glasgow Centre for Virus Research said, “we are already using a transmission-blocking symbiont called Wolbachia to control dengue, a virus transmitted by mosquitoes. The Microsporidia MB symbiont has some similar characteristics, making it an attractive prospect for developing comparable approaches for malaria control”. Image Credits: icipe (International Centre of Insect Physiology and Ecology), University of Glasgow. Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts
Rare, Severe COVID-19-Associated Illness Reported In UK and US Children; Virtual World Health Assembly Scheduled For 18-19 May 06/05/2020 Grace Ren & Elaine Ruth Fletcher A rare, severe inflammatory illness – largely believed to be associated with COVID-19 – is putting children in ICUs in the United Kingdom and the United States. The children present with symptoms similar to toxic shock syndrome or Kawasaki’s disease – a pediatric heart disease that causes inflammation or swelling of the blood vessels, according to a new correspondence published today in The Lancet. The publication described 8 cases identified in 2-to-15 year old COVID-19 patients at Evelina London Children’s Hospital in the United Kingdom. Oddly enough, many of the children did not “present with significant respiratory symptoms,” according to The Lancet publication. “The intention of this Correspondence is to bring this subset of children to the attention of the wider paediatric community and to optimise early recognition and management,” the authors of The Lancet piece wrote. Since the pandemic began, young children have largely escaped the worst effects, with much lower rates of infection and critical disease seen in those under 10 years old. However, case reports of this rare ‘Kawasaki-like’ syndrome in young children previously exposed to COVID-19 seem to buck the trend – causing severe cardiovascular distress in children. World Health Assembly May 18 to Focus on COVID-19: EU Resolution on Technologies Access Meanwhile, the World Health Organization’s legal counsel confirmed that this year’s World Health Assembly (WHA) would focus primarily on the COVID-19, and occur virtually on 18-19 May. A skeletal agenda is being circulated among Member States and observer organizations. The main issue to be discussed at this year’s World Health Assembly is a European Union resolution on access to COVID-19 technologies, the latest draft of which was obtained by Health Policy Watch. Negotiations among member states are scheduled to resume tomorrow and continue daily until the WHA. The latest draft text stresses the importance of “equitable access” to COVID-19 treatments, protective gear and future vaccines and ”fair distribution to all countries, including through using fully the provisions of international treaties” (OP4). The working draft, doesn’t however, explicitly mention the most operable international agreement – the so-called TRIPS flexibilities, of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allow countries to override patent rules in cases of vital national health interests. Also buried at the end of the 4-page document is a stunning call for a wholesale review of the entire WHO-led pandemic response, including revisiting the International Health Regulations, WHO’s timelines, and the contribution of the agency to the United Nations-wide response. The new draft text also makes reference twice, to the voluntary ”pooling” of product patents –which might provide another window through which low- and middle-income countries can more easily access new medical technologies. WHO Experts Reassured Parents After Reports Of Rare Illness Surfaced WHO has been monitoring reports of the ‘Kawasaki-like’ syndrome since UK doctors first notified the agency of sporadic cases in pediatric COVID-19 patients two weeks ago. WHO experts last week underlined that the large majority of parents still need not panic, as cases still “seemed to be very rare,” according to WHO COVID-19 Technical Lead Maria Van Kerkhove. “To emphasize for all parents out there, the vast majority of children who get COVID-19 will have a mild infection and recover completely,” added WHO Executive Director of Health Emergencies Mike Ryan when pressed about the cases last week. But in the week since, more reports of the rare syndrome have emerged, although the total numbers are still low. Since the correspondence’s submission to The Lancet, over 20 children at the same hospital in the United Kingdom have been treated for similar systems. Ten of the children tested positive for SARS-CoV-2 antibodies, indicating they had been exposed to the virus that causes COVID-19 in the past. Some 15 children across New York City have been hospitalized in pediatric ICUs with similar symptoms, caused by a “pediatric multi-system inflammatory syndrome” according to a statement released Tuesday from the city’s Deputy Commissioner for Disease Control. Four of the children tested positive for COVID-19, and an additional six tested positive for SARS-CoV-2 antibodies. The official statement confirmed reports that had been circulating among New York doctors for weeks, and urged clinicians to be on the lookout for any similar cases. Most of the children in the United Kingdom cluster and about half of the children in New York City did not present with any significant respiratory symptoms. Seven of the eight children described in The Lancet correspondence were placed on mechanical ventilation for “cardiovascular stabilisation,” and five children in New York City have been placed on mechanical ventilation. Approximately half of the children in both hotspots presented with persistent fever and gastrointestinal symptoms. US President Pushes to Reopen Country and Disband COVID-19 Taskforce, Even As New Cases Climb As other countries experienced declines in new cases and considered easing lockdown restrictions, the United States is reopening even as new cases continue to climb. Trump is briefed on COVID-19 at the White House US President Donald Trump is considering disbanding the national coronavirus taskforce to focus on restarting the economy, telling reporters on Tuesday that the pandemic had been controlled enough, that the coronavirus task force can be disbanded. This news came even as a draft government report projected a doubling in deaths in the coming weeks if the country reopens, and new hotspots in the US experienced a surge in cases, preventing the country’s infection curve from flattening. ““I’m not saying anything is perfect, and, yes, will some people be affected? Yes. Will some people be affected badly? Yes. But we have to get our country open, and we have to get it open soon,” Trump said. He made these remarks while touring a mask factory in Arizona without wearing any protective gear, despite instructions. He told journalists that the task force will be replaced with an unspecified new advisory body as the country moved into what he called Phase 2 of the pandemic response. The move to reopen has also been criticized by scientists and Democrats. Jeffrey Shaman, a top epidemiologist leading Columbia University’s COVID-19 modeling team, said it is particularly alarming that states are reopening without first developing the tools needed to detect and control the virus. “The rebound will be masked because of the lag in the system,” he predicted. “By the time you recognize the rebound, it could be too late. Cases will still increase for another two weeks or more.” The United States continues to have the highest number of both confirmed coronavirus cases as well as deaths globally, with over 1.2 million confirmed cases and more than 71,000 deaths, already surpassing optimistic death estimates touted by the White House in early April. Total cases of COVID-19 as of 12:32PM CET 6 May 2020, with active case distribution globally. Numbers change rapidly. Rising Cases In Africa and Southeast Asia Raise Alarm But although US and Europe remain the pandemic hotspots, some countries in Africa are experiencing an exponential rise in cases, raising fears that the next pandemic hotspot could be somewhere on the continent. Over 80% of all cases are in 10 countries, including South Africa, Algeria, Nigeria, Ghana, and Cameroon. However, the toll in Africa is still far lower than in Europe and the US – with close to 50,000 cases and almost 2,000 deaths reported across the continent as of Wednesday. And the rising case count may not be all bad – Van Kerkhove told reporters Wednesday that, “Many countries that are seeing increases in cases have ramped up their testing and so, I don’t want to equate countries that are seeing an increase in testing or a rapid increase as a negative thing.” “It’s not good in terms of seeing cases in terms of transmission, but I think I don’t want to equate that with something is wrong. I want to equate that with countries are working very hard to increase their ability to find the virus,” added Van Kerkhove. Early lockdown measures taken by many African nations may have also helped slow the spread of the virus, but a new report revealed that many people in cities with stay-at-home orders are struggling to survive without work and money to buy food, highlighting the need for countries to pursue a balanced response to protecting lives and livelihoods during the COVID-19 pandemic. Total number of cases in each WHO Region as of Tuesday night. Gauri Saxena contributed to this story Image Credits: www.vperemen.com, White House, Johns Hopkins CSSE, WHO. Posts navigation Older postsNewer posts