Shelves stand empty in a Wuhan supermarket in an earlier lockdown.

China administered the world’s first oral aerosol COVID-19 vaccine boosters in Shanghai on Wednesday, as new lockdown measures were imposed on Wuhan, the supposed birthplace of the pandemic.

Chinese vaccine manufacturer CanSino Biologics said in a media statement that the inclusion of its vaccine in Shanghai’s booster vaccination program marked “the start of the rollout of the world’s first inhaled COVID-19 vaccine, Convidecia Air”.

The inhaler, approved as a booster for adults last month by the National Medical Products Administration of China, “provides a non-invasive option that uses a nebulizer to change liquid into an aerosol for inhalation through the mouth”, according to the company.

“Convidecia Air is needle-free and can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” it added. The aerosol vaccine is based on Sinovac (marketed as CoronaVac).

The Chinese-developed Sinovac uses a modified version of an adenovirus to deliver inactive parts of SARS CoV2 to a person’s immune system to prime it recognise and attack the virus when it becomes infected. This is followed by a second vaccine to boost the immune system a few weeks later.

Results from a clinical trial that compared the oral aerosol vaccine to an injectable version of Sinovac, published in The Lancet in August, found that the aerosol elicited 6.7 to 10.7 more neutralising antibodies than the injection after two to four weeks.

However, Sinovac is less efficacious against COVID-19 than mRNA vaccines, and there are some early indications that it offers very little protection against the latest variants.

Nasal sprays

Meanwhile, there are other clinical trials of SARS-CoV-2 vaccines delivered through the mucosa, but these are all nasal sprays.

Researchers at Yale University in the US recently published a pre-print paper reporting early success in mice using a vaccine booster strategy, “prime and spike”.

Noting that protection offered by mRNA vaccines weakens fairly fast, particularly in the nasal mucosa and respiratory tract, in those already vaccinated (“primed”), they tested an intranasal “spike” to “elicit mucosal immune memory within the respiratory tract”. 

Their trial found that “prime and spike” induced a robust immune response in animals that protected against SARS-CoV-2 infection. 

Indian company Bharat has also developed an intranasal vaccine for Covaxin, which it says has been successful in animal studies although it has not yet submitted results for peer review.

Wuhan locks down

Meanwhile, China has locked down Wuhan’s central Hanyang district after COVID cases were found, as China persists with a zero-tolerance approach almost three years after the virus was first reported in the city, and about 900,000 residents were told to stay at home, according to Bloomberg.

This follows the re-election of Chinese President Xi Jinping – the architect of the “zero-COVID” strategy – for a third five-year term as leader of the country’s ruling communist party.

China’s zero-COVID strategy has resulted in lockdowns of entire cities. People living in districts where COVID-19 cases are detected are obliged to stay indoors for seven days and take a daily test.

The lockdowns have had a negative effect on the country’s economy, with a 1.7% contraction in sales last month largely as a result of quarantines in various parts of the country.

Meanwhile, a 14-year-old girl teenager, Guo Jingjing, died in a quarantine facility earlier this month, according to the BBC.

She apparently developed a fever two days after being taken to a facility in Ruzhou, and her family posted videos on social media of her shaking and convulsing on a bed. Her father, Guo Lele, said in a video on Douyin (Chinese TikTok) that the facility had not provided her with any help.

However, the videos and most references to the incident have since been removed.

Image Credits: Studio Incendo.

Testing for antimicrobial resistance at the Liverpool School of Tropical Science.

The World Health Organization (WHO) has raised the alarm over drug-resistant fungi as it released its first-ever priority list of fungal pathogens at risk from antimicrobial resistance (AMR). Nineteen species of fungi have been identified by the global health agency as representing “the greatest threat to public health” due to their growing drug resistance.  

Meanwhile,  a new report by a civil society coalition warned that unmitigated use of anti-fungal and antibacterial drugs on crop and animal production is fueling the fires of AMR – with too little action by countries and the UN system.

Speaking to media Tuesday, Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, said that WHO had compiled a list of piority fungal pathogens to put the issue on the public agenda and identify the areas for further research and development on fungal diseases.

Underlining the need for more documentation and surveillance on the fungal infections and diseases, Dr Getahun said, “ “We want the documentation of what’s happening currently … to dictate or to guide, while waiting for the evidence to be complete, what public health actions can be taken, particularly in raising awareness around these fungal infections.” 

Of the 19 species of fungi identified as priority pathogens, four pathogens were labelled as having “critical priority”. Those include Aspergillus fumigates, which causes respiratory infections in humans.  Others are Cryptococcus neoformans, Candida auris, which can cause bloodstream infections, wound infections and ear infections, and Candida albicans (thrush).  

Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, explaining the risk posed by drug-resistant fungi
Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, at the virtual press briefing on Tuesday.

The WHO report highlights how common fungal infections are becoming increasingly resistant to available treatments, raising risks particularly for people with low immunity. “Populations at greatest risk of invasive fungal infections include those with cancer, HIV/AIDS, organ transplants, chronic respiratory disease, and post-primary tuberculosis infection,” the report stated. During the Covid-19 pandemic, many health agencies also reported spikes in drug-resistant bacteria in samples collected from patients. 

While bacterial antimicrobial resistance (bacterial AMR) has received increasing attention from researchers and health ministries, information and data on fungal AMR is nowhere close. This is reflected in the fact that currently there are only four classes of antifungal medicines available to treat pathogenic fungal diseases. With few more treatment candidates in the clinical pipeline, WHO has warned that drug-resistant fungal pathogens are spreading far and wide across the globe due to many factors including unchecked use of antifungal agents in agriculture and aquaculture and climate change. 

All-age rate of deaths attributable to and associated with bacterial antimicrobial resistance by GBD
region, 2019

Role of azoles in fungal AMR

Rice fields are one type of agriculture where azoles are widely used.

Meanwhile, the new report on AMR released Monday by a civil society coalition carried an even stiffer warning abou the role of agrobusiness in spurring AMR – through rampant use of antifungal, antiboitic and antiviral agents on livestock and crops.

The report was co-authored by Nicoletta Dentico of the Society for International Development and the Geneva-based AMR Think-Do Tank.

The report, Untangling Antimicrobial Resistance, highlights, in particular, the role played by the widespread use of fungicides belonging to the azole family on agricultural crops – in the process fostering more drug resistant strains of Aspergillus fumigates, one of the pathogens on WHO’s priority list as a hazard for human health.

While antifungals may be regarded as key to food security, wanton use is increasing drug resistant mutations of fungi, and thus “selective pressure on human pathogens”, especially in regions where regulations against the on the use of fungicides are weak, the SID report added. 

