Dramatic Population Drop in Russia, as War, COVID and Emigration Exacerbate Declining Births 06/03/2023 Kerry Cullinan Anti-war protest in Germany As Russia’s war against Ukraine intensifies around Bakhmut, a new report estimates that the invading army has had between 200,000 to 250,000 casualties – dead and wounded – in the past year. The Center for Strategic and International Studies (CSIS) calculates that the average rate of Russian soldiers killed in Ukraine every month is “at least 25 times the number killed per month in Chechnya and 35 times the number killed in Afghanistan”. Coming on the heels of one of the worst COVID-19 mortality rates in the world and a mass exodus of young men and their families fleeing from conscription, Russia may have lost two million people in the past three years, according to The Economist. The life expectancy of Russian males aged 15 is currently at the same level as those in Haiti. The country’s birth rates have been in decline since 1994 when Russia was estimated to have 149 million citizens. By the start of 2022, its population was estimated to be 145,6 million, with 3,358 births a day being more than cancelled out by a daily death rate of 3,663, according to Statistica. Between 1 January 2022 and 1 January this year, the Russian population was estimated to have decreased by approximately 560,000. Aside from deaths, estimates of people immigrating range from 500,000 to a million people in the past year alone. Excess deaths during COVID Using a statistical method based on changes in the population age structure, there were 351,158 excess deaths in 2020 and 678,022 in 2021 in the Russian Federation, according to an article published in the journal, PlosOne last November. There was significant regional variation, with men and urban residents suffering the greatest mortality. Meanwhile in 2021, there were approximately 1.04 million more deaths than births recorded in Russia, according to Statistica. Russia recorded one of the biggest excess mortality gaps globally, with 580,000 more deaths than expected between April 2020 and June 2021, although its official COVID-19 toll was only 130,000, according to The Economist. In one year, the mortality rate leapt from 14.6 deaths per 1000 people (2020) to 16.7 per 1000 in 2021. Find more statistics at Statista In 2021, the most common cause of death in Russia was circulatory system diseases (particularly, heart attacks, strokes and aneurysms), causing an estimated 640 deaths per 100,000 people. COVID-19 was the second-highest cause of death, with 319 deaths per 100,000. Neoplasms, predominantly cancers, caused over 194 deaths per 100,000 and were the third biggest cause of death. War cancels out government solutions Patriarch Kirill, the head of the Russian Orthodox Church in Moscow, called for a ban on abortions to reverse the demographic trend. Meanwhile, in 2020, Russian President Vladimir Putin’s government announced a package of tax breaks and welfare benefits aimed at stimulating the country’s birth rate. This follows the lead of Hungary, which has a wide range of tax incentive aimed at stimulating that country’s declining birth rate. However, the war on Ukraine has effectively cancelled out whatever positive effects this stimulus package had on the country’s birth rate. Image Credits: Dea Andreea/ Unsplash. First Draft of Pandemic Accord Possible in April – But INB Won’t Commit to This 06/03/2023 Kerry Cullinan INB co-chair Precious Matsoso and WHO Director-General Tedros at the start of INB 4. After spending the past week negotiating a proposed future pandemic accord in the intergovernmental negotiating body (INB) set up by the World Health Organization (WHO), member states will pick up discussions from 3 to 6 April. Last week’s discussions were based on the zero draft developed by the INB’s Bureau after a series of meetings and public hearings during 2022 about the contents of the document aimed to guide and protect the world in the next pandemic. During the closing session of Friday’s meeting, a number of delegates expressed the hope that it would be possible for the INB Bureau to develop a first draft of the accord after the April meeting, but the INB ultimately chose not to commit to this. “The start of discussions of concrete language for the WHO pandemic accord sends a clear signal that countries of the world want to work together for a safer, healthier future where we are better prepared for, and able to prevent future pandemic threats, and respond to them effectively and equitably,” said Roland Driece, co-chair of the INB Bureau. He noted at the start of last week’s fourth INB meeting that the April meeting would be taken as a continuation of the current meeting, the bulk of which was held in private. Co-chair Precious Matsoso described the meeting, which ended last Friday, as “a critical step in ensuring we do not repeat the mistakes of the COVID-19 pandemic response, including in sharing life-saving vaccines, provision of information and development of local capacities”. “That we have been able to move forward so decisively is testimony to the global consensus that exists on the need to work together and to strengthen WHO’s and the international community’s ability to protect the world from pandemic threats,’ Matsoso added. The INB Bureau is to convene informal intercessional meetings between meetings to help facilitate agreements, but Matsoso urged delegates to have their own informal meetings before April to “iron out the wrinkles”. A progress report on the accord will be given to the World Health Assembly in May, with the final draft due to be considered by the 77th World Health Assembly in 2024. Also present at the INB meeting were the co-facilitators of the United Nations General Assembly High-Level Meeting on Pandemic Prevention, Preparedness, and Response, set for 20 September. The co-facilitators, Morocco and Israel’s ambassadors to the UN in New York, told INB members that they wanted to ensure that the INB process and the high-level meeting were in sync. The co-facilitators also meet with the World Intellectual Property Organization (WIPO) and the World Trade Organization (WTO). WHO Chief Is First Top UN Official to Visit Northwest Syria in 12 Years 03/03/2023 Stefan Anderson WHO Director-General Tedros Adhanom Ghebreyesus (centre) is the first top UN official to visit Syria since the start of its civil war. World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus is the first senior United Nations (UN) official to visit northwest Syria since the war began 12 years ago. The visit was a bid to underline the organization’s commitment to the region, which has provided around a third of all medicines to arrive in northwest Syria in the past decade. Since the earthquake, that number has risen to two-thirds. According to the UN, the devastating earthquakes have killed at least 50,000 people across Turkey and Syria. Tens of thousands more are still missing, hundreds of thousands have been left homeless, and thousands of families are yet to be reunited. “The suffering is impossible to describe in words or even in pictures,” Tedros said at a Friday press briefing. “The destruction is immense.” While NGOs and local authorities expressed gratitude for the WHO chief’s visit, they also voiced deep “disappointment” in the UN’s high-level team for avoiding setting foot in the region since the beginning of the war. The scale of devastation in Turkey has been extreme, counting at least 44,000 deaths and $34.2 billion in infrastructural damage. A World Bank report published on Monday estimated the costs of reconstruction and economic disruption will likely cost twice that amount. In Syria, about 6,000 people have been confirmed dead, mostly in the rebel-held northwest. But while the challenges and trauma faced on both sides of the Turkish-Syrian border are similar, the Syrians are working with far fewer resources. “Twelve years of war has destroyed infrastructure, homes and hope,” Tedros said, “Drought, economic collapse, the COVID-19 pandemic, and the ongoing cholera outbreak have heaped misery upon misery. The risks now being faced by people on the Syrian side are far higher than those living just a few kilometers away.” The @UN says that $54 bn are needed to meet the basic needs of the world’s most vulnerable, but the UN doesn’t expect to raise even half of that. @UNReliefChief tells me “how do you choose between a school & a clinic, how do you choose between food & nutritional support”. pic.twitter.com/lXu6rh0Cow — Isa Soares (@IsaCNN) February 22, 2023 Before the earthquakes, 15.3 million Syrians – 70% of the country’s population – needed of humanitarian assistance. Price increases of more than 800% in the past two years had driven another 90% below the poverty line and led to food insecurity for 12.4 million people. In an address to the UN Security Council on Tuesday, UN Emergency Relief Coordinator Martin Griffiths called the situation in Syria an “almost unbelievable tragedy.” “Amid the harsh winter season, the earthquake has destroyed entire neighborhoods, rendering them uninhabitable … In many areas, four to five families are packed into tents,” Griffiths said. “The risk of disease is growing amid pre-existing cholera outbreaks. Women and children face increased harassment, violence, and risk of exploitation.” UN efforts to mobilize international relief funding are underway, but underfunded. The emergency appeal for $397.6 million in aid for Syrian quake victims has raised just 42% of its target. Meanwhile, the 2023 Syria Humanitarian Response Plan – the largest humanitarian appeal in the world – needs $4.8 billion to address needs pre-dating the earthquake. I met Mohammed, 15 years old, who jumped out of a window during the earthquake and broke his arms. He had surgery at Aaqrabate orthopedic hospital, after our visit. The surgery went well. I’m in awe of the doctors in north-west #Syria. @WHO will support them in any way possible. pic.twitter.com/FVc44Z46Nv — Tedros Adhanom Ghebreyesus (@DrTedros) March 2, 2023 Children have also been caught in the crossfire, with thousands separated from their parents, without access to education, or displaced from their homes. “I met a 15-year-old boy who broke his arms when he jumped out of a window during the earthquake,” Tedros said. “He hasn’t been to school since he was nine years old.” With world leaders set to gather for a donor conference in Brussels next week on the 12th anniversary of the Syrian war, Tedros called on the international community to confront the humanitarian crisis. “The Syrian people have suffered more than most people ever will, or ever could,” he said. “Their needs, dreams and hopes are the same as all people; for health, food, water, shelter, and peace for a better future for their children.” Image Credits: WHO. Former WHO Assistant Director General Ranieri Guerra Indicted in Italy 03/03/2023 Elaine Ruth Fletcher WHO Assistant Director General, Ranieri Guerra Italian prosecutors in Bergamo have indicted Ranieri Guerra, a former World Health Organization (WHO) Assistant Director General, for making false statements before a public prosecutor about his role in the suppression of a major WHO report on Italy’s response to the pandemic. The WHO report had criticized the Italian government for failing to update a pandemic preparedness plan prior to the COVID outbreak – and at a time when Guerra was in fact in charge of updating the plan as the Italian Ministry of Health’s General Director for Prevention. Published on WHO’s website on May 13, 2020, and deleted a day later, the 102-page report “An Unprecedented Challenge”, revealed that the country’s pandemic preparedness plan had not been updated since 2006 – despite European Union instructions to countries to update their plans in 2013-2014 – when Guerra was in charge. “Just one word: Finally,” tweeted Francesco Zambon, the whistleblower who left WHO in protest over the suppression of the report, in response to news of the indictments. Speaking to Health Policy Watch, Zambon added that “after three years no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which concerned some of the most senior officials in the organization.” Solo una parola: finalmente.Non dimentichiamoci delle guerre di casa nostra#COVID19 #Italia #bergamo #Russia #UkraineRussiaWar pic.twitter.com/E1mTCMRMYL — Francesco Zambon (@frazambon) March 1, 2023 Guerra, a WHO ADG for special initiatives, was dispatched exceptionally by WHO’s Director General Dr Tedros Adhanom Ghebreyesus to Italy in early 2020 to support the initial phase of the country’s pandemic response – as one of the first and hardest hit countries in the world initially. A few months later, WHO’s Venice Office, under the direction of Francesco Zambon prepared an independent WHO report on Italy’s pandemic response, that frankly addressed Italy’s lack of an updated preparedness plan, in just a few phrases. After seeing a draft of the report, Guerra demanded that the language referring to the lack of preparedness, be redacted. When Zambon refused, the report was deleted from WHO’s website – only a day after its publication. At the time, Guerra publicly denied that he had had a role in suppressing the report – which had sought to highlight both the successes as well as the weaknesses in Italy’s pandemic response. However a series of publications in both the Italian media and abroad, including in Health Policy Watch, revealed a trail of emails that reflected the pressure Guerra had applied on Zambon and his superiors in WHO’s European Office to have the report redacted and then suppressed. Following that, other revelations in the Italian media suggested that Guerra had even bragged to Italian officials about his role in convincing WHO’s Regional Director for Europe, Hans Kluge and others to delete the report. It was on the basis of those communications that Guerra was finally indicted by Bergamo legal authorities. WHO, meanwhile, staunchly stood by Guerra, refusing to answer questions about his role – citing UN immunity. Zambon ultimately resigned in protest after being frozen out of his management role at the Venice office. Speaking to Health Policy Watch on Friday, Zambon said of the indictment: “Yes, it is quite a big thing actually. It would be worth noting that, after three years, no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which was about the highest officials in the organization. “Nor was any apology provided to me for being a whistleblower who tried to protect WHO from scandals. To the very contrary, WHO continues stating I am not a whistleblower as – in their opinion – there was no retaliation. Even Transparency International and 40plus organizations wrote to Tedros about this untenable position. They never got a reply. “WHO lost a huge opportunity of being a credible and transparent agency towards national authorities. Also not being compliant with the same privileges that it benefits from, which unequivocally states that immunity MUST be waived when interfering with a national investigation. This certainly was the case. “I wonder and I ask citizens of the world: where is