Aspergillus fumigates causes an “environmentally acquired respiratory illness,” with Europe reporting the highest number of cases from the fungus. A 2021-study described how Aspergillus fumigatus has been spreading in all continents across the world, except Antarctica. 

Uncontrolled release of drug-laced effluents by industry, agriculture, households and the health sector is another pathway by which AMR resistance is growing silently, but steadily – particularly in parts of the world lacking good sewage treatment systems, the report states.

Not enough data on drug-resistant fungi

Deaths from drug resistant bacteria such as S. pneumonia and K. pneumonia have been mapped recently – but similar work is lacking for fungal agents.

Another issue faced in coming to grips with the surge of fungal AMR, is the lack of data, WHO officials said at their briefing. There are no systematic requirements for countries’ reporting on the use of antimicrobial or antifungal agents in human health or agriculture – or for reporting on AMR hotspots that emerge from overuse.  Whatever data may be collected by WHO, it is not harmonised with data collected by FAO or OIE.  Without data, it is tough to know where fungal drug resistance is growing, and what is the global burden of diseases from related deaths.

“But it doesn’t mean that it’s not a problem,” Dr Getahun pointed out. “That is why we have identified the priority pathogen list. And that is why we are actually encouraging more research, more surveillance, to understand the actual extent. Then we will be able to have appropriate estimates about global [burden].”

“Currently, fungal infections receive less than 1.5% of all infectious disease research funding. Consequently, the evidence base is weak, and most treatment guidelines are informed by limited evidence and expert opinion. Tackling the problems posed by invasive fungal disease will require increased research funding, targeted at the key priorities, new antifungal medicines and improved diagnostics,” the report added. 

While a recent Lancet study estimated that drug-resistant bacterial infections directly cause around 1.3 million deaths every year, and are associated with the deaths of some five million people every year, no such numbers are available for drug-resistant fungi. “We do need surveillance to identify the real burden and direct the public health as it is.”

Coordination between WHO, FAO, OIE and UNEP – hope or smokescreen?

Stefano Prato, top left, describes the economic model that has locked in farmers to overuse of drugs critical to human health. Nicoletta Dentico, lower left, moderates.

Recognizing the growing AMR threats from animal production and crop cultivation, WHO in April 2022 signed a Memorandum of Understanding (MoU) with Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE) and United Nations Environment Programme (UNEP) to collaborate on so-called One Health, approaches encouraging more judicious use of available drugs and chemical agents. 

Getahun, who is also director of the Quadripartite joint secretariat, told Health Policy Watch that under the MoU, the agencies – dubbed the Quadripartite – are working more closely together to identify those antibiotics that are critical to human and veterinary health. “[This was done] in order to ensure that these antimicrobials are not prescribed without the necessary veterinary or physiotherapy, you know, indications for plants.”

However, Getahun acknowledged that this work is in its early stages.

Speaking at the launch of the civil society report on AMR at Geneva’s South Centre, SID managing director Stefano Prato criticized the Quadripartite’s work as largely “theatrical” lacking normative teeth.  Meanwhile, veterinarians and farm extension advisors often receive huge financial incentives from encouraging farmers’ over-use of antibiotics, antivirals, antifungal agents and other drugs, driving uncontrolled use of such products.

“In many countries vets are really the ones who prescribe, earn and enjoy income and profits from the prescription of antiviral or antibiotics at the farm level,” observed Prato, who is both a veterinarian and an economist by training.”

In addition, developing countries have become locked into monoculture systems of industrial crop production, which typically require large drug and chemical applications – in order to generate cash crops for export.  Shifting out of that model to more sustainable agriculture systems that can supply more nutritious foods locally, is now extremely difficult because of their foreign debt burden, Prato said.

“Many countries that are locked into that export-driven model are also exposed to significan foreign debt… That means that they need the income and the currencies that are related to their export of commodities, because they need to repay those currencies”

“And so the conflicts of interest are so entrenched, not only at the global level but also at the national and micro level,” he said.

As for the new collaborations between WHO, FAO OIE and UNEP, Prato observed: “Without a proper governance structure, there will be no solution… it will end up being some kind of policy entertainment..theatrical red carpet solutions.”

-Updated 26 October with correction to the names of the report co-authors.

Image Credits: Flickr – UK Department for International Development, WHO, The Lancet, Creative Commons Zero, E. Fletcher/Health Policy Watch.

Exercise is an essential part of health.

Most countries are failing dismally to promote physical exercise despite inactivity playing a major role in heart disease, obesity and diabetes, according to the World Health Organization (WHO).

The WHO’s newly released Global status report on physical activity 2022 measures the extent to which governments are implementing recommendations to increase physical activity across all ages and abilities. 

Data from 194 countries shows that less than half the countries have a national physical activity policy, and only 30% have physical activity guidelines for all age groups. Just over 40% of countries have roads designed to enable safer walking and cycling.  

“We need more countries to scale up implementation of policies to support people to be more active through walking, cycling, sport, and other physical activity. The benefits are huge, not only for the physical and mental health of individuals, but also for societies, environments, and economies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, “We hope countries and partners will use this report to build more active, healthier, and fairer societies for all.”  

The economic burden of physical inactivity is significant and the cost of treating new cases of preventable non-communicable diseases (NCDs) will reach nearly $300 billion by 2030, according to the WHO. 

To help countries increase physical activity, WHO’s Global action plan on physical activity 2018-2030 offers 20 policy recommendations, including policies to create safer roads to encourage more active transport, provide more programmes and opportunities for physical activity in key settings, such as childcare, schools, primary health care and the workplace. 

The report calls for countries to prioritize physical activity as key to improving health and tackling NCDs, integrate physical activity into all relevant policies, and develop tools, guidance and training to improve implementation. 

“It is good for public health and makes economic sense to promote more physical activity for everyone,” said Dr Ruediger Krech, Director Department of Health

Exercise and COVID-19 vaccine

Meanwhile, a South African observational study of over 190,000 people suggests that regular physical activity may have boosted the efficacy of the Johnson & Johnson (J&J) COVID-19 vaccine. 

The study, published in the British Journal of Sports Medicine on Wednesday, was conducted by the health insurance company, Discovery Health, and its wellness programme, Vitality, in collaboration with Witwatersrand Sport and Health Research Group and the South African Medical Research Council (SAMRC).

It drew on the anonymised medical records, and recordable activity tracker data for 196,444 healthcare workers vaccinated with the J&J vaccine, who were clients of both a Discovery Health Administered Scheme and a Vitality wellness programme.

Those who were fully vaccinated and had high weekly levels of physical activity were nearly three times less likely to be admitted to hospital than those who were vaccinated but in the low physical activity category. 

“We set out to test the hypothesis that regular physical activity enhances the immune-boosting effect of COVID-19 vaccines, reducing severe outcomes in vaccinated people (measured by hospital admission),” explains Discovery Health’s analytics actuary, Shirley Collie. 

“The risk of hospital admission among fully vaccinated healthcare workers was reduced by 60% in the group who engaged in low levels of physical activity, and by 72% and 86% in the medium and high physical activity groups, respectively.” 

However, Professor Glenda Gray, President of the South African Medical Research Council, cautions that more research is needed to understand why exercise enhances the vaccine’s effects.

“For now, we suggest this may be a combination of enhanced antibody levels, improved T-cell immunosurveillance and psychosocial factors,” said Gray.

Image Credits: WHO/A. Loke.

Polio
Representatives from Rotary International and the government of the Philippines sign the agreement that starts Rotary International’s first polio project, 1979.

A historic window of opportunity to eradicate polio could be slipping away, World Health Organization (WHO) Europe leaders warned at a press conference marking World Polio Day on Monday. 

Since the 1980s, global polio cases have fallen by 99.9% and if polio were to be eradicated, it would join smallpox as only the second disease to be consigned to history.

“Polio is on the verge of becoming a story of the past,” said Dr Hans Kluge, WHO Europe Regional Director. “We stand on the cusp of eradicating the virus, but progress and the European region’s polio free status remain vulnerable.” 

The European region has been free from wild polio for two decades. But over the past year, circulation of vaccine-derived polio virus – a strain mutated from the weakened virus contained in the oral polio vaccine – has been confirmed in Israel, Ukraine, and the United Kingdom. This weakened variant can only spread in pockets of under-immunized communities, highlighting the need to reinforce vaccination efforts.

“The fight against polio has demonstrated the wonders of immunization, but this is not something we can take for granted,” Kluge said. “We are so close to the prospect of a polio free world. Choosing to leave the fight now would be a tragedy for future generations.”

Journey to eradication: from dream to reality

Polio
The 1979 agreement between Rotary International and the Philippine Ministry of Health for a joint multi-year effort to immunize children against polio

In 1979, a member of Rotary International issued a challenge to their peers in the Philippines chapter to eliminate polio from the island nation. It would take years of work, but the initiative was successful. The last case of wild polio in the Philippines was recorded in 1993. 

The challenge was then put to Rotary’s 1.4 million members globally. With representatives in over 200 countries, the goal became global eradication of the disease. Since the start of the 1979 vaccination campaign in the Philippines, Rotary International has invested $2.6 billion in the fight against polio.

“The thought was ‘if we can do it here, can we do it everywhere?‘” explained Rotary international president Jennifer Jones in her opening statement at the Monday press conference. “We started to speak with health professionals and organizations around the world, but it wasn’t seen as being a possibility at all.”

In 1988, the WHO, UNICEF and the Centers for Disease Control and Prevention, came together to form the Global Polio Eradication Initiative (GPEI). Later, the Bill and the Melinda Gates Foundation joined and GPEI became the largest international public health initiative in history.

Just last week, GPEI secured $2.6 billion in commitments at the World Health Summit, which is over half of its funding target of $4.8 billion set out in its 2022-2026 Strategy. This money is needed to provide vaccinations and essential healthcare services to over 370 million children worldwide. In total, over $19 billion has been invested into the programme since its launch.

The global effort has led to a reduction in polio cases by 99.9%.  “We are closer than we’ve ever been,” Jones said.

Endemic regions making progress

The mountains of North Waziristan, Pakistan.

Two years ago, wild polio was eradicated from endemic reservoirs in India and the African continent, and efforts in the last two endemic countries – Pakistan and Afghanistan – are trending in the right direction. But with the finish line in sight, the last mile is proving difficult.

“Pakistan has made incredible progress against polio, but recent challenges have allowed the virus to persist,” said Dr Zulfi Bhutta, professor at Aga Khan University in Pakistan. “Polio, like any virus, knows no borders; its continued transmission threatens children everywhere.”

Waziristan, a mountainous region of Pakistan on its Afghan border, faces high levels of vaccine hesitancy that have led to it becoming polios’ most resilient reservoir. The surrounding mountains – once strongholds of the Taliban – are a fitting backdrop for the disease to take its final stand.

The return of the Taliban from these very mountains to the levers of power in Afghanistan have complicated progress in reaching its unvaccinated communities. But negotiations to allow vaccinators better access to the country are underway.

Children pay the price of low-vaccination

Vaccine-derived polio strains are only a threat to the under-immunized. Too often, this means the heaviest burden falls on children.

“The occurrence of vaccine-derived polio around the globe clearly indicates one thing: we have left our children behind by not getting them vaccinated,” said Dr Siddhartha Datta, WHO Europe’s Regional Immunization Advisor. “It is extremely important that every child gets the vaccine doses which are part of the national vaccination schedule.”

Hundreds of children have already been paralyzed this year due to the spread of a vaccine derived strain amongst non-immune people in parts of Africa, Asia and Europe.

“Children deserve to live in a polio-free world, but as we have seen this year with painful clarity, until we reach every community and vaccinate every child, the threat of polio will persist,” said UNICEF Executive Director Catherine Russell. 

Polio anywhere is a threat everywhere

The re-emergence of polio in non-endemic regions highlights the difficulties of eradicating diseases in an increasingly interconnected world.  

“Polio is still a plane ride away,” Carol Pandak, the Chicago-based director of Rotary’s PolioPlus program told Bloomberg. “We’re sticking with the fight until we finish the job and keep our promise to the children of the world.”

But while cases in non-endemic countries are cause for anxiety, there is no need to panic, Jones explained.

“Seeing cases outside of the endemic areas is concerning, but we don’t need to fear-monger,” she said. “We should utilize the opportunity to raise awareness of what polio is and why it’s important to eradicate.”

COVID-19 has also taken a toll on polio immunization programmes. Across the WHO’s European region, coverage of the third dose of polio vaccine fell by 1% between 2019 and 2020. In 2021, only 25 out of 53 of the region’s countries had reached the 95% polio vaccination coverage rate recommended by the WHO.

“It is paramount that we ensure high vaccination coverage in all population groups,” said Kluge. “Until polio is eradicated, every country will remain at risk.”

COVID remains a threat, and forecasting is shaky

WHO Europe Director Hans Kluge at a press conference marking World Polio Day.

Last week marked 1000 days since the first cases of COVID-19 arrived in Europe. Entering the third pandemic winter, the continued evolution of the virus driven by a range of sub-lineages of the Omicron variant remains a concern.

An autumn surge has led to a tripling of cases in the European region since early September. In the second week of October, the region accounted for nearly 60% of new global cases and 42% of deaths.

“We are much better prepared, and the surge has not led to previous ICU admission or severe disease levels,” Kluge noted. “But the virus has surprised us more than once, and forecasting is tricky.”