WHO’S accountability? How much should the world wait for having a ground-shaking reform permitting WHO to be at the ethical standard it should be?” Reportedly Guerra is also under investigation for “neglect of official duties” in relation to his failure to update the 2006 pandemic preparedness plan during the time in which he served as head of prevention. Sharp Rise in Homophobia in East Africa Sparks Fear of Violence 03/03/2023 Kerry Cullinan UNAIDS Executive Director Winnie Byanyima (left), has warned that laws criminalising same-sex relationships are exacerbating HIV. Over the past week, there has been a steep rise in anti-LGBTQ activity organised by prominent politicians and religious leaders in Kenya and Uganda, which has sparked condemnation by health and human rights activists and fears that this will result in violence. On Thursday, Kenya’s newly elected evangelical president, William Ruto, said he would not allow “homosexual acts or same-sex marriage” during his term. His remarks came after an outcry led by conservative Christian and Muslim groups after last week’s Supreme Court judgement confirming that LGBTQ people had the right of association and that the NGO Board’s decision to bar LGBTQ people from forming recognised groups is discriminatory. Meanwhile, Ugandan opposition Member of Parliament Asuman Basalirwa tabled a private Member’s Bill in that country’s parliament on Tuesday seeking life in prison for homosexuality. That same day, Anitah Among, Uganda’s Speaker of Parliament and a prominent member of the ruling party, told religious leaders that “a Bill will be introduced as soon as possible to deal with homosexuality and lesbianism”, and that voting on it would be “by show of hands” not secret ballot. This followed a national anti-homosexuality protest on 24 February called by the Uganda Muslim Supreme Council. The Uganda Muslim Supreme Council held a national protest against homosexuality on 24 February. Fuelling HIV Ironically, the anti-LGBTQ frenzy coincided with Zero Discrimination Day on 1 March, when UNAIDS highlighted the need to remove laws that criminalise people living with HIV and “key populations”, its term for those most vulnerable to HIV, including LGBTQ people. “Criminalizing laws chase people away from life-saving treatment. Those need to be removed,” said Winnie Byanyima, Executive Director of UNAIDS. Byanyima added that “at the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.” Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalise same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions. ‘Homo-hysteria’ “The current wave of homo-hysteria in Kenya began earlier this year with the death of [gay activist and fashion designer] Edwin Chiloba,” human rights lawyer and Amnesty International Kenya Board member Tabitha Saoyo told Health Policy Watch. “This was exacerbated by the Supreme Court judgement favouring LGBTQ groups. What we are now currently witnessing is an attack on the judiciary, massive disinformation on the contents of the judgement coupled with intentional fear, hate and panic from religious groups, politicians and public influencers. “This wave of hate is manifesting through formation of anti-LGBTQ WhatsApp groups, public protests, online threats of rape, death and myriad of other harmful attacks in grassroots communities,” she added. Thirteen Kenyan human rights organisations and LGBTQ organisations including the Kenya Human Rights Commission and the International Commission of Jurists (Kenya Section) issued a statement on Thursday expressing alarm at the misinformation and disinformation that has followed the Supreme Court ruling. Noting that the Kenyan Constitution “expressly prohibits incitement to violence, discrimination and vilification of others or incitement to cause harm”, they said that there have been “increasing incidents of malicious online and offline comments, profiling and public demonstrations against persons who identify as intersex, gay, lesbian or non-binary, and the personal details of LGBTQ+ citizens and their family members are being openly shared and intimidated online, violating the right to privacy and human dignity”. Evacuation requests “Citizens are reporting confrontations with landlords and employers. They are increasing requests for evacuation, relocation and psychotherapy, while legal and health services and officers are having to close due to safety concerns, organisations have been responding to no less than 117 homophobic cases in the last month,” they noted. Meanwhile, the United Nations Human Rights Office urged the Ugandan parliament to refrain from passing an anti-homosexuality bill, adding that “the State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity”. We urge the Uganda Parliament to refrain from passing an Anti-Homosexuality bill. The State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity. — UN Human Rights (@UNHumanRights) February 28, 2023 HIV targets far off track In 2021, the UN adopted a Polical Declaration on HIV and AIDS that committed member states to “ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services” by 2025. However, this goal is far form being realised with 67 of the 134 reporting countries still criminalizing consensual same-sex sexual activity and 20 criminalizing and/or prosecuting transgender people. “Criminalisation drives discrimination and structural inequalities. It robs people of the prospect of healthy and fulfilling lives. And it holds back the end of AIDS,” said UNAIDS. Image Credits: Twitter. WHO Executive Board to Meet on Fate of Western Pacific Regional Director After Countries Vote to Remove Him from Post 03/03/2023 Elaine Ruth Fletcher The World Health Organization’s 152nd Executive Board meeting in February 2023 – now set to convene again in a special closed session next week. WHO’s Executive Board is set to meet again next week in a special closed session to consider the fate of the Regional Director of WHO’s Western Pacific Regional Office (WPRO), who has been accused of racism and harassment of staff at the Manila-based office. In a meeting earlier this week, WHO member states from the Asian Pacific region reportedly voted by a narrow margin to remove Dr Takeshi Kasai from his post as Regional Director, Health Policy Watch has learned. WHO did not comment on the report, which was corroborated by multiple sources. The special EB session is set to meet on the matter on 6th and 7th March in line with the mandate outlined in a memorandum circulated last month at the 152nd regular session of the WHO governing board. The EB memorandum stated that a special session would be convened “should such sessions be required to consider the outcome of the investigation process in respect of allegations concerning the Regional Director for the Western Pacific”. Directors in all six WHO’s regional offices are elected by the member states of the region in which they serve and then these appointments are confirmed by the WHO Executive Board, with the regional director’s contract issued by the WHO Director General. Investigation of Regional Director is on agenda In the wake of the vote by the WPRO to remove Kasai from his position as Regional Director, the EB would be almost certainly be bound by WHO rules to confirm his removal from the post. They would also have to recommend to WHO Director-General Dr Tedros Adhanom Ghebreyesus what other steps to take regarding Kasai’s future as a WHO staff member. The WHO investigation has corroborated at least four of the allegations that had been brought against the Kasai, according to sources. However Japan, a major WHO donor, led the minority faction against Kasai’s removal in the regional meeting and can be expected to muster significant political pressure against further action. The EB memo from early February does not elaborate publicly, however on what steps might be considered, stating only that: “The procedure for considering the findings of the investigation and related decisions, reflecting the advice of the Independent Expert Oversight Advisory Committee, was set out in the confidential briefing note of 16 November 2022 ….. and was discussed at the informal briefing for members of the Board held on 29 November 2022.” The vote by a WHO Regional Committee to remove an elected director on the basis of such allegations is unprecedented in WHO´s history. Put on administrative leave in 2022 Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference in 2021. In September 2022 Kasai was put on administrative leave by WHO after the formal investigation was launched into a range of staff allegations against him. At the time, WHO did not specify the reasons for Kasai’s indefinite removal, stating only that: “WHO is not in a position to comment on matters pertaining to ongoing investigations.” The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia. During his absence, WHO Deputy Director-General Dr Zsuzsanna Jakab has been overseeing the administration of the Regional Office. ‘Toxic’ atmosphere A medical doctor, Kasai, was alleged to have been presiding over a “toxic atmosphere” at the WHO regional office in Manila, “with a culture of systemic bullying and public ridiculing.” The allegations first came to light in an Associated Press report, published in January 2022. According to AP, more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of WHO’s Executive Board. However, Kasai denied using racist language or any other wrongdoing. Kasai began his term as regional director on 1 February 2019 after more than 15 years in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014. WHO Internal justice system in spotlight Over the past two years, WHO’s internal management of complaints around harassment, both sexual and managerial, has been the focus of increased scrutiny in the wake of a string of scandals and media reports involving senior and mid-senior WHO officials. Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo. Since then, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022. Those allegations involved WHO official Dr Temo Waqanivalu, who had reportedly been eyeing a run as a candidate to replace Kasai as the next WPRO Regional Director. In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide. But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO. Image Credits: WHO. Child and Adolescent Obesity Rising More Sharply Than In Other Age Groups 02/03/2023 Elaine Ruth Fletcher Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today. More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation. About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March. Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added. “The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states. And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people. About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035. Obesity trends among boys and girls aged 5-19 years. “A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns. Low and middle income countries among the most vulnerable to rising obesity Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found. It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension. Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life. By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity. And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment. The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children. At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks. Image Credits: Commons , World Obesity Atlast . U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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First Draft of Pandemic Accord Possible in April – But INB Won’t Commit to This 06/03/2023 Kerry Cullinan INB co-chair Precious Matsoso and WHO Director-General Tedros at the start of INB 4. After spending the past week negotiating a proposed future pandemic accord in the intergovernmental negotiating body (INB) set up by the World Health Organization (WHO), member states will pick up discussions from 3 to 6 April. Last week’s discussions were based on the zero draft developed by the INB’s Bureau after a series of meetings and public hearings during 2022 about the contents of the document aimed to guide and protect the world in the next pandemic. During the closing session of Friday’s meeting, a number of delegates expressed the hope that it would be possible for the INB Bureau to develop a first draft of the accord after the April meeting, but the INB ultimately chose not to commit to this. “The start of discussions of concrete language for the WHO pandemic accord sends a clear signal that countries of the world want to work together for a safer, healthier future where we are better prepared for, and able to prevent future pandemic threats, and respond to them effectively and equitably,” said Roland Driece, co-chair of the INB Bureau. He noted at the start of last week’s fourth INB meeting that the April meeting would be taken as a continuation of the current meeting, the bulk of which was held in private. Co-chair Precious Matsoso described the meeting, which ended last Friday, as “a critical step in ensuring we do not repeat the mistakes of the COVID-19 pandemic response, including in sharing life-saving vaccines, provision of information and development of local capacities”. “That we have been able to move forward so decisively is testimony to the global consensus that exists on the need to work together and to strengthen WHO’s and the international community’s ability to protect the world from pandemic threats,’ Matsoso added. The INB Bureau is to convene informal intercessional meetings between meetings to help facilitate agreements, but Matsoso urged delegates to have their own informal meetings before April to “iron out the wrinkles”. A progress report on the accord will be given to the World Health Assembly in May, with the final draft due to be considered by the 77th World Health Assembly in 2024. Also present at the INB meeting were the co-facilitators of the United Nations General Assembly High-Level Meeting on Pandemic Prevention, Preparedness, and Response, set for 20 September. The co-facilitators, Morocco and Israel’s ambassadors to the UN in New York, told INB members that they wanted to ensure that the INB process and the high-level meeting were in sync. The co-facilitators also meet with the World Intellectual Property Organization (WIPO) and the World Trade Organization (WTO). WHO Chief Is First Top UN Official to Visit Northwest Syria in 12 Years 03/03/2023 Stefan Anderson WHO Director-General Tedros Adhanom Ghebreyesus (centre) is the first top UN official to visit Syria since the start of its civil war. World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus is the first senior United Nations (UN) official to visit northwest Syria since the war began 12 years ago. The visit was a bid to underline the organization’s commitment to the region, which has provided around a third of all medicines to arrive in northwest Syria in the past decade. Since the earthquake, that number has risen to two-thirds. According to the UN, the devastating earthquakes have killed