WHO Senior Emergency Officer Dr Catherine Smallwood echoed the difficulty of projecting how the disease will develop through the winter.

“We’re having trouble isolating which of the omicron sub-variants will have a growth advantage and will take over in dominating the spread,” she explained. “Some variants like BQ.1 have been noted as potentially accelerated, but we’re not sure yet how this is going to pan out in the longer term.”

Image Credits: Rotary International, Rizwan Ullah Wazir.

IFPMA Director-General Thomas Cueni

The Biotechnology Innovation Organization (BIO) and Developing Countries Vaccine Manufacturers’ Network (DCVMN) have thrown their weight behind the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) proposal to improve access to vaccines in future pandemics.

The proposal, known as the Berlin Declaration, outlines how the pharmaceutical industry would reserve an allocation of real-time production of vaccines for priority populations in lower-income countries in future global pandemics.

In exchange, the industry wants their intellectual property protected, and for governments to “guarantee the immediate and unhindered sharing of emerging pathogens and their associated data to all researchers”, as well as committing to unrestricted trade, no export bans, and expedited processes for import and export during a pandemic.

The three pharma associations –  representing vaccines innovators as well as manufacturers – announced their agreement on Monday following a meeting in India hosted by DCVMN.  They called upon the G20, G7 and multilateral organizations to implement their part of the proposed bargain, etched out by the Berlin Declaration. 

“By supporting the vision for equitable access in pandemics, vaccine innovators and manufacturers acknowledge that while innovation, business-to-business voluntary collaboration and manufacturing scaling up succeeded in an unprecedented way during COVID-19, efforts to achieve equitable access were not fully realised,” the three bodies acknowledged.

“The three trade bodies invite the G7, G20, as well as multilateral organizations and other decision-makers to accept this practical solution and include it in their future pandemic preparedness response plans, whilst impressing upon governments that for the proposal to succeed the health systems in lower-income countries need to be better prepared to absorb and deliver vaccines and treatments, while high-income countries need to provide the necessary political and financial support,” according to the statement.

Industry ‘power-grab’?

Manufacturing COVID-19 vaccine at a Pfizer facility.

However, the People’s Vaccine Alliance once again denounced the industry’s offer.  A policy brief on the Berlin Declaration, issued by the alliance last week described it as “a continuation of a consistent ‘third way’ campaign by the biopharmaceutical industry to maintain exclusive intellectual property (IP) protections and monopoly control over the medical technologies needed to defeat the pandemic”.

The alliance, which is made up of over 100 civil society organisations, has taken issue with a number of clauses including the declaration’s insistence on IP protection, pointing out that  “decades of publicly funded research” was behind the development of mRNA vaccines.

​​“Waiting for pharmaceutical companies to voluntarily supply life-saving medicines and vaccines to people in developing countries has not worked in the AIDS pandemic, it has not worked in the COVID-19 pandemic, and it will not work in future pandemics,” said Winnie Byanyima, executive director of UNAIDS and co-chair of the People’s Vaccine Alliance, in a media release.

“Governments negotiating a pandemic treaty need to resist the siren calls of industry. The profiteers of this pandemic must not set the rules that govern the preparations for the next pandemic. The world needs an international agreement that guarantees fair and equitable access to medical products for everyone, everywhere, not a power grab by big pharma,” she added.

The World Health Organization (WHO)’s intergovernmental negotiating body (INB), established to guide member state discussions on developing a pandemic accord for future pandemics, is currently refining the current working draft of the initial agreement, referred to as document A/INB/2/3. This will be presented as a “conceptual zero draft of the accord” at the INB’s third meeting in December.  Framing of equity and medicines access in the zero draft will set the stage for how member states negotiate over these charged issues in their attempts to reach a binding international accord.  

The INB will submit a progress report to the Seventy-sixth World Health Assembly in 2023 and the final accord is expected to be presented for consideration at the Seventy-seventh World Health Assembly in 2024.

Vaccine price hikes

People’s Vaccine Alliance co-chair, UNAIDS Executive Director Winnie Byanyima.

Meanwhile, the People’s Vaccine Alliance also condemned the announcement by Pfizer that it will increase the price of its COVID-19 vaccine fourfold, to around $110-$130 after the US government’s federally-sponsored purchase programme for the vaccine expires at the end of this year.  Currently, the vaccine is sold for $30 a dose to the US government and provided for free.  As of 2023, the vaccine will be provided through the usual US public and private insurance channels, Pfizer said, in a statement that justified its price-hike to weakened demand for the vaccine. 

However, in a statement to Health Policy Watch, a Pfizer spokesperson said that the “company comments made regarding potential future vaccine pricing were specific to the United States.”

The spokesperson added: “We have government contracts in many developed markets outside the US, valid through 2023. And as such, have agreed prices for those markets.  During the pandemic, we priced our vaccine and oral treatment to ensure equitable global access for all countries, regardless of income levels… This tiered pricing, which provides to low and middle-income countries at cost, remains in effect.”

A People’s Vaccine Alliance spokesperson said that at its current US sale price, the vaccine already is priced nearly 30 times above its manufacturing cost – even at current US rates: “Experts have estimated that Pfizer’s vaccine costs just $1.18 per dose to make. Charging $130 per dose would represent a markup of more than 10,000%. This is daylight robbery. Governments must not stand by while companies like Pfizer hold the world to ransom in a global pandemic,” said alliance policy advisor Julia Kosgei.

Cost price estimates, she said. are based on Oxfam analysis of studies of mRNA production techniques, carried out by Public Citizen with engineers at Imperial College. Public Citizen and Imperial College’s analysis suggests that it could cost $9.4 billion to produce 8 billion doses of the Pfizer/BioNTech vaccine ―$1.18 per vaccine.

“While health workers and the vulnerable continue to go unvaccinated in developing countries, Pfizer is shamelessly fleecing the public for ever-greater sums of money. This latest obscene price hike is truly a mask-off moment for one of the great profiteers of this pandemic,” said Kosgei.

Not just about vaccines

Mapping of the MPP-brokered licenses awarded for the manufacture of a generic version of Paxlovid

“This isn’t just about vaccines. Right now, people in developing countries are dying without access to Paxlovid, an antiviral COVID-19 treatment for which Pfizer is charging hundreds of dollars per course. But there is a proposal at the World Trade Organization that would make it easier for poorer countries to produce generic doses. It’s time for governments to stand up to pandemic profiteers and support it.”

With regard to Paxlovid, the Pfizer spokesperson said that the company had established “a comprehensive strategy with governments, international global health leaders and global manufacturers to optimize overall supply and access to all parts of the world. ”

That, the spokesperson said, includes: a voluntary license agreement with the Medicines Patent Pool to allow generic production of the treatment, sublicensed to 38 manufacturers in 13 different countries; agreements with the Global Fund and UNICEF to supply some 10 million treatment courses through their channels; and collaborations with WHO and its partners to enable supply to reach “more vulnerable populations.

In a separate channel, World Trade Organization members are still negotiating over a proposal to extend a limited intellectual property waiver on vaccine manufacture, approved by the WTO in June, to treatments as well. The 17 June agreement calls for a WTO decision on whether to extend the waiver to diagnostics and treatments “no later than six months from the date of this decision.”

Image Credits: Pfizer, Medicines Patent Pool .

Affordable, healthy food options are key to good health.

“The bottom line is that our food environment is deeply unhealthy. And unless we change that, millions of people will suffer from avoidable illness and die early from preventable death,” Dr Tom Frieden, CEO of Resolve to Save Lives, told the World Health Summit in Berlin.

“Voluntary changes are much less likely to result in sustainable positive healthy development than a predictable regulatory framework,” said Frieden, speaking at a session on ‘Transforming Food Systems for Healthy and Sustainable Diets. 

He pointed to five areas that needed targeted action to address malnutrition – micronutrient deficiencies, artificial transfat, excessive sodium, excessive sugar and the higher cost of healthier foods.

“Let’s be clear that simply encouraging people to eat better and exercise more will not only fail, but is essentially a form of blaming the victim.

According to the WHO, 1.9 billion adults in the world are obese and 462 million are underweight. Almost 233 million children under the age of five suffer from some form of malnutrition and around 45% of deaths among children in that age group is linked to undernutrition. 


In 2019, The Lancet Commission on obesity, undernutrition and climate change identified these three issues as the biggest threats to the world, and called for significant funding to address them, including but not limited to agriculture, food production and policy, land use and environment. 

The United Nations Food Systems Summit in New York in 2021 also called for sustainable food systems and healthy diets for all, and Tuesday’s session was aimed at addressing the various commercial determinants involved in achieving this goal. 

Some countries are already reforming their food systems to deliver healthier options to their populations using measures such as investment in agriculture, tax subsidies for companies that produce healthier foods to make them more affordable and regulations ensure processed food adheres to strict health standards. 

More regulation

Government regulation of companies that manufacture processed and unhealthy foods and their marketing strategies can help the cause, according to Frieden.

“We’re not absolving individuals from responsibility. But we’re not absolving society from the responsibility of establishing the structure to make the healthy choice the easier choice either,” added Frieden, explaining that measures like front-of-the-pack warnings, increasing the price of unhealthy food and reducing the price of healthy food have helped. 

Commercial determinants of obesity and chronic diseases are very well-documented and so is the power wielded by influential processed food corporations across the world, said Dr Marion Nestle, professor of nutrition, food studies, and public health at New York University.

Prof Dr Marion Nestle
Dr Marion Nestle speaking at the World Health Summit 2022.

She pointed to the Lancet Commission’s report and stated that big food companies are not social service agencies with public health as the goal: “They’re businesses with stockholders to please. They have to put profits to stockholders as their first priority, no matter what the people in the companies think they would like to do about hunger, malnutrition, chronic disease and climate change,” she said, calling for a regulatory framework that puts all food companies on the same level playing field.

Keep companies out of public policy

One of the Lancet Commission’s recommendations was the reduction in the influence of large commercial interests in public policy development to “enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet”.

Explaining the complicated relationship many governments have with processed food companies, Nestle said that this is a difficult situation. “It’s one that public health advocates have to figure out how to deal with, which means increasing advocacy in civil society,” she said. 

“We ought to be doing what the Lancet Commission suggested, which is keeping food companies out of public policy decisions. They should not be at the table when public health policy is being discussed. They need to be regulated in terms of marketing, and in terms of what the formulation of their products is.”

Secy General IFBA
Rocco Renaldi, secretary-general of the International Food and Beverage Alliance.

However, companies that manufacture and market processed foods play a crucial role in the eco-system and should not be ignored, argued Rocco Renaldi, the secretary-general of the International Food and Beverage Alliance (IFBA).

“We made a commitment on (reducing) sodium…to achieve a global set of sodium targets for our products by 2025, and 2030. These are minimum global targets, you can go further at national level,” he said. 

He was referring to the Nutrition for Growth Summit held in Tokyo in 2021, where the member states of the WHO agreed to a 30% reduction in the global salt intake by 2025. 

While reformulation of products to reduce salt and sugar was important, demonising processed foods is not the answer, he said. “The real answer is how to rebalance the system so that different types of food occupy the right space within that system,” Renaldi argued.

Food financing

Like many other public health challenges, money is a crucial bottleneck in addressing the issue of malnutrition across the world. 

Food financing needs to be envisioned in a different way to achieve these goals, said Dr Geeta Sethi, an advisor at the World Bank. She added that the private sector has deep pockets that will help fund these goals but are deterred by perceived risks. 

“For some reason, we in the food sector have not been able to price risk in a way that allows private finance to come in. This is urgently needed.. the change agents have to be the private finance,” she added. 

“In a nutshell, food systems do not lack financing…the public support for agriculture and food is $700billion a year,” she stated, adding that if food subsidies were a country, they would be the 19th largest economy in the world. “And this is not even considering the massive spending of the private sector, which is around $2 trillion.”

Sustainable food systems

While countries like Indonesia and Bhutan are actively redesigning their food systems and production pathways, countries like Germany, Sweden and Fiji have been successful in creating sustainable food systems that are healthy for their populations. 

“We would like to establish a framework that will be tracking institutional things that are happening in the governments, but also the behavioural change that’s happening in the stakeholders and in the private sector,” Dr Stefanos Fotiou, the director of the UN Food Systems Coordination Hub said. 

The need for political will to address these challenges also came up repeatedly as various ministers shared their experiences in designing and implementing policies around the issue. 

Speaking about her experience in Germany, Dr Doris Heberle, from the federal ministry of food and agriculture said that reducing the intake of salt is not an easy task since it impacts trade-related issues like the shelf-life of food products. 

“But we are going to have more scientific advice and scientific evidence to get better targets for reduction patterns and also to attune those to the target groups which are the most vulnerable,” she added. 

Dr Ifereimi Waqainabete
Dr Ifereimi Waqainabete, Fiji’s Health Minister, at the World Health Summit 2022.

Taking public health decisions when trade is a huge factor in the economy is difficult, said Dr Ifereimi Waqainabete, Fiji’s health minister. He added that small countries like Fiji are pushed to choose between nutritious food that is expensive and cheap food that is less nutritious. 

Waqainabete added that his government had distributed seeds and plants to people during the COVID-19 lockdown to encourage local food production and the regeneration of agriculture.