at least 50,000 people across Turkey and Syria. Tens of thousands more are still missing, hundreds of thousands have been left homeless, and thousands of families are yet to be reunited. “The suffering is impossible to describe in words or even in pictures,” Tedros said at a Friday press briefing. “The destruction is immense.” While NGOs and local authorities expressed gratitude for the WHO chief’s visit, they also voiced deep “disappointment” in the UN’s high-level team for avoiding setting foot in the region since the beginning of the war. The scale of devastation in Turkey has been extreme, counting at least 44,000 deaths and $34.2 billion in infrastructural damage. A World Bank report published on Monday estimated the costs of reconstruction and economic disruption will likely cost twice that amount. In Syria, about 6,000 people have been confirmed dead, mostly in the rebel-held northwest. But while the challenges and trauma faced on both sides of the Turkish-Syrian border are similar, the Syrians are working with far fewer resources. “Twelve years of war has destroyed infrastructure, homes and hope,” Tedros said, “Drought, economic collapse, the COVID-19 pandemic, and the ongoing cholera outbreak have heaped misery upon misery. The risks now being faced by people on the Syrian side are far higher than those living just a few kilometers away.” The @UN says that $54 bn are needed to meet the basic needs of the world’s most vulnerable, but the UN doesn’t expect to raise even half of that. @UNReliefChief tells me “how do you choose between a school & a clinic, how do you choose between food & nutritional support”. pic.twitter.com/lXu6rh0Cow — Isa Soares (@IsaCNN) February 22, 2023 Before the earthquakes, 15.3 million Syrians – 70% of the country’s population – needed of humanitarian assistance. Price increases of more than 800% in the past two years had driven another 90% below the poverty line and led to food insecurity for 12.4 million people. In an address to the UN Security Council on Tuesday, UN Emergency Relief Coordinator Martin Griffiths called the situation in Syria an “almost unbelievable tragedy.” “Amid the harsh winter season, the earthquake has destroyed entire neighborhoods, rendering them uninhabitable … In many areas, four to five families are packed into tents,” Griffiths said. “The risk of disease is growing amid pre-existing cholera outbreaks. Women and children face increased harassment, violence, and risk of exploitation.” UN efforts to mobilize international relief funding are underway, but underfunded. The emergency appeal for $397.6 million in aid for Syrian quake victims has raised just 42% of its target. Meanwhile, the 2023 Syria Humanitarian Response Plan – the largest humanitarian appeal in the world – needs $4.8 billion to address needs pre-dating the earthquake. I met Mohammed, 15 years old, who jumped out of a window during the earthquake and broke his arms. He had surgery at Aaqrabate orthopedic hospital, after our visit. The surgery went well. I’m in awe of the doctors in north-west #Syria. @WHO will support them in any way possible. pic.twitter.com/FVc44Z46Nv — Tedros Adhanom Ghebreyesus (@DrTedros) March 2, 2023 Children have also been caught in the crossfire, with thousands separated from their parents, without access to education, or displaced from their homes. “I met a 15-year-old boy who broke his arms when he jumped out of a window during the earthquake,” Tedros said. “He hasn’t been to school since he was nine years old.” With world leaders set to gather for a donor conference in Brussels next week on the 12th anniversary of the Syrian war, Tedros called on the international community to confront the humanitarian crisis. “The Syrian people have suffered more than most people ever will, or ever could,” he said. “Their needs, dreams and hopes are the same as all people; for health, food, water, shelter, and peace for a better future for their children.” Image Credits: WHO. Former WHO Assistant Director General Ranieri Guerra Indicted in Italy 03/03/2023 Elaine Ruth Fletcher WHO Assistant Director General, Ranieri Guerra Italian prosecutors in Bergamo have indicted Ranieri Guerra, a former World Health Organization (WHO) Assistant Director General, for making false statements before a public prosecutor about his role in the suppression of a major WHO report on Italy’s response to the pandemic. The WHO report had criticized the Italian government for failing to update a pandemic preparedness plan prior to the COVID outbreak – and at a time when Guerra was in fact in charge of updating the plan as the Italian Ministry of Health’s General Director for Prevention. Published on WHO’s website on May 13, 2020, and deleted a day later, the 102-page report “An Unprecedented Challenge”, revealed that the country’s pandemic preparedness plan had not been updated since 2006 – despite European Union instructions to countries to update their plans in 2013-2014 – when Guerra was in charge. “Just one word: Finally,” tweeted Francesco Zambon, the whistleblower who left WHO in protest over the suppression of the report, in response to news of the indictments. Speaking to Health Policy Watch, Zambon added that “after three years no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which concerned some of the most senior officials in the organization.” Solo una parola: finalmente.Non dimentichiamoci delle guerre di casa nostra#COVID19 #Italia #bergamo #Russia #UkraineRussiaWar pic.twitter.com/E1mTCMRMYL — Francesco Zambon (@frazambon) March 1, 2023 Guerra, a WHO ADG for special initiatives, was dispatched exceptionally by WHO’s Director General Dr Tedros Adhanom Ghebreyesus to Italy in early 2020 to support the initial phase of the country’s pandemic response – as one of the first and hardest hit countries in the world initially. A few months later, WHO’s Venice Office, under the direction of Francesco Zambon prepared an independent WHO report on Italy’s pandemic response, that frankly addressed Italy’s lack of an updated preparedness plan, in just a few phrases. After seeing a draft of the report, Guerra demanded that the language referring to the lack of preparedness, be redacted. When Zambon refused, the report was deleted from WHO’s website – only a day after its publication. At the time, Guerra publicly denied that he had had a role in suppressing the report – which had sought to highlight both the successes as well as the weaknesses in Italy’s pandemic response. However a series of publications in both the Italian media and abroad, including in Health Policy Watch, revealed a trail of emails that reflected the pressure Guerra had applied on Zambon and his superiors in WHO’s European Office to have the report redacted and then suppressed. Following that, other revelations in the Italian media suggested that Guerra had even bragged to Italian officials about his role in convincing WHO’s Regional Director for Europe, Hans Kluge and others to delete the report. It was on the basis of those communications that Guerra was finally indicted by Bergamo legal authorities. WHO, meanwhile, staunchly stood by Guerra, refusing to answer questions about his role – citing UN immunity. Zambon ultimately resigned in protest after being frozen out of his management role at the Venice office. Speaking to Health Policy Watch on Friday, Zambon said of the indictment: “Yes, it is quite a big thing actually. It would be worth noting that, after three years, no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which was about the highest officials in the organization. “Nor was any apology provided to me for being a whistleblower who tried to protect WHO from scandals. To the very contrary, WHO continues stating I am not a whistleblower as – in their opinion – there was no retaliation. Even Transparency International and 40plus organizations wrote to Tedros about this untenable position. They never got a reply. “WHO lost a huge opportunity of being a credible and transparent agency towards national authorities. Also not being compliant with the same privileges that it benefits from, which unequivocally states that immunity MUST be waived when interfering with a national investigation. This certainly was the case. “I wonder and I ask citizens of the world: where is WHO’S accountability? How much should the world wait for having a ground-shaking reform permitting WHO to be at the ethical standard it should be?” Reportedly Guerra is also under investigation for “neglect of official duties” in relation to his failure to update the 2006 pandemic preparedness plan during the time in which he served as head of prevention. Sharp Rise in Homophobia in East Africa Sparks Fear of Violence 03/03/2023 Kerry Cullinan UNAIDS Executive Director Winnie Byanyima (left), has warned that laws criminalising same-sex relationships are exacerbating HIV. Over the past week, there has been a steep rise in anti-LGBTQ activity organised by prominent politicians and religious leaders in Kenya and Uganda, which has sparked condemnation by health and human rights activists and fears that this will result in violence. On Thursday, Kenya’s newly elected evangelical president, William Ruto, said he would not allow “homosexual acts or same-sex marriage” during his term. His remarks came after an outcry led by conservative Christian and Muslim groups after last week’s Supreme Court judgement confirming that LGBTQ people had the right of association and that the NGO Board’s decision to bar LGBTQ people from forming recognised groups is discriminatory. Meanwhile, Ugandan opposition Member of Parliament Asuman Basalirwa tabled a private Member’s Bill in that country’s parliament on Tuesday seeking life in prison for homosexuality. That same day, Anitah Among, Uganda’s Speaker of Parliament and a prominent member of the ruling party, told religious leaders that “a Bill will be introduced as soon as possible to deal with homosexuality and lesbianism”, and that voting on it would be “by show of hands” not secret ballot. This followed a national anti-homosexuality protest on 24 February called by the Uganda Muslim Supreme Council. The Uganda Muslim Supreme Council held a national protest against homosexuality on 24 February. Fuelling HIV Ironically, the anti-LGBTQ frenzy coincided with Zero Discrimination Day on 1 March, when UNAIDS highlighted the need to remove laws that criminalise people living with HIV and “key populations”, its term for those most vulnerable to HIV, including LGBTQ people. “Criminalizing laws chase people away from life-saving treatment. Those need to be removed,” said Winnie Byanyima, Executive Director of UNAIDS. Byanyima added that “at the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.” Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalise same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions. ‘Homo-hysteria’ “The current wave of homo-hysteria in Kenya began earlier this year with the death of [gay activist and fashion designer] Edwin Chiloba,” human rights lawyer and Amnesty International Kenya Board member Tabitha Saoyo told Health Policy Watch. “This was exacerbated by the Supreme Court judgement favouring LGBTQ groups. What we are now currently witnessing is an attack on the judiciary, massive disinformation on the contents of the judgement coupled with intentional fear, hate and panic from religious groups, politicians and public influencers. “This wave of hate is manifesting through formation of anti-LGBTQ WhatsApp groups, public protests, online threats of rape, death and myriad of other harmful attacks in grassroots communities,” she added. Thirteen Kenyan human rights organisations and LGBTQ organisations including the Kenya Human Rights Commission and the International Commission of Jurists (Kenya Section) issued a statement on Thursday expressing alarm at the misinformation and disinformation that has followed the Supreme Court ruling. Noting that the Kenyan Constitution “expressly prohibits incitement to violence, discrimination and vilification of others or incitement to cause harm”, they said that there have been “increasing incidents of malicious online and offline comments, profiling and public demonstrations against persons who identify as intersex, gay, lesbian or non-binary, and the personal details of LGBTQ+ citizens and their family members are being openly shared and intimidated online, violating the right to privacy and human dignity”. Evacuation requests “Citizens are reporting confrontations with landlords and employers. They are increasing requests for evacuation, relocation and psychotherapy, while legal and health services and officers are having to close due to safety concerns, organisations have been responding to no less than 117 homophobic cases in the last month,” they noted. Meanwhile, the United Nations Human Rights Office urged the Ugandan parliament to refrain from passing an anti-homosexuality bill, adding that “the State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity”. We urge the Uganda Parliament to refrain from passing an Anti-Homosexuality bill. The State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity. — UN Human Rights (@UNHumanRights) February 28, 2023 HIV targets far off track In 2021, the UN adopted a Polical Declaration on HIV and AIDS that committed member states to “ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services” by 2025. However, this goal is far form being realised with 67 of the 134 reporting countries still criminalizing consensual same-sex sexual activity and 20 criminalizing and/or prosecuting transgender people. “Criminalisation drives discrimination and structural inequalities. It robs people of the prospect of healthy and fulfilling lives. And it holds back the end of AIDS,” said UNAIDS. Image Credits: Twitter. WHO Executive Board to Meet on Fate of Western Pacific Regional Director After Countries Vote to Remove Him from Post 03/03/2023 Elaine Ruth Fletcher The World Health Organization’s 152nd Executive Board meeting in February 2023 – now set to convene again in a special closed session next week. WHO’s Executive Board is set to meet again next week in a special closed session to consider the fate of the Regional Director of WHO’s Western Pacific Regional Office (WPRO), who has been accused of racism and harassment of staff at the Manila-based office. In a meeting earlier this week, WHO member states from the Asian Pacific region reportedly voted by a narrow margin to remove Dr Takeshi Kasai from his post as Regional Director, Health Policy Watch has learned. WHO did not comment on the report, which was corroborated by multiple sources. The special EB session is set to meet on the matter on 6th and 7th March in line with the mandate outlined in a memorandum circulated last month at the 152nd regular session of the WHO governing board. The EB memorandum stated that a special session would be convened “should such sessions be required to consider the outcome of the investigation process in respect of allegations concerning the Regional Director for the Western Pacific”. Directors in all six WHO’s regional offices are elected by the