“We also regenerated our ocean area by bringing back the village system and the tribal system where you have your own ‘parish’ where you fish traditionally and stop fishing at a particular time. And we found that by doing that we’re able to regenerate our ocean,” said Waqainabete.

Sweden’s Ambassador for Global Health, Dr Anders Nordström said his government only procured healthy food for the education and healthcare sectors and this ensured that the most vulnerable received the healthiest options. 

“This has been a policy for a long time… we serve about three million meals every day and this has had a dramatic positive impact. What is interesting is that (the government) has been also putting into those policies that those meals should not just be healthy, they should be affordable.”

Image Credits: Scott Warman/ Unsplash, Megha Kaveri/Health Policy Watch.

For “Nundy,” a mother of two living in South Africa’s Khayelitsha township, going to the doctor more than once a year is not an option.

She would have to pay 50% of her total household income in a month in order to see a doctor, so she saves up all of her medical questions and then makes one appointment, at which she tries to collect as much information as possible to take care of her 18-year-old son, two-year-old daughter and ailing mother.

In the meantime, she buys over-the-counter health products and tries to treat her families ailments herself.

“She told us a story of having many products and she told us all the ways she used them. And she was not sure what their expiry date was or exactly what they were for … but she knew she had to do something,” said Manoj Raghunandanan, global president of self-care and consumer experience at Johnson & Johnson.

He met Nundy a few years ago during a visit to the area.

Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J
Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J

Raghunandanan was speaking Wednesday at the launch of the Global Self-Care Readiness Index (SCRI) 2.0, the kick-off session of the Global Self-Care Federation World Congress 2022, which runs until Thursday.

“She was a consumer that deserved better,” Raghunandanan said, “someone that deserved access, affordability and the right to take care of herself, her family and her loved ones in a responsible way.”

How to improve self-care health policies and practices for people like Nundy was the topic of the congress and the focus of the SCRI report, which is published by the Global Self-Care Federation (GSCF).

The index is 89 pages long and covers 10 additional countries, which supplements the original set of countries examined in the 2021 edition and covers at least one from each of the World Health Organization’s (WHO) six regions: Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean, and Western Pacific.

The index is supported by the WHO and forms part of the working plan between itself and GSCF. It aims to arm healthcare decision-makers and professionals with the data they need to increase self-care in their own countries and around the world.

Judy Stenmark, Director General of the Global Self-Care Federation (GSCF), speaks at the launch of the Self-Care Readiness Index 2.0 on Wednesday, October 19, 2022
Judy Stenmark, director-general of the Global Self-Care Federation (GSCF), speaks at the launch of the Self-Care Readiness Index 2.0.

Regulatory environment

The self-care industry has sometimes come under fire for making far-fetched claims about products to encourage people to spend money on things that don’t work, but GSCF director-general Judy Stenmark said that is something her organization is working to fix.

“Consumers become aware of the products or activities mainly through marketing and advertising, especially online,” she told Health Policy Watch. “We must ensure that we continue with our self-care literacy education efforts, especially in the digital sphere, including product guidance and e-labelling.”

SCRI 2.0 highlights the regulatory environment as one of the key enablers of self-care, advising countries to “focus on regulations and processes governing approval of new health products, from prescriptions to over-the-counter medications.”

Stenmark also stressed that while some people think of self-care as providing consumers with over-the-counter medicines, it is a multi-dimensional concept, which encompasses different notions, starting from self-medication to maintaining a healthy diet and raising health literacy levels.

WHO resolution by 2025

In order to help persuade policymakers of the importance of self-care, GSCF is working to have a self-care resolution adopted by WHO by 2025, something Stenmark said would provide a clear articulation of self-care and outline the value for health systems, governments and a people-centered care network.

It would also help facilitate member states’ development and effective implementation of national self-care strategies and provide them with direction on aligning resources.

“If we pass a resolution, things start to change, and then we get self-care embedded in policy,” she stressed. “That is why we want a WHO resolution. We want to build the political wheel for self-care.”

Socio-economic benefits

Currently, half the world lacks access to adequate healthcare, according to Dr Bente Mikkelsen, WHO’s director of non-communicable Diseases, who spoke at the beginning of the launch event.

According to the SCRI report, the sector could be improved by increased support and trust of self-care behaviors and products by healthcare providers, patients, consumers and regulators; increased health literacy; and policymakers’ recognition that self-care has economic value.

Low- and middle-income countries, often plagued by disease, have the highest potential to benefit from self-care policies.

Africa faces the “largest and biggest disease burden of all the regions in the world,” said Skhumbuzo Ngozwana, Chief Executive Officer of Kiara Health in South Africa. Some 90% of malaria deaths take place on the continent, tuberculous is still common and there is a “burgeoning and exploding” non-communicable disease problem,  Ngozwana said.

“Clearly Africa has a major problem,” he said. “All of this is in the context of significant infrastructure challenges, constrained budgets and that less than 3% of global healthcare workers are deployed on this continent. If people have to spend 50% of their monthly income on doctors, it makes it impossible.”

GSCF has also put out a supplementary report, Global Social and Economic Value of Self-Care,  which shows the potential socio-economic benefits of self-care around the world and specifically in sub-Saharan Africa.

If proper self-care policies were put into practice, the report showed, it would represent a $4 billion savings on annual healthcare costs in sub-Saharan Africa by 2030. Moreover, it could save individuals a collective 513 million hours in time savings and physicians 44 million hours. It would also reduce welfare spending by $31.5 billion.

Annual socio-economic benefits of self-care in Sub-Saharan Africa presented by the Global Self-Care Federation
Annual socio-economic benefits of self-care in Sub-Saharan Africa presented by the Global Self-Care Federation

Globally, the numbers are even greater: $179 billion in healthcare cost savings and $2.8 trillion in welfare spending.

“Self-care integration has significant long-term economic benefits for health budgets and health systems in general,” GSCF told Health Policy Watch. “Integrating self-care into the healthcare continuum allows for better resource allocation, alleviates burden placed on health systems, and ultimately improves the quality of care provided.”

Image Credits: The Global Social and Economic Value of Self-Care report, Screenshot.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

A shortage of cholera vaccines and a number of outbreaks have prompted the World Health Organization (WHO) to advise countries to administer single doses of the vaccine instead of the usual two doses.

So far, 29 countries have reported cholera outbreaks, with Haiti, Syria and Malawi dealing with large outbreaks. The standard preventive approach to cholera is two-dose vaccination with the second dose administered within six months of the first. The immunity of a fully vaccinated person against cholera lasts for three years. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Tedros Adhanom Ghebreyesus, the director-general of WHO told a media briefing on Wednesday. 

However, he stressed that “this is clearly less than ideal and rationing must only be a temporary solution”.

“In the long term, we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks. The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation,” he stressed.

Stockpile depleted

Four organisations – WHO, UNICEF, Médecins sans Frontières and the International Federation of the Red Cross and Red Crescent Societies – have managed the global stockpile of cholera vaccines since 2013. 

Of the 36 million doses produced this year, 24 million doses have already been shipped to countries facing outbreaks. The International Coordination Group (ICG), a WHO group that manages and coordinates emergency vaccine supplies and antibiotics during major outbreaks, has approved eight million doses for the second round of emergency vaccination in four countries, leaving only four million doses for further outbreak management. 

This shortage has prompted the ICG to recommend that countries temporarily suspend the two-dose vaccination regime and instead follow a single-dose regime so that more people can be protected against the bacteria. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Ghebreyesus said, calling for a scale-up of vaccine production. “The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation.”

Narrow window to prevent Tigray genocide

Tedros also called for international attention to the civil war in Tigray, Ethiopia, which has left around six million people “under siege for almost two years”.

“I’m running out of diplomatic language for the deliberate targeting of civilians in Tigray, Ethiopia,” said Tedros. “There is a very narrow window now to prevent genocide in Tigray.”

The WHO Chief quoted Antonio Guterres, the UN Secretary-General, who called for the immediate withdrawal of Eritrean armed forces from the region.

Tedros described the “indiscriminate attacks” on civilians as “war crimes”.

“There are no services for tuberculosis, HIV, diabetes, hypertension and more – those diseases, which are treatable elsewhere, are now a death sentence in Tigray…This is a health crisis for six million people, and the world is not paying enough attention,” added Tedros, who was a former health minister of Ethiopia.

“Banking, fuel, food, electricity and health care are being used as weapons of war. Media is also not allowed and destruction of civilians is done in darkness.”

Ebola and COVID-19

WHO expressed concerns about the Ebola outbreak in Uganda and added that there is a possibility that more transmission chains and contacts might be involved in the spread of the virus. 

As of Wednesday, there are 60 confirmed and 20 probable cases of Ebola in the country, with 25 recoveries and 44  deaths.

Two people with confirmed infection in Mubende district had travelled to Uganda’s capital city, Kampal,a for treatment, thus prompting fears of transmission in the capital. The Ugandan government issued lockdown orders in Mubende on 16 October. 

“The Ministry of Health is investigating the most recent eight cases, as initial reports indicate they were not among known contacts,” Tedros said. 

Meanwhile, COVID-19 remains a public health emergency of global concern as per the Emergency Committee meeting last week. WHO urged countries to strengthen surveillance, and not reduce testing, treatment and vaccination for their populations.

“While the global situation has obviously improved since the pandemic began, the virus continues to change, and there remain many risks and uncertainties.”

Cary Adams, Bente Mikkelsen, Alejandra de Cima Aldrete, Valerie McCormack, Miriam Mutebi and Olivier Michielin address the World Cancer Congress press conference.

Common cancers that can be treated successfully when they’re detected early – breast, cervical, colorectal and prostate – are causing high mortality in low and middle-income countries (LMICs) because of a lack of screening and treatment, Dr Cary Adams, CEO of the Union for International Cancer Control (UICC), told a press conference at the start of the World Cancer Congress in Geneva on Tuesday.

“We see this inequity in childhood cancer, with 80% survival rates in high-income countries and as low as 20% in low and middle-income countries,” he added at the start of the hybrid in-person and online congress, which is being attended by some 2,000 scientists, public health officials, civil society representatives and cancer control experts from 120 countries.

A new study by members of the Bloomberg New Economy International Cancer Coalition released this week calculates that at least 1.5 million deaths, representing 20% of global cancer deaths, could be avoided each year if international regulations around patient trials were more standardized and people placed on life-saving treatment immunotherapy treatments such as Pembrolizumab (for lung cancer) and Enzalutamide (prostate cancer).

Despite the US Food and Drug Administration (FDA) approval of Pembrolizumab in 2016 and Enzalutamide in 2012, neither drug is yet available in many countries and regions of the world due to “regulatory isolationism that is preventing approval and usage of these and other much-needed oncology therapies”, according to the study.

The  Access to Oncology Medicines (ATOM) Coalition, which was formed in May, has started to engage with pharmaceutical generic and biosimilar companies “to see whether we can find ways to get their medicines into LMIC countries either by increasing donations, by tier pricing or using a voluntary licence mechanism”, said Adams. 

Dr Bente Mikkelsen, director of non-communicable diseases (NCDs) at the World Health Organization (WHO), said that the WHO had private sector dialogues every six months “where we have defined asks for most of the diseases and we call for commitments to be able to increase access to medicines and devices”. 

“On cancer, our focus is now of course on the medicines that are already on the essential medicine list, but we don’t shy away from the innovative new drugs and devices,” said Mikkelsen, adding that the dialogue was a structured and safe way to discuss access to medicine.

COVID disruptions

Mikkelsen pointed out that, in the four years since the last cancer congress, 30 million people had died of cancer – and there had been disruptions to 50-60% of cancer treatments during the COVID-19 pandemic.

“This is happening because the health system is actually too weak,” said Mikkelsen. “There is no [pandemic] preparedness without including cancer in universal health coverage. We will not be able to manage the new pandemic or for a humanitarian crisis unless we build stronger health systems.”

Mikkelsen added that over 70% of people diagnosed with cancer in LMICs “pay out of their own pocket for things that should be covered by the governments and this is very often the choice between food, care of the family or actual treatment and diagnosis”.

‘Financial toxicity’

Dr Miriam Mutebi, UICC Board Member and a breast surgical oncologist, said that “financial toxicity –  the fact that patients paid themselves for cancer treatment”, was a big reason why the majority of African patients are “still getting diagnosed with advanced disease and frequently not completing their care”. 

Women were particularly affected by a lack of finances as many were involved in the informal economy.

“Looking at the system’s challenges, we know in sub-Saharan Africa, women patients will see, on average four to six healthcare providers before a definitive diagnosis of their cancer, and this really underscores the need for increasing awareness, not just in the community but also amongst healthcare workers,” stressed Mutebi.

Mexico’s civil society makes cancer ‘law’

Mexican cancer survivor Alejandra de Cima Aldrete, Founder and President of Fundación CIMA, said that civil society in her country was in the process of drawing up cancer laws themselves.

“Every day I hear horrible stories about a massive shortages of medicine, about women that have to wait months before they get they get seen by a specialist, of woman that died because they didn’t have the money to continue their treatment,” said Aldrete.

“So my commitment today with my people in my country is to improve the lives of people living with cancer through changes in the legislation, the most meaningful, efficient and with the outmost reach being the general cancer law from Mexico that is currently being drawn up by 13 NGOs, mine included.”