member states of the region in which they serve and then these appointments are confirmed by the WHO Executive Board, with the regional director’s contract issued by the WHO Director General. Investigation of Regional Director is on agenda In the wake of the vote by the WPRO to remove Kasai from his position as Regional Director, the EB would be almost certainly be bound by WHO rules to confirm his removal from the post. They would also have to recommend to WHO Director-General Dr Tedros Adhanom Ghebreyesus what other steps to take regarding Kasai’s future as a WHO staff member. The WHO investigation has corroborated at least four of the allegations that had been brought against the Kasai, according to sources. However Japan, a major WHO donor, led the minority faction against Kasai’s removal in the regional meeting and can be expected to muster significant political pressure against further action. The EB memo from early February does not elaborate publicly, however on what steps might be considered, stating only that: “The procedure for considering the findings of the investigation and related decisions, reflecting the advice of the Independent Expert Oversight Advisory Committee, was set out in the confidential briefing note of 16 November 2022 ….. and was discussed at the informal briefing for members of the Board held on 29 November 2022.” The vote by a WHO Regional Committee to remove an elected director on the basis of such allegations is unprecedented in WHO´s history. Put on administrative leave in 2022 Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference in 2021. In September 2022 Kasai was put on administrative leave by WHO after the formal investigation was launched into a range of staff allegations against him. At the time, WHO did not specify the reasons for Kasai’s indefinite removal, stating only that: “WHO is not in a position to comment on matters pertaining to ongoing investigations.” The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia. During his absence, WHO Deputy Director-General Dr Zsuzsanna Jakab has been overseeing the administration of the Regional Office. ‘Toxic’ atmosphere A medical doctor, Kasai, was alleged to have been presiding over a “toxic atmosphere” at the WHO regional office in Manila, “with a culture of systemic bullying and public ridiculing.” The allegations first came to light in an Associated Press report, published in January 2022. According to AP, more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of WHO’s Executive Board. However, Kasai denied using racist language or any other wrongdoing. Kasai began his term as regional director on 1 February 2019 after more than 15 years in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014. WHO Internal justice system in spotlight Over the past two years, WHO’s internal management of complaints around harassment, both sexual and managerial, has been the focus of increased scrutiny in the wake of a string of scandals and media reports involving senior and mid-senior WHO officials. Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo. Since then, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022. Those allegations involved WHO official Dr Temo Waqanivalu, who had reportedly been eyeing a run as a candidate to replace Kasai as the next WPRO Regional Director. In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide. But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO. Image Credits: WHO. Child and Adolescent Obesity Rising More Sharply Than In Other Age Groups 02/03/2023 Elaine Ruth Fletcher Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today. More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation. About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March. Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added. “The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states. And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people. About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035. Obesity trends among boys and girls aged 5-19 years. “A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns. Low and middle income countries among the most vulnerable to rising obesity Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found. It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension. Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life. By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity. And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment. The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children. At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks. Image Credits: Commons , World Obesity Atlast . U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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WHO Chief Is First Top UN Official to Visit Northwest Syria in 12 Years 03/03/2023 Stefan Anderson WHO Director-General Tedros Adhanom Ghebreyesus (centre) is the first top UN official to visit Syria since the start of its civil war. World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus is the first senior United Nations (UN) official to visit northwest Syria since the war began 12 years ago. The visit was a bid to underline the organization’s commitment to the region, which has provided around a third of all medicines to arrive in northwest Syria in the past decade. Since the earthquake, that number has risen to two-thirds. According to the UN, the devastating earthquakes have killed at least 50,000 people across Turkey and Syria. Tens of thousands more are still missing, hundreds of thousands have been left homeless, and thousands of families are yet to be reunited. “The suffering is impossible to describe in words or even in pictures,” Tedros said at a Friday press briefing. “The destruction is immense.” While NGOs and local authorities expressed gratitude for the WHO chief’s visit, they also voiced deep “disappointment” in the UN’s high-level team for avoiding setting foot in the region since the beginning of the war. The scale of devastation in Turkey has been extreme, counting at least 44,000 deaths and $34.2 billion in infrastructural damage. A World Bank report published on Monday estimated the costs of reconstruction and economic disruption will likely cost twice that amount. In Syria, about 6,000 people have been confirmed dead, mostly in the rebel-held northwest. But while the challenges and trauma faced on both sides of the Turkish-Syrian border are similar, the Syrians are working with far fewer resources. “Twelve years of war has destroyed infrastructure, homes and hope,” Tedros said, “Drought, economic collapse, the COVID-19 pandemic, and the ongoing cholera outbreak have heaped misery upon misery. The risks now being faced by people on the Syrian side are far higher than those living just a few kilometers away.” The @UN says that $54 bn are needed to meet the basic needs of the world’s most vulnerable, but the UN doesn’t expect to raise even half of that. @UNReliefChief tells me “how do you choose between a school & a clinic, how do you choose between food & nutritional support”. pic.twitter.com/lXu6rh0Cow — Isa Soares (@IsaCNN) February 22, 2023 Before the earthquakes, 15.3 million Syrians – 70% of the country’s population – needed of humanitarian assistance. Price increases of more than 800% in the past two years had driven another 90% below the poverty line and led to food insecurity for 12.4 million people. In an address to the UN Security Council on Tuesday, UN Emergency Relief Coordinator Martin Griffiths called the situation in Syria an “almost unbelievable tragedy.” “Amid the harsh winter season, the earthquake has destroyed entire neighborhoods, rendering them uninhabitable … In many areas, four to five families are packed into tents,” Griffiths said. “The risk of disease is growing amid pre-existing cholera outbreaks. Women and children face increased harassment, violence, and risk of exploitation.” UN efforts to mobilize international relief funding are underway, but underfunded. The emergency appeal for $397.6 million in aid for Syrian quake victims has raised just 42% of its target. Meanwhile, the 2023 Syria Humanitarian Response Plan – the largest humanitarian appeal in the world – needs $4.8 billion to address needs pre-dating the earthquake. I met Mohammed, 15 years old, who jumped out of a window during the earthquake and broke his arms. He had surgery at Aaqrabate orthopedic hospital, after our visit. The surgery went well. I’m in awe of the doctors in north-west #Syria. @WHO will support them in any way possible. pic.twitter.com/FVc44Z46Nv — Tedros Adhanom Ghebreyesus (@DrTedros) March 2, 2023 Children have also been caught in the crossfire, with thousands separated from their parents, without access to education, or displaced from their homes. “I met a 15-year-old boy who broke his arms when he jumped out of a window during the earthquake,” Tedros said. “He hasn’t been to school since he was nine years old.” With world leaders set to gather for a donor conference in Brussels next week on the 12th anniversary of the Syrian war, Tedros called on the international community to confront the humanitarian crisis. “The Syrian people have suffered more than most people ever will, or ever could,” he said. “Their needs, dreams and hopes are the same as all people; for health, food, water, shelter, and peace for a better future for their children.” Image Credits: WHO. Former WHO Assistant Director General Ranieri Guerra Indicted in Italy 03/03/2023 Elaine Ruth Fletcher WHO Assistant Director General, Ranieri Guerra Italian prosecutors in Bergamo have indicted Ranieri Guerra, a former World Health Organization (WHO) Assistant Director General, for making false statements before a public prosecutor about his role in the suppression of a major WHO report on Italy’s response to the pandemic. The WHO report had criticized the Italian government for failing to update a pandemic preparedness plan prior to the COVID outbreak – and at a time when Guerra was in fact in charge of updating the plan as the Italian Ministry of Health’s General Director for Prevention. Published on WHO’s website on May 13, 2020, and deleted a day later, the 102-page report “An Unprecedented Challenge”, revealed that the country’s pandemic preparedness plan had not been updated since 2006 – despite European Union instructions to countries to update their plans in 2013-2014 – when Guerra was in charge. “Just one word: Finally,” tweeted Francesco Zambon, the whistleblower who left WHO in protest over the suppression of the report, in response to news of the indictments. Speaking to Health Policy Watch, Zambon added that “after three years no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which concerned some of the most senior officials in the organization.” Solo una parola: finalmente.Non dimentichiamoci delle guerre di casa nostra#COVID19 #Italia #bergamo #Russia #UkraineRussiaWar pic.twitter.com/E1mTCMRMYL — Francesco Zambon (@frazambon) March 1, 2023 Guerra, a WHO ADG for special initiatives, was dispatched exceptionally by WHO’s Director General Dr Tedros Adhanom Ghebreyesus to Italy in early 2020 to support the initial phase of the country’s pandemic response – as one of the first and hardest hit countries in the world initially. A few months later, WHO’s Venice Office, under the direction of Francesco Zambon prepared an independent WHO report on Italy’s pandemic response, that frankly addressed Italy’s lack of an updated preparedness plan, in just a few phrases. After seeing a draft of the report, Guerra demanded that the language referring to the lack of preparedness, be redacted. When Zambon refused, the report was deleted from WHO’s website – only a day after its publication. At the time, Guerra publicly denied that he had had a role in suppressing the report – which had sought to highlight both the successes as well as the weaknesses in Italy’s pandemic response. However a series of publications in both the Italian media and abroad, including in Health Policy Watch, revealed a trail of emails that reflected the pressure Guerra had applied on Zambon and his superiors in WHO’s European Office to have the report redacted and then suppressed. Following that, other revelations in the Italian media suggested that Guerra had even bragged to Italian officials about his role in convincing WHO’s Regional Director for Europe, Hans Kluge and others to delete the report. It was on the basis of those communications that Guerra was finally indicted by Bergamo legal authorities. WHO, meanwhile, staunchly stood by Guerra, refusing to answer questions about his role – citing UN immunity. Zambon ultimately resigned in protest after being frozen out of his management role at the Venice office. Speaking to Health Policy Watch on Friday, Zambon said of the indictment: “Yes, it is quite a big thing actually. It would be worth noting that, after three years, no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which was about the highest officials in the organization. “Nor was any apology provided to me for being a whistleblower who tried to protect WHO from scandals. To the very contrary, WHO continues stating I am not a whistleblower as – in their opinion – there was no retaliation. Even Transparency International and 40plus organizations wrote to Tedros about this untenable position. They never got a reply. “WHO lost a huge opportunity of being a credible and transparent agency towards national authorities. Also not being compliant with the same privileges that it benefits from, which unequivocally states that immunity MUST be waived when interfering with a national investigation. This certainly was the case. “I wonder and I ask citizens of the world: where is WHO’S accountability? How much should the world wait for having a ground-shaking reform permitting WHO to be at the ethical standard it should be?” Reportedly Guerra is also under investigation for “neglect of official duties” in relation to his failure to update the 2006 pandemic preparedness plan during the time in which he served as head of prevention. Sharp Rise in Homophobia in East Africa Sparks Fear of Violence 03/03/2023 Kerry Cullinan UNAIDS Executive Director Winnie Byanyima (left), has warned that laws criminalising same-sex relationships are exacerbating HIV. Over the past week, there has been a steep rise in anti-LGBTQ activity organised by prominent politicians and religious leaders in Kenya and Uganda, which has sparked condemnation by health and human rights activists and fears that this will result in violence. On Thursday, Kenya’s newly elected evangelical president, William Ruto, said he would not allow “homosexual acts or same-sex marriage” during his term. His remarks came after an outcry led by conservative Christian and Muslim groups after last week’s Supreme Court judgement confirming that LGBTQ people had the right of association and that the NGO Board’s decision to bar LGBTQ people from forming recognised groups is discriminatory. Meanwhile, Ugandan opposition Member of Parliament Asuman Basalirwa tabled a private Member’s Bill in that country’s parliament on Tuesday seeking life in prison for homosexuality. That same day, Anitah Among, Uganda’s Speaker of Parliament and a prominent member of the ruling party, told religious leaders that “a Bill will be introduced as soon as possible to deal with homosexuality and lesbianism”, and that voting on it would be “by show of hands” not secret ballot. This followed a national anti-homosexuality protest on 24 February called by the Uganda Muslim Supreme Council. The Uganda Muslim Supreme Council held a national protest against homosexuality on 24 February. Fuelling HIV Ironically, the anti-LGBTQ frenzy coincided with Zero Discrimination Day on 1 March, when UNAIDS highlighted the need to remove laws that criminalise people living with HIV and “key populations”, its term for those most vulnerable to HIV, including LGBTQ people. “Criminalizing laws chase people away from life-saving treatment. Those need to be removed,” said Winnie Byanyima, Executive Director of UNAIDS. Byanyima added that “at the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.” Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalise same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions. ‘Homo-hysteria’ “The current wave of homo-hysteria in Kenya began earlier this year with the death of [gay activist and fashion designer] Edwin Chiloba,” human rights lawyer and Amnesty International Kenya Board member Tabitha Saoyo told Health Policy Watch. “This was exacerbated by the Supreme Court judgement favouring LGBTQ groups. What we are now currently witnessing is an attack on the judiciary, massive disinformation on the contents of the judgement coupled with intentional fear, hate and panic from religious groups, politicians and public influencers. “This wave of hate is manifesting through formation of anti-LGBTQ WhatsApp groups, public protests, online threats of rape, death and myriad of other harmful attacks in grassroots communities,” she added. Thirteen Kenyan human rights organisations and LGBTQ organisations including the Kenya Human Rights Commission and the International Commission of Jurists (Kenya Section) issued a statement on Thursday expressing alarm at the misinformation and disinformation that has followed the Supreme Court ruling. Noting that the Kenyan Constitution “expressly prohibits incitement to violence, discrimination and vilification of others or incitement to cause harm”, they said that there have been “increasing incidents of malicious online and offline comments, profiling and public demonstrations against persons who identify as intersex, gay, lesbian or non-binary, and the personal details of LGBTQ+ citizens and their family members are being openly shared and intimidated online, violating the right to privacy and human dignity”. Evacuation requests “Citizens are reporting confrontations with landlords and employers. They are increasing requests for evacuation, relocation and psychotherapy, while legal and health services and officers are having to close due to safety concerns, organisations have been responding to no less than 117 homophobic cases in the last month,” they noted. Meanwhile, the United Nations Human Rights Office urged the Ugandan parliament to refrain from passing an anti-homosexuality bill, adding that “the State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity”. We urge the Uganda Parliament to refrain from passing an Anti-Homosexuality bill. The State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity. — UN Human Rights (@UNHumanRights) February 28, 2023 HIV targets far off track In 2021, the UN adopted a Polical Declaration on HIV and AIDS that committed member states to “ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services” by 2025. However, this goal is far form being realised with 67 of the 134 reporting countries still criminalizing consensual same-sex sexual activity and 20 criminalizing and/or prosecuting transgender people. “Criminalisation drives discrimination and structural inequalities. It robs people of the prospect of healthy and fulfilling lives. And it holds back the end of AIDS,” said UNAIDS. Image Credits: Twitter. WHO Executive Board to Meet on Fate of Western Pacific Regional Director After Countries Vote to Remove Him from Post 03/03/2023 Elaine Ruth Fletcher The World Health Organization’s 152nd Executive Board meeting in February 2023 – now set to convene again in a special closed session next week. WHO’s Executive Board is set to meet again next week in a special closed session to consider the fate of the Regional Director of WHO’s Western Pacific Regional Office (WPRO), who has been accused of racism and harassment of staff at the Manila-based office. In a meeting earlier this week, WHO member states from the Asian Pacific region reportedly voted by a narrow margin to remove Dr Takeshi Kasai from his post as Regional Director, Health Policy Watch has learned. WHO did not comment on the report, which was corroborated by multiple sources. The special EB session is set to meet on the matter on 6th and 7th March in line with the mandate outlined in a memorandum circulated last month at the 152nd regular session of the WHO governing board. The EB memorandum stated that a special session would be convened “should such sessions be required to consider the outcome of the investigation process in respect of allegations concerning the Regional Director for the Western Pacific”. Directors in all six WHO’s regional offices are elected by the member states of the region in which they serve and then these appointments are confirmed by the WHO Executive Board, with the regional director’s contract issued by the WHO Director General. Investigation of Regional Director is on agenda In the wake of the vote by the WPRO to remove Kasai from his position as Regional Director, the EB would be almost certainly be bound by WHO rules to confirm his removal from the post. They would also have to recommend to WHO Director-General Dr Tedros Adhanom Ghebreyesus what other steps to take regarding Kasai’s future as a WHO staff member. The WHO investigation has corroborated at least four of the allegations that had been brought against the Kasai, according to sources. However Japan, a major WHO donor, led the minority faction against Kasai’s removal in the regional meeting and can be expected to muster significant political pressure against further action. The EB memo from early February does not elaborate publicly, however on what steps might be considered, stating only that: “The procedure for considering the findings of the investigation and related decisions, reflecting the advice of the Independent Expert Oversight Advisory Committee, was set out in the confidential briefing note of 16 November 2022 ….. and was discussed at the informal briefing for members of the Board held on 29 November 2022.” The vote by a WHO Regional Committee to remove an elected director on the basis of such allegations is unprecedented in WHO´s history. Put on administrative leave in 2022 Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference in 2021. In September 2022 Kasai was put on administrative leave by WHO after the formal investigation was launched into a range of staff allegations against him. At the time, WHO did not specify the reasons for Kasai’s indefinite removal, stating only that: “WHO is not in a position to comment on matters pertaining to ongoing investigations.” The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia. During his absence, WHO Deputy Director-General Dr Zsuzsanna Jakab has been overseeing the administration of the Regional Office. ‘Toxic’ atmosphere A medical doctor, Kasai, was alleged to have been presiding over a “toxic atmosphere” at the WHO regional office in Manila, “with a culture of systemic bullying and public ridiculing.” The allegations first came to light in an Associated Press report, published in January 2022. According to AP, more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of WHO’s Executive Board. However, Kasai denied using racist language or any other wrongdoing. Kasai began his term as regional director on 1 February 2019 after more than 15 years in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014. WHO Internal justice system in spotlight Over the past two years, WHO’s internal management of complaints around harassment, both sexual and managerial, has been the focus of increased scrutiny in the wake of a string of scandals and media reports involving senior and mid-senior WHO officials. Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo. Since then, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022. Those allegations involved WHO official Dr Temo Waqanivalu, who had reportedly been eyeing a run as a candidate to replace Kasai as the next WPRO Regional Director. In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide. But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO. Image Credits: WHO. Child and Adolescent Obesity Rising More Sharply Than In Other Age Groups 02/03/2023 Elaine Ruth Fletcher Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today. More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation. About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March. Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added. “The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states. And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people. About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035. Obesity trends among boys and girls aged 5-19 years. “A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns. Low and middle income countries among the most vulnerable to rising obesity Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found. It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension. Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life. By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity. And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment. The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children. At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks. Image Credits: Commons , World Obesity Atlast . U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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Former WHO Assistant Director General Ranieri Guerra Indicted in Italy 03/03/2023 Elaine Ruth Fletcher WHO Assistant Director General, Ranieri Guerra Italian prosecutors in Bergamo have indicted Ranieri Guerra, a former World Health Organization (WHO) Assistant Director General, for making false statements before a public prosecutor about his role in the suppression of a major WHO report on Italy’s response to the pandemic. The WHO report had criticized the Italian government for failing to update a pandemic preparedness plan prior to the COVID outbreak – and at a time when Guerra was in fact in charge of updating the plan as the Italian Ministry of Health’s General Director for Prevention. Published on WHO’s website on May 13, 2020, and deleted a day later, the 102-page report “An Unprecedented Challenge”, revealed that the country’s pandemic preparedness plan had not been updated since 2006 – despite European Union instructions to countries to update their plans in 2013-2014 – when Guerra was in charge. “Just one word: Finally,” tweeted Francesco Zambon, the whistleblower who left WHO in protest over the suppression of the report, in response to news of the indictments. Speaking to Health Policy Watch, Zambon added that “after three years no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which concerned some of the most senior officials in the organization.” Solo una parola: finalmente.Non dimentichiamoci delle guerre di casa nostra#COVID19 #Italia #bergamo #Russia #UkraineRussiaWar pic.twitter.com/E1mTCMRMYL — Francesco Zambon (@frazambon) March 1, 2023 Guerra, a WHO ADG for special initiatives, was dispatched exceptionally by WHO’s Director General Dr Tedros Adhanom Ghebreyesus to Italy in early 2020 to support the initial phase of the country’s pandemic response – as one of the first and hardest hit countries in the world initially. A few months later, WHO’s Venice Office, under the direction of Francesco Zambon prepared an independent WHO report on Italy’s pandemic response, that frankly addressed Italy’s lack of an updated preparedness plan, in just a few phrases. After seeing a draft of the report, Guerra demanded that the language referring to the lack of preparedness, be redacted. When Zambon refused, the report was deleted from WHO’s website – only a day after its publication. At the time, Guerra publicly denied that he had had a role in suppressing the report – which had sought to highlight both the successes as well as the weaknesses in Italy’s pandemic response. However a series of publications in both the Italian media and abroad, including in Health Policy Watch, revealed a trail of emails that reflected the pressure Guerra had applied on Zambon and his superiors in WHO’s European Office to have the report redacted and then suppressed. Following that, other revelations in the Italian media suggested that Guerra had even bragged to Italian officials about his role in convincing WHO’s Regional Director for Europe, Hans Kluge and others to delete the report. It was on the basis of those communications that Guerra was finally indicted by Bergamo legal authorities. WHO, meanwhile, staunchly stood by Guerra, refusing to answer questions about his role – citing UN immunity. Zambon ultimately resigned in protest after being frozen out of his management role at the Venice office. Speaking to Health Policy Watch on Friday, Zambon said of the indictment: “Yes, it is quite a big thing actually. It would be worth noting that, after three years, no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which was about the highest officials in the organization. “Nor was any apology provided to me for being a whistleblower who tried to protect WHO from scandals. To the very contrary, WHO continues stating I am not a whistleblower as – in their opinion – there was no retaliation. Even Transparency International and 40plus organizations wrote to Tedros about this untenable position. They never got a reply. “WHO lost a huge opportunity of being a credible and transparent agency towards national authorities. Also not being compliant with the same privileges that it benefits from, which unequivocally states that immunity MUST be waived when interfering with a national investigation. This certainly was the case. “I wonder and I ask citizens of the world: where is WHO’S accountability? How much should the world wait for having a ground-shaking reform permitting WHO to be at the ethical standard it should be?” Reportedly Guerra is also under investigation for “neglect of official duties” in relation to his failure to update the 2006 pandemic preparedness plan during the time in which he served as head of prevention. Sharp Rise in Homophobia in East Africa Sparks Fear of Violence 03/03/2023 Kerry Cullinan UNAIDS Executive Director Winnie Byanyima (left), has warned that laws criminalising same-sex relationships are exacerbating HIV. Over the past week, there has been a steep rise in anti-LGBTQ activity organised by prominent politicians and religious leaders in Kenya and Uganda, which has sparked condemnation by health and human rights activists and fears that this will result in violence. On Thursday, Kenya’s newly elected evangelical president, William Ruto, said he would not allow “homosexual acts or same-sex marriage” during his term. His remarks came after an outcry led by conservative Christian and Muslim groups after last week’s Supreme Court judgement confirming that LGBTQ people had the right of association and that the NGO Board’s decision to bar LGBTQ people from forming recognised groups is discriminatory. Meanwhile, Ugandan opposition Member of Parliament Asuman Basalirwa tabled a private Member’s Bill in that country’s parliament on Tuesday seeking life in prison for homosexuality. That same day, Anitah Among, Uganda’s Speaker of Parliament and a prominent member of the ruling party, told religious leaders that “a Bill will be introduced as soon as possible to deal with homosexuality and lesbianism”, and that voting on it would be “by show of hands” not secret ballot. This followed a national anti-homosexuality protest on 24 February called by the Uganda Muslim Supreme Council. The Uganda Muslim Supreme Council held a national protest against homosexuality on 24 February. Fuelling HIV Ironically, the anti-LGBTQ frenzy coincided with Zero Discrimination Day on 1 March, when UNAIDS highlighted the need to remove laws that criminalise people living with HIV and “key populations”, its term for those most vulnerable to HIV, including LGBTQ people. “Criminalizing laws chase people away from life-saving treatment. Those need to be removed,” said Winnie Byanyima, Executive Director of UNAIDS. Byanyima added that “at the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.” Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalise same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions. ‘Homo-hysteria’ “The current wave of homo-hysteria in Kenya began earlier this year with the death of [gay activist and fashion designer] Edwin Chiloba,” human rights lawyer and Amnesty International Kenya Board member Tabitha Saoyo told Health Policy Watch. “This was exacerbated by the Supreme Court judgement favouring LGBTQ groups. What we are now currently witnessing is an attack on the judiciary, massive disinformation on the contents of the judgement coupled with intentional fear, hate and panic from religious groups, politicians and public influencers. “This wave of hate is manifesting through formation of anti-LGBTQ WhatsApp groups, public protests, online threats of rape, death and myriad of other harmful attacks in grassroots communities,” she added. Thirteen Kenyan human rights organisations and LGBTQ organisations including the Kenya Human Rights Commission and the International Commission of Jurists (Kenya Section) issued a statement on Thursday expressing alarm at the misinformation and disinformation that has followed the Supreme Court ruling. Noting that the Kenyan Constitution “expressly prohibits incitement to violence, discrimination and vilification of others or incitement to cause harm”, they said that there have been “increasing incidents of malicious online and offline comments, profiling and public demonstrations against persons who identify as intersex, gay, lesbian or non-binary, and the personal details of LGBTQ+ citizens and their family members are being openly shared and intimidated online, violating the right to privacy and human dignity”. Evacuation requests “Citizens are reporting confrontations with landlords and employers. They are increasing requests for evacuation, relocation and psychotherapy, while legal and health services and officers are having to close due to safety concerns, organisations have been responding to no less than 117 homophobic cases in the last month,” they noted. Meanwhile, the United Nations Human Rights Office urged the Ugandan parliament to refrain from passing an anti-homosexuality bill, adding that “the State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity”. We urge the Uganda Parliament to refrain from passing an Anti-Homosexuality bill. The State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity. — UN Human Rights (@UNHumanRights) February 28, 2023 HIV targets far off track In 2021, the UN adopted a Polical Declaration on HIV and AIDS that committed member states to “ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services” by 2025. However, this goal is far form being realised with 67 of the 134 reporting countries still criminalizing consensual same-sex sexual activity and 20 criminalizing and/or prosecuting transgender people. “Criminalisation drives discrimination and structural inequalities. It robs people of the prospect of healthy and fulfilling lives. And it holds back the end of AIDS,” said UNAIDS. Image Credits: Twitter. WHO Executive Board to Meet on Fate of Western Pacific Regional Director After Countries Vote to Remove Him from Post 03/03/2023 Elaine Ruth Fletcher The World Health Organization’s 152nd Executive Board meeting in February 2023 – now set to convene again in a special closed session next week. WHO’s Executive Board is set to meet again next week in a special closed session to consider the fate of the Regional Director of WHO’s Western Pacific Regional Office (WPRO), who has been accused of racism and harassment of staff at the Manila-based office. In a meeting earlier this week, WHO member states from the Asian Pacific region reportedly voted by a narrow margin to remove Dr Takeshi Kasai from his post as Regional Director, Health Policy Watch has learned. WHO did not comment on the report, which was corroborated by multiple sources. The special EB session is set to meet on the matter on 6th and 7th March in line with the mandate outlined in a memorandum circulated last month at the 152nd regular session of the WHO governing board. The EB memorandum stated that a special session would be convened “should such sessions be required to consider the outcome of the investigation process in respect of allegations concerning the Regional Director for the Western Pacific”. Directors in all six WHO’s regional offices are elected by the member states of the region in which they serve and then these appointments are confirmed by the WHO Executive Board, with the regional director’s contract issued by the WHO Director General. Investigation of Regional Director is on agenda In the wake of the vote by the WPRO to remove Kasai from his position as Regional Director, the EB would be almost certainly be bound by WHO rules to confirm his removal from the post. They would also have to recommend to WHO Director-General Dr Tedros Adhanom Ghebreyesus what other steps to take regarding Kasai’s future as a WHO staff member. The WHO investigation has corroborated at least four of the allegations that had been brought against the Kasai, according to sources. However Japan, a major WHO donor, led the minority faction against Kasai’s removal in the regional meeting and can be expected to muster significant political pressure against further action. The EB memo from early February does not elaborate publicly, however on what steps might be considered, stating only that: “The procedure for considering the findings of the investigation and related decisions, reflecting the advice of the Independent Expert Oversight Advisory Committee, was set out in the confidential briefing note of 16 November 2022 ….. and was discussed at the informal briefing for members of the Board held on 29 November 2022.” The vote by a WHO Regional Committee to remove an elected director on the basis of such allegations is unprecedented in WHO´s history. Put on administrative leave in 2022 Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference in 2021. In September 2022 Kasai was put on administrative leave by WHO after the formal investigation was launched into a range of staff allegations against him. At the time, WHO did not specify the reasons for Kasai’s indefinite removal, stating only that: “WHO is not in a position to comment on matters pertaining to ongoing investigations.” The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia. During his absence, WHO Deputy Director-General Dr Zsuzsanna Jakab has been overseeing the administration of the Regional Office. ‘Toxic’ atmosphere A medical doctor, Kasai, was alleged to have been presiding over a “toxic atmosphere” at the WHO regional office in Manila, “with a culture of systemic bullying and public ridiculing.” The allegations first came to light in an Associated Press report, published in January 2022. According to AP, more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of WHO’s Executive Board. However, Kasai denied using racist language or any other wrongdoing. Kasai began his term as regional director on 1 February 2019 after more than 15 years in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014. WHO Internal justice system in spotlight Over the past two years, WHO’s internal management of complaints around harassment, both sexual and managerial, has been the focus of increased scrutiny in the wake of a string of scandals and media reports involving senior and mid-senior WHO officials. Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo. Since then, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022. Those allegations involved WHO official Dr Temo Waqanivalu, who had reportedly been eyeing a run as a candidate to replace Kasai as the next WPRO Regional Director. In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide. But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO. Image Credits: WHO. Child and Adolescent Obesity Rising More Sharply Than In Other Age Groups 02/03/2023 Elaine Ruth Fletcher Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today. More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation. About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March. Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added. “The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states. And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people. About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035. Obesity trends among boys and girls aged 5-19 years. “A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns. Low and middle income countries among the most vulnerable to rising obesity Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found. It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension. Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life. By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity. And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment. The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children. At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks. Image Credits: Commons , World Obesity Atlast . U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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Sharp Rise in Homophobia in East Africa Sparks Fear of Violence 03/03/2023 Kerry Cullinan UNAIDS Executive Director Winnie Byanyima (left), has warned that laws criminalising same-sex relationships are exacerbating HIV. Over the past week, there has been a steep rise in anti-LGBTQ activity organised by prominent politicians and religious leaders in Kenya and Uganda, which has sparked condemnation by health and human rights activists and fears that this will result in violence. On Thursday, Kenya’s newly elected evangelical president, William Ruto, said he would not allow “homosexual acts or same-sex marriage” during his term. His remarks came after an outcry led by conservative Christian and Muslim groups after last week’s Supreme Court judgement confirming that LGBTQ people had the right of association and that the NGO Board’s decision to bar LGBTQ people from forming recognised groups is discriminatory. Meanwhile, Ugandan opposition Member of Parliament Asuman Basalirwa tabled a private Member’s Bill in that country’s parliament on Tuesday seeking life in prison for homosexuality. That same day, Anitah Among, Uganda’s Speaker of Parliament and a prominent member of the ruling party, told religious leaders that “a Bill will be introduced as soon as possible to deal with homosexuality and lesbianism”, and that voting on it would be “by show of hands” not secret ballot. This followed a national anti-homosexuality protest on 24 February called by the Uganda Muslim Supreme Council. The Uganda Muslim Supreme Council held a national protest against homosexuality on 24 February. Fuelling HIV Ironically, the anti-LGBTQ frenzy coincided with Zero Discrimination Day on 1 March, when UNAIDS highlighted the need to remove laws that criminalise people living with HIV and “key populations”, its term for those most vulnerable to HIV, including LGBTQ people. “Criminalizing laws chase people away from life-saving treatment. Those need to be removed,” said Winnie Byanyima, Executive Director of UNAIDS. Byanyima added that “at the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.” Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalise same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions. ‘Homo-hysteria’ “The current wave of homo-hysteria in Kenya began earlier this year with the death of [gay activist and fashion designer] Edwin Chiloba,” human rights lawyer and Amnesty International Kenya Board member Tabitha Saoyo told Health Policy Watch. “This was exacerbated by the Supreme Court judgement favouring LGBTQ groups. What we are now currently witnessing is an attack on the judiciary, massive disinformation on the contents of the judgement coupled with intentional fear, hate and panic from religious groups, politicians and public influencers. “This wave of hate is manifesting through formation of anti-LGBTQ WhatsApp groups, public protests, online threats of rape, death and myriad of other harmful attacks in grassroots communities,” she added. Thirteen Kenyan human rights organisations and LGBTQ organisations including the Kenya Human Rights Commission and the International Commission of Jurists (Kenya Section) issued a statement on Thursday expressing alarm at the misinformation and disinformation that has followed the Supreme Court ruling. Noting that the Kenyan Constitution “expressly prohibits incitement to violence, discrimination and vilification of others or incitement to cause harm”, they said that there have been “increasing incidents of malicious online and offline comments, profiling and public demonstrations against persons who identify as intersex, gay, lesbian or non-binary, and the personal details of LGBTQ+ citizens and their family members are being openly shared and intimidated online, violating the right to privacy and human dignity”. Evacuation requests “Citizens are reporting confrontations with landlords and employers. They are increasing requests for evacuation, relocation and psychotherapy, while legal and health services and officers are having to close due to safety concerns, organisations have been responding to no less than 117 homophobic cases in the last month,” they noted. Meanwhile, the United Nations Human Rights Office urged the Ugandan parliament to refrain from passing an anti-homosexuality bill, adding that “the State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity”. We urge the Uganda Parliament to refrain from passing an Anti-Homosexuality bill. The State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity. — UN Human Rights (@UNHumanRights) February 28, 2023 HIV targets far off track In 2021, the UN adopted a Polical Declaration on HIV and AIDS that committed member states to “ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services” by 2025. However, this goal is far form being realised with 67 of the 134 reporting countries still criminalizing consensual same-sex sexual activity and 20 criminalizing and/or prosecuting transgender people. “Criminalisation drives discrimination and structural inequalities. It robs people of the prospect of healthy and fulfilling lives. And it holds back the end of AIDS,” said UNAIDS. Image Credits: Twitter. WHO Executive Board to Meet on Fate of Western Pacific Regional Director After Countries Vote to Remove Him from Post 03/03/2023 Elaine Ruth Fletcher The World Health Organization’s 152nd Executive Board meeting in February 2023 – now set to convene again in a special closed session next week. WHO’s Executive Board is set to meet again next week in a special closed session to consider the fate of the Regional Director of WHO’s Western Pacific Regional Office (WPRO), who has been accused of racism and harassment of staff at the Manila-based office. In a meeting earlier this week, WHO member states from the Asian Pacific region reportedly voted by a narrow margin to remove Dr Takeshi Kasai from his post as Regional Director, Health Policy Watch has learned. WHO did not comment on the report, which was corroborated by multiple sources. The special EB session is set to meet on the matter on 6th and 7th March in line with the mandate outlined in a memorandum circulated last month at the 152nd regular session of the WHO governing board. The EB memorandum stated that a special session would be convened “should such sessions be required to consider the outcome of the investigation process in respect of allegations concerning the Regional Director for the Western Pacific”. Directors in all six WHO’s regional offices are elected by the member states of the region in which they serve and then these appointments are confirmed by the WHO Executive Board, with the regional director’s contract issued by the WHO Director General. Investigation of Regional Director is on agenda In the wake of the vote by the WPRO to remove Kasai from his position as Regional Director, the EB would be almost certainly be bound by WHO rules to confirm his removal from the post. They would also have to recommend to WHO Director-General Dr Tedros Adhanom Ghebreyesus what other steps to take regarding Kasai’s future as a WHO staff member. The WHO investigation has corroborated at least four of the allegations that had been brought against the Kasai, according to sources. However Japan, a major WHO donor, led the minority faction against Kasai’s removal in the regional meeting and can be expected to muster significant political pressure against further action. The EB memo from early February does not elaborate publicly, however on what steps might be considered, stating only that: “The procedure for considering the findings of the investigation and related decisions, reflecting the advice of the Independent Expert Oversight Advisory Committee, was set out in the confidential briefing note of 16 November 2022 ….. and was discussed at the informal briefing for members of the Board held on 29 November 2022.” The vote by a WHO Regional Committee to remove an elected director on the basis of such allegations is unprecedented in WHO´s history. Put on administrative leave in 2022 Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference in 2021. In September 2022 Kasai was put on administrative leave by WHO after the formal investigation was launched into a range of staff allegations against him. At the time, WHO did not specify the reasons for Kasai’s indefinite removal, stating only that: “WHO is not in a position to comment on matters pertaining to ongoing investigations.” The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia. During his absence, WHO Deputy Director-General Dr Zsuzsanna Jakab has been overseeing the administration of the Regional Office. ‘Toxic’ atmosphere A medical doctor, Kasai, was alleged to have been presiding over a “toxic atmosphere” at the WHO regional office in Manila, “with a culture of systemic bullying and public ridiculing.” The allegations first came to light in an Associated Press report, published in January 2022. According to AP, more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of WHO’s Executive Board. However, Kasai denied using racist language or any other wrongdoing. Kasai began his term as regional director on 1 February 2019 after more than 15 years in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014. WHO Internal justice system in spotlight Over the past two years, WHO’s internal management of complaints around harassment, both sexual and managerial, has been the focus of increased scrutiny in the wake of a string of scandals and media reports involving senior and mid-senior WHO officials. Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo. Since then, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022. Those allegations involved WHO official Dr Temo Waqanivalu, who had reportedly been eyeing a run as a candidate to replace Kasai as the next WPRO Regional Director. In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide. But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO. Image Credits: WHO. Child and Adolescent Obesity Rising More Sharply Than In Other Age Groups 02/03/2023 Elaine Ruth Fletcher Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today. More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation. About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March. Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added. “The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states. And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people. About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035. Obesity trends among boys and girls aged 5-19 years. “A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns. Low and middle income countries among the most vulnerable to rising obesity Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found. It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension. Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life. By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity. And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment. The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children. At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks. Image Credits: Commons , World Obesity Atlast . U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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WHO Executive Board to Meet on Fate of Western Pacific Regional Director After Countries Vote to Remove Him from Post 03/03/2023 Elaine Ruth Fletcher The World Health Organization’s 152nd Executive Board meeting in February 2023 – now set to convene again in a special closed session next week. WHO’s Executive Board is set to meet again next week in a special closed session to consider the fate of the Regional Director of WHO’s Western Pacific Regional Office (WPRO), who has been accused of racism and harassment of staff at the Manila-based office. In a meeting earlier this week, WHO member states from the Asian Pacific region reportedly voted by a narrow margin to remove Dr Takeshi Kasai from his post as Regional Director, Health Policy Watch has learned. WHO did not comment on the report, which was corroborated by multiple sources. The special EB session is set to meet on the matter on 6th and 7th March in line with the mandate outlined in a memorandum circulated last month at the 152nd regular session of the WHO governing board. The EB memorandum stated that a special session would be convened “should such sessions be required to consider the outcome of the investigation process in respect of allegations concerning the Regional Director for the Western Pacific”. Directors in all six WHO’s regional offices are elected by the member states of the region in which they serve and then these appointments are confirmed by the WHO Executive Board, with the regional director’s contract issued by the WHO Director General. Investigation of Regional Director is on agenda In the wake of the vote by the WPRO to remove Kasai from his position as Regional Director, the EB would be almost certainly be bound by WHO rules to confirm his removal from the post. They would also have to recommend to WHO Director-General Dr Tedros Adhanom Ghebreyesus what other steps to take regarding Kasai’s future as a WHO staff member. The WHO investigation has corroborated at least four of the allegations that had been brought against the Kasai, according to sources. However Japan, a major WHO donor, led the minority faction against Kasai’s removal in the regional meeting and can be expected to muster significant political pressure against further action. The EB memo from early February does not elaborate publicly, however on what steps might be considered, stating only that: “The procedure for considering the findings of the investigation and related decisions, reflecting the advice of the Independent Expert Oversight Advisory Committee, was set out in the confidential briefing note of 16 November 2022 ….. and was discussed at the informal briefing for members of the Board held on 29 November 2022.” The vote by a WHO Regional Committee to remove an elected director on the basis of such allegations is unprecedented in WHO´s history. Put on administrative leave in 2022 Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference in 2021. In September 2022 Kasai was put on administrative leave by WHO after the formal investigation was launched into a range of staff allegations against him. At the time, WHO did not specify the reasons for Kasai’s indefinite removal, stating only that: “WHO is not in a position to comment on matters pertaining to ongoing investigations.” The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia. During his absence, WHO Deputy Director-General Dr Zsuzsanna Jakab has been overseeing the administration of the Regional Office. ‘Toxic’ atmosphere A medical doctor, Kasai, was alleged to have been presiding over a “toxic atmosphere” at the WHO regional office in Manila, “with a culture of systemic bullying and public ridiculing.” The allegations first came to light in an Associated Press report, published in January 2022. According to AP, more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of WHO’s Executive Board. However, Kasai denied using racist language or any other wrongdoing. Kasai began his term as regional director on 1 February 2019 after more than 15 years in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014. WHO Internal justice system in spotlight Over the past two years, WHO’s internal management of complaints around harassment, both sexual and managerial, has been the focus of increased scrutiny in the wake of a string of scandals and media reports involving senior and mid-senior WHO officials. Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo. Since then, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022. Those allegations involved WHO official Dr Temo Waqanivalu, who had reportedly been eyeing a run as a candidate to replace Kasai as the next WPRO Regional Director. In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide. But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO. Image Credits: WHO. Child and Adolescent Obesity Rising More Sharply Than In Other Age Groups 02/03/2023 Elaine Ruth Fletcher Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today. More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation. About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March. Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added. “The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states. And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people. About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035. Obesity trends among boys and girls aged 5-19 years. “A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns. Low and middle income countries among the most vulnerable to rising obesity Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found. It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension. Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life. By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity. And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment. The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children. At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks. Image Credits: Commons , World Obesity Atlast . U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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Child and Adolescent Obesity Rising More Sharply Than In Other Age Groups 02/03/2023 Elaine Ruth Fletcher Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today. More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation. About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March. Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added. “The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states. And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people. About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035. Obesity trends among boys and girls aged 5-19 years. “A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns. Low and middle income countries among the most vulnerable to rising obesity Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found. It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension. Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life. By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity. And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment. The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children. At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks. Image Credits: Commons , World Obesity Atlast . U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