“The cancer law would provide the very needed legal instrument that will allow us citizens to demand the policies that ensure quality and timely medical care for cancer patients. It will force also the government to comply to its sections which include amongst others, the national cancer plan and the National Cancer Registry,” said Aldrete.

A million maternal orphans

Over one million children lose their mothers to cancer every year, according to a congress paper that modelled maternal orphans for the first time using data from 185 countries. 

In 2020, an estimated 4.4 million women died from all types of cancer worldwide leaving behind 1.04 million new orphans (aged 18 and under), according to researcher Dr Valerie McCormack from the French International Agency for Research on Cancer (IARC).

Almost half the orphans were in Asia (49%), and over one-third were from Africa (35%). 

Their mothers died predominantly from breast (25%), cervical (18%) and upper-gastrointestinal cancers (13%). 

The mortality rate of cervical cancer should be reduced through screening for, and vaccinating against, the human papillomavirus (HPV), while early detection and quality treatment of other cancers was essential “to avoid the impact on on the next generation”, said McCormack.

“Orphans in some settings have lower educational levels and higher mortality than their peers. So it’s not only the women who die, we need to prevent their deaths,” she added.

WHO cancer survey

Meanwhile, the WHO launched the first global survey on Tuesday to better understand and address the needs of all those affected by cancer. 

Noting that nearly every family globally is affected by cancer, either directly – 1 in 5 people are diagnosed with cancer during their lifetime – or as caregivers or family members, the survey “is part of a broader campaign, designed with and intended to amplify the voices of those affected by cancer – survivors, caregivers and the bereaved – as part of WHO’s Framework for Meaningful Engagement of People Living with Noncommunicable diseases”. 

“For too long, the focus in cancer control has been on clinical care and not on the broader needs of people affected by cancer,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Global cancer policies must be shaped by more than data and scientific research, to include the voices and insight of people impacted by the disease.”

Germany’s health minister, Dr Karl Lauterbach and WHO’s Dr Mike Ryan

Amid criticism that the World Health Summit was ‘speed-dating for consultants’, panellists lamented a lack of practical plans to empower local service delivery

A more empowered World Health Organization (WHO), stronger health local systems and better surveillance are some of the weapons that will protect the world against future pandemics, according to panellists at the World Health Summit in Berlin.

“The WHO needs more powers to deal with pandemics. Isn’t there something ridiculous about the fact that the International Atomic Energy Agency can go into a war zone and inspect what’s happening in a nuclear power plant and WHO doesn’t have an absolute right to get visas to go to the site of any outbreak anywhere in the world?” said Helen Clark, the former prime minister of New Zealand and co-chair of the Independent Panel for Pandemic Preparedness and Response. 

She was referring to how China denied WHO-appointed experts access to the outbreak of the pandemic in Wuhan.

“The International Health Regulations need to be made fit for purpose and empowering the WHO on very practical issues like that,” said Clark, who also asserted that “it was not the WHO that failed the world. It is member states that failed the WHO.” 

No one had a plan

Germany’s health minister, Dr Karl Lauterbach, said that when his country assumed leadership of the G7, it was clear that no country had a plan on how to address pandemics. To get a better understanding of the gaps, he convened three informal meetings of scientists.

What emerged, said Lauterbach, were two key consensus points: first, “we are lacking a workforce which is better prepared to recognise a possible pandemic and to avoid that an outbreak becomes a pandemic” and second, a lack of surveillance to identify a pandemic Lauterbach appealed for everything to be geared towards addressing these two crucial needs – and training young people to “get them interested in pandemic control”. 

“We will either spiral upwards or spiral downwards. If we spiral downwards, we will have more climate change, and more pandemics because of climate change. We will have poorer primary health because of climate change and pandemics and we will have more wars because all of this is happening.”

‘Last mile of delivery is first mile of health security’

Dr Mike Ryan, WHO executive director of health emergencies,  agreed that “without data, you’re blind and without a workforce, you have no capacity to act”.

However, he added that “95% of people who survive natural disasters survive because their neighbours and their families dig them out from under a building or pull them out of the water”. 

“That’s exactly the same principle in epidemics. It is local, community-based surveillance, point-of-care diagnostics, the ability to understand there’s a problem in the community and the rapid provision of support to a community before an outbreak becomes a national or global event,” said Ryan.

The “last mile” of health care was also the “first mile of health security” – and often the weakest link.

Describing the health summit as “speed dating for global consultants”, Ryan said that things were very different at the country level where Ministries of Health were “usually underfunded, and the weakest ministry in government”.

“Then we come in with our vertical systems and we start pushing everyone: ‘you must do this and you must do that. We have decided this is best for you’. How paternalistic is that?” Ryan said, appealing for attention to “that principle of service to the people” – and humility.

South Sudan Minster of Health Elizabeth Chuei receiving a COVID-19 vaccine after delivery from COVAX.

‘Little white, northern cabals’

He also took aim at “many unelected individuals around the world who live in their little, white northern cabals who like to sit in rooms and decide what the future of global health is going to be”.

“The reality is 194 ministers of health come together every year in Geneva, and they set out under democratic principles, what are the policies for the world and we need to continue to invest in that,” said Ryan.

“We’re a flawed organisation. But we are radically transparent and we are open. Everything we do is on the table. Everything we do is out there for criticism. I wish it were the same for other entities and institutions.”

He also blamed any failures in the global vaccine delivery platform, COVAX, on “the greed of the north”, “the greed of pharmaceutical industry” and “self-interest in certain member states” that were not prepared to share.

“COVAX went against that trend, and COVAX tried in its best way to represent that need around the world,” said Ryan, adding that he and others often worked “26 hours a day” to address the pandemic and sometimes needed to be “peeled off the wales”.

Principles not plans

Professor Lawrence Gostin from Georgetown University in the US said there was a need for “better governance” of the WHO.

“We need to have more honesty and stewardship, transparency and openness, most important, inclusive participation, effective performance monitoring benchmarks, quality improvement, accountability, and the most important thing is equity,” said Gostin.

German health ministry official Björn Kümmel, who has driven the re-financing of the WHO as co-chair of the Intergovernmental Working Group on Sustainable Financing, said that his country would like to “enable WHO not only financially but also technically, potentially legally through new mechanisms in the IHR and obviously, the pandemic treaty, and politically also vis a vie other global health agencies or other actors who are engaging in global health”. 

However, Kummel conceded that “nobody seems to have a plan”.

Discussion was largely about “principles” – such as “better governance, trust, transparency, acceptance of criticism, [ensuring] the voice of civil society, equity, community intelligence systems.

“All the big words that were mentioned here, I think it’s clear that none of us seems to have the right plan.”

Image Credits: UNICEF.