U.S. Government Invested $31.9 Billion in mRNA Vaccine Research and Procurement 02/03/2023 Stefan Anderson COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue. A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21. The study is based upon an extensive analysis of US government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense. Most funds invested in vaccine procurement Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines. While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology. Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development. “The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study. Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines. An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus. After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. “[This is] the largest public investment for a disease ever,” Lalani said. Risks were socialized while financial rewards were privatized A network analysis of COVID-19 mRNA vaccine patents. The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. “In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. “However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.” Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose. Research or share buy-backs? A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development. Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. “Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines. “As this research shows, that claim is a total myth,” she said. What’s the counter? The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed. And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. The medical upside of mRNA The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary. “Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.” The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients. “Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.” Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.” Image Credits: Ajay Suresh, NIH, Nature Biotechnology. Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Africa CDC Promises Smooth Leadership Transition, Expands COVID Vaccination Campaign to Include Other Vaccines 02/03/2023 Paul Adepoju Outgoing Africa CDC Director Ahmed Ogwell Ouma meets WHO Director General Tedros Adhanom Ghebreyesus in Geneva during the May 2022 World Health Assembly. No date has yet been set for the recently-elected Director General of the Africa Centres for Disease Control and Prevention (Africa CDC) Jean Kaseya to take over his new tasks, said acting director Dr Ahmed Ogwell Ouma on Thursday. But he promised that the transition period would be a smooth one, saying: “After the decision by the African Union summit, there are internal processes that continue to be done. And as soon as those have been completed, you will be hearing from us. “Suffice to say that we are in a transition period and Africa CDC continues to work until the incoming leadership is in place,” Ouma told Health Policy Watch at a press briefing on Thursday. Kaseya was electeed as Africa CDC’s new head, in late February on the sidelines of the 36th session of the African Union. A Democratic Republic of Congo national with a seasoned international health career, he beat 179 other candidates, including Ouma, who had been appointed as acting director following the departure of John Nkengasong in May 2022, to head the US President’s Emergency Plan For AIDS Relief (PEPFAR). Africa CDC pivots COVID-19 vaccine campaign to broader aims Vials of Pfizer´s COVID-19 vaccine. Meanwhile, Ouma said that the agency has also extended its COVID-19 vaccination acceleration campaign, the Bingwa Initiative, which was due to end in April, until the end of 2023. That comes even as multiple countries in eastern and southern Africa battle a prolonged cholera outbreak, which WHO has blamed on excessive flooding. Launched in April 2022, the COVID-19 vaccine acceleration campaign originally aimed to have 100 million African citizens vaccinated by April 2023. But as that goal remains far from being achieved, Africa CDC is now also striving to expand the initiative’s scope, Ouma said. Going forward, the initiative, supported by the MasterCard Foundation, the German Development Cooperation Project, UNICEF and others, will not only be utilized to promote COVID-19 vaccination but to promote immunization against other vaccine-preventable diseases, harnessing the energies of a new Africa CDC youth advisory team, he said. “We are extending the Bingwa initiative at least until the end of the year. In fact, we are not only going to utilize this initiative for COVID-19 vaccination, which is the primary objective, but we are going to utilize it for health in general. It is part of the reason why I set up the youth advisory team for health so that we can be able to bring the youth into our work, our strategizing as Africa CDC.” Training of the initiative’s ambassadors is set to begin in South Sudan, in addition to central and western African regions in the coming weeks, he added. “We want to be sure that the youth are firmly part of all our community-based activities going forward as far as leadership is concerned,” he added. Floods exacerbate cholera risks, but poor WASH and vaccine shortages also to blame Dr Matshidiso Moeti, Africa Regional Director at WHO Meanwhile, in a separate briefing, WHO’s Regional Director for Africa said that extreme weather leading to excessive flooding is prolonging the multi-country cholera outbreak in southern and eastern Africa – despite falling case rates over the past week. Addressing journalists on Thursday, Dr Matshidiso Moeti noted that even though weekly cholera cases in the affected African countries are declining, heavy rains in southern Africa continue to raise the risk of disease spread – exacerbating peoples’ exposure to contaminated food and water. “In southern Africa, cholera outbreaks are occurring amid seasonal rains and tropical storms that have caused heavy flooding. While climate change is a key factor, poor water and sanitation more generally, and lack of vaccine access are other critical drivers of the outbreaks, global health experts say. Due to a shortage of cholera vaccines, WHO last year recommended that countries move from a two-dose to one-dose regimen to allow for more people to get at least one jab. And WHO says it has helped facilitate Malawi’s access to some 4.9 million doses since May 2022. But public health officials lament the fact that preventative campaigns were not conducted prior to last year. South Africa, Tanzania and Zimbabwe latest to detect cases Cholera flourishes in dirty water. According to the WHO, 12 African countries are currently reporting cases, with South Africa, Tanzania and Zimbabwe the latest to detect cholera cases. The number of new cholera cases fell to 2880 in the week ending on 26 February, a 37% decline compared with the week before when 4584 cases were recorded. The number of deaths in the same period however remained nearly unchanged, declining marginally from 82 to 81. In Malawi, where cholera has so-far killed 1500 people over the last year, increased rainfall is slowing outbreak control efforts in some areas, with response teams facing difficulty reaching people in need of assistance due to inaccessible roads and infrastructure damage. Some cholera treatment units have been flooded and there has been an increase in cases reported in some locations following the heavy rainfall,” Moeti stated. In Mozambique, WHO’s regional director noted that Tropical Storm Freddy, which made landfall on 24 February, has caused widespread infrastructure damage with over 44,000 people affected, 55 health facilities damaged or destroyed and nearly 3500 km of road damaged. Six out of Mozambique’s 11 districts have been affected by cholera outbreaks and the country has seen a sharp increase in cases since December 2022 amid the ongoing rainy season. “Countries have stepped up cholera control measures and early indications are promising. However, the heavy flooding and cyclonic events in parts of southern Africa risk fuelling the spread of the disease,” said Moeti. “We’re reinforcing our support to countries to increase disease detection capacity, providing medical supplies and stepping up readiness in regions at risk of flooding.” Image Credits: Ahmed Ogwell/Twitter , Photo by Mat Napo on Unsplash, L Pezzoli/ WHO. The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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The World May Agree on a Pandemic Accord, But How Will it be Implemented? 01/03/2023 Editorial team Social distancing squares marked out during the COVID-19 pandemic. As World Health Organization (WHO) member states get into line-by-line negotiations on a proposed pandemic accord to guide the world’s approach to future pandemics, there are growing calls for independent monitoring to ensure that the terms of such an accord are implemented. Layth Hanbali explains. Health Policy Watch: You and other colleagues have noted that the zero draft of the WHO’s Pandemic Accord “contains little on holding countries accountable for the obligations they sign up to” and that it implies that the governing body of the accord would need to “agree to accountability measures after the accord is implemented”. You propose that the accord itself needs to include a mechanism to monitor countries’ compliance, particularly on the legally-binding elements. What should this look like? Layth Hanbali: An independent monitoring committee should consist of a group of experts from a broad range of disciplines who would assess countries’ compliance with their obligations under the pandemic accord and the timeliness, completeness, and robustness of their reporting on these obligations. They would meet regularly (for example, quarterly) to review the available evidence on countries’ compliance, which would include countries’ own reports, shadow reports by non-state actors, and confidential reports. They would be supported by a dedicated secretariat who would work on behalf of the committee to collect and collate data and prepare analyses and reports. HPW: Who would this “independent committee of experts” report to, and how would it be financed? LH: The independent monitoring committee should report to a high-level political body; that means it should consist of, or represent, heads of state. This could, for example, be the proposed Global Health Threats Council or the UN Secretary-General or UN General Assembly. Financing should be through an international or multilateral mechanism or body, such as the UN Secretary-General’s office or the General Assembly or the Pandemic Fund. The important thing is that the funding enables the committee to operate while firewalled from the influence of any political or commercial actors with a vested interest in pandemic preparedness nnd response (PPR). That also means the funding should be ring-fenced, unconditional, up-front, and sustained. HPW: Isn’t this the job of the WHO? LH: The WHO has struggled in the past with calling out countries for failing to fulfil their obligations, such as under the International Health Regulations (IHR). This is partly because it needs to maintain good relations with its members to continue to provide them with the technical support that only WHO can provide. It is therefore not best suited for this kind of function, where it would sometimes be necessary to criticize countries transparently. An independent monitoring mechanism taking on this responsibility would therefore allow the WHO to fulfil its responsibilities and dedicate its resources and expertise to the tasks that it is best placed to do. This will include supporting countries to fill the gaps identified by the independent monitoring committee. HPW: Some member states fear that the pandemic accord will undermine their sovereignty. How would an implementation mechanism address this? LH: The pandemic accord can only come into existence if it is agreed upon by member states and there remains a high level of commitment to maintaining state sovereignty in the negotiations of the accord. An accountability mechanism would therefore only assess countries’ compliance with the obligations that they themselves would agree to take on. HPW: The WHO Director-General has proposed a Global Health Emergency Council, described as a “high-level body on global health emergencies, comprising Heads of State and other international leaders”. Could this council oversee the implementation of the accord, and do you envisage that this could oversee your proposed independent monitoring committee? LH: The Director-General’s commitment to secure high-level political commitment to global health emergencies is welcome. There are three main issues with his proposal for such a council to be based at WHO, however. First, the WHO has historically struggled to call out countries for failing to meet obligations, for example under the International Health Regulations. An accountability mechanism should be removed from those dynamics. Second, his proposal would have the council report to the World Health Assembly, which is traditionally seen as an arena for ministers of health. It is therefore unrealistic to expect heads of state to agree to report to ministers of health. Third, keeping oversight over the pandemic accord at WHO may undermine the accord’s aim of adopting a whole-of-government approach to pandemic prevention, preparedness, response and recovery while the WHO remains focused on the health sector. HPW: The Independent Panel for Pandemic Preparedness and Response (IPPPR), co-chaired by Helen Clark and Ellen Sirleaf, has proposed a Global Health Threats Council. Could this be the appropriate body to oversee the accord’s implementation? LH: The IPPPR’s proposal for a Global Health Threats Council fulfils what we envision as a body that the independent monitoring committee would report to. The proposed council would provide high-level political leadership, monitor actors’ performance, and take on accountability functions. If this comes into existence as it is currently proposed, it would be appropriate for an independent monitoring committee to report its findings to the Global Health Threats Council. HPW: There is also the Global Preparedness Monitoring Board (GPMB), convened by the WHO and the World Bank. It is described as an “independent monitoring and accountability body to ensure preparedness for global health crises” that is comprised of “globally recognized leaders and experts”, which is “tasked with providing an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences”. How does this fit in? LH: Our proposal is for an independent committee to monitor each country’s compliance with its individual obligations under the pandemic accord. Meanwhile, the GPMB focuses on global preparedness for pandemics, which it describes as more than the sum of each country’s preparedness. The mandates of these two bodies are therefore related but distinct. Layth Hanbali is an analyst focusing on global health governance at Spark Street Advisors. His current work tracks developments in the governance of pandemic preparedness and response, and analysing how independent monitoring could promote compliance and accountability in the proposed pandemic accord. He is also an Assistant Researcher in community health at Birzeit University in Palestine, and has worked as a researcher, public health practitioner and doctor; volunteered as a civil society organizer; and taught for several global health programmes. He has a master’s degree in Health Policy, Planning and Financing, a medical degree, and a bachelor’s degree in Global Health. * Kerry Cullinan asked the questions. Image Credits: Shahin Khalaji/ Unsplash. 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