New Malaria Vaccine With 75% Efficacy is a Potential Game-Changer 10/09/2022 Paul Adepoju Dr Matshidiso Moeti, WHO’s regional director for Africa A new R21/Matrix-M malaria vaccine shows 75% efficacy in a Phase2b trial – a potentially game-changing result compared to the WHO-approved RTS,S/AS01 (RTS,S) vaccine. The WHO has said it will continue with the rollout of its approved RTS,S vaccine, despite the promise of a new malaria vaccine candidate, the R21/Matrix-M, that shows an efficacy of 75% in a recent Phase 2b trial – nearly double that of the recently-approved RTS,S vaccine. At a WHO press briefing on Thursday, Dr Matshidiso Moeti, WHO’s regional director for Africa, welcomed the findings on the R21/Matrix-M vaccine, which were published on Wednesday in the Lancet, but said the rollout of the RTS,S vaccine would continue. The R21/Matrix M vaccine candidate still must be tested clinically against the RTS,S vaccine in a large-scale field setting, Moeti said. “We can look forward to – eventually once the data is finalized – the vaccine going through all the phases of clinical trials, and then a field test with the RTS,S vaccine,” she said. The R21/Matrix M, she said, “can be an additional tool to join the vaccine that has been found to have a reasonable level of efficacy, the RTS,S vaccine, in reducing severe malaria and deaths in children.” Only three months ago, the Gates Foundation said it was withdrawing financial support from the rollout of the RTS,S vaccine because of its low efficacy ratings, and would prioritize its investments in classical measures like insecticide treated bednets. The RTS,S vaccine, the first ever to be approved by WHO in October 2021, was piloted among some 800,000 infants and children, demonstrating a 40% reduction in malaria episodes and a 31% reduction in severe malaria infections in a three country pilot. WHO later said it would spend US$160 million to roll out the vaccine more widely between now and 2025, beginning in Ghana, Kenya and Malawi. ‘Aimed at licensing this vaccine for widespread use next year’ Midwife treating a baby with severe malaria. But if the results of the R21/Matrix-M hold up in a Phase 3 trial – which researchers hope will yield sufficient results for licensing by next year – this newer vaccine could very well supercede the other vaccine, upending WHO’s original plans. In their findings reported in The Lancet Infectious Diseases, researchers from the University of Oxford and their partners found that a vaccine booster dose at one year following a primary three-dose regime, had an efficacy of at least 75% in preventing malaria episodes – as compared to about 40% for the WHO-approved RTS,S vaccine. This higher efficacy also meets the WHO’s Malaria Vaccine Technology Roadmap goal – once considered largely aspirational. The R21/Matrix-M vaccine had previously demonstrated efficacy of 77% over the first 12 months of the randomized, controlled vaccine trial involving a total of 450 participants aged five to 17 months, recruited in the region of Nanoro, Burkina Faso. In the most recent study of a booster dose of the R21/Matrix-M, some 409 of the original 450 participants returned to receive the booster after a year, leading to a similar outcome. The trial is continuing for another two years to assess both potential value of additional booster vaccine doses, and longer-term safety. Halidou Tinto, a professor in parasitology and the trial’s principal investigator, said it is “fantastic to see such high efficacy again after a single booster dose of vaccine. We are currently part of a very large Phase III trial aimed at licensing this vaccine for widespread use next year.” Adrian Hill, a co-author of the paper who is a professor of vaccinology and director of the University of Oxford’s Jenner Institute, also expressed delight “to find that a standard four-dose immunization regime can now, for the first time, reach the high efficacy level over two years that has been an aspirational target for malaria vaccines for so many years.” Mechanism of action Researching new anti-malarial medications R21/Matrix-M is a pre-erythrocytic malaria vaccine candidate developed by scientists at the University of Oxford and manufactured by the Serum Institute of India. It is produced by expressing recombinant Hepatitis surface antigen virus-like particles in Hansenula polymorpha, a microorganism that occurs naturally in some insects and food. The trial was funded by the EDCTP2 programme, supported by the European Union, Wellcome Trust and NIHR Oxford Biomedical Research Centre. RTS,S, a recombinant protein-based malaria vaccine, aims to trigger the immune system to defend against the first stages of malaria when the Plasmodium falciparum parasite enters the human host’s bloodstream through a mosquito bite and infects liver cells. The vaccine is designed to prevent the parasite from infecting the liver, where it can mature, multiply, re-enter the bloodstream, and infect red blood cells, which can lead to disease symptoms. It resulted from 30 years of research and development by GSK and through a partnership with PATH, with support from a network of African research centres. The Bill and Melinda Gates Foundation provided catalytic funding for late-stage development of RTS,S between 2001 and 2015, according to WHO. Image Credits: Elizabeth Poll/MMV, MMV. New Pandemic Fund Created at World Bank 10/09/2022 John Heilprin Barbados receives 33,600 doses of COVID-19 vaccines, its first shipment through the COVAX facility, in April 2021 In one of the first concrete measures to attempt to redress huge inequities exposed by the COVID-19 pandemic, the Washington-based World Bank formally established a new billion-dollar financial intermediary fund (FIF) to invest in helping the world – particularly low- and middle-income countries – strengthen defenses against pandemics and epidemics. FIF’s governing board officially set up the new fund at a meeting in Washington, the World Health Organization announced on Friday. The new fund is hosted by the World Bank with technical leadership from Geneva-based WHO. Its main purpose is to provide long-term financing that fills critical gaps mainly in low- and middle-income countries. It also will serve as a platform to advocate for stronger health systems. FIF plans to start soliciting its first funding proposals in November. “COVID-19 has highlighted the pressing need for action to build stronger health systems,” said World Bank Group President David Malpass. “Investing now will save lives and resources for the years to come.” The World Bank’s board of directors approved FIF’s creation in late June. The World Bank serves as FIF’s trustee and hosts its Secretariat, which includes technical staff from WHO. A technical advisory panel chaired by WHO will help guide FIF’s governing board on the merits of funding proposals, ensuring linkages to the International Health Regulations (IHR), the legally binding rules among nations for responding to global health emergencies like the coronavirus pandemic. The new fund was developed with support from some of the Group of 20 major economies, and has lined up more than US$1.4 billion in financial commitments. The financing is intended to strengthen capacity in labs, emergency communication, zoonotic disease surveillance, pandemic coordination and management, workforce capacities and community engagement, according to WHO. “The COVID-19 pandemic has been a seismic shock to the world, but we also know that the next pandemic is a matter of when not if,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Nations that have made financial commitments to support the FIF include Australia, Canada, China, the European Commission, France, Germany, India, Indonesia, Italy, Japan, New Zealand, Norway, Singapore, South Africa, South Korea, Spain, the United Arab Emirates, the United Kingdom and the United States. Organizations that have promised support include the Bill and Melinda Gates Foundation, the Rockefeller Foundation and Wellcome Trust. Pandemic suffering ‘will be in vain’ unless there are lessons learned Tedros Adhanom Ghebreyesus, WHO Director-General Already, the world is grappling with a repeat of some of the same challenges it has faced during the pandemic as it navigates the monkeypox public health emergency – and rich nations’ continued stronghold on access to vaccines. And more than a month after declaring monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly. FIF aims to address the critical funding problems that already began to emerge a couple years ago. With COVID-19 vaccines, the multilateral COVAX financial facility was forced to the back of the line when trying to lock in advance purchases because it lacked the upfront funds to make legal commitments to drug makers. FIF’s governing board also is supposed to include equal representation from among sovereign donors, governments, foundations and civil society organizations. Tedros said the suffering and loss everyone has endured “will be in vain unless we learn the painful lessons from COVID-19 and put in place the measures to fill critical gaps in the world’s defences against epidemics and pandemics.” The new fund is one of those key measures, he said, and WHO “looks forward to fulfilling its technical leadership role in advising the FIF Board on where to make the most effective investments to protect health, especially in low- and middle-income countries.” Image Credits: PMO Barbados. WHO Submission Period for Development of International Instrument on Pandemic Prevention, Preparedness, and Response is Now Open 09/09/2022 Editorial team World Health Assembly The submission period for the second round of public hearings to inform the development of a new international instrument on pandemic prevention, preparedness and response is now open and will The World Health Organization (WHO) is inviting interested parties to submit a video statement in response to the question: Based on your experience with the COVID-19 pandemic, what do you believe should be addressed at the international level to better protect against future pandemics? The statements should be up to 90 seconds long and can be submitted in any six official WHO languages (Arabic, Chinese, English, French, Russian or Spanish). Public hearings inform the deliberations of the Interngovernmental Negotiating Body (INB) to help draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness, and response, as mandated by the World Health Assembly during its special session in December 2021. Read more about the submission process here at WHO COVID Threatens Meningitis Fight in Africa 09/09/2022 Paul Adepoju & John Heilprin Dr Matshidiso Moeti, director of WHO’s regional office for Africa The COVID-19 pandemic delayed plans to vaccinate more than 50 million African children with doses of MenAfriVac, a vaccine designed for the African meningitis belt. That could undo the progress in controlling a lethal form of meningitis in Africa, the World Health Organization warns. Until 12 years ago, meningitis type A made up 90% of the meningitis cases and deaths in Africa. One particularly deadly outbreak in 1996 infected a quarter million people, and killed 25,000. After African health ministers pleaded for a solution, the MenAfriVac was developed through a partnership between WHO, the Bill and Melinda Gates Foundation and PATH. Starting in 2010, more than 350 million people in 24 high-risk nations received the single-dose vaccine. The stunning result? Not a single new case of meningitis type A has been reported in Africa in the past five years, WHO reported on Thursday, and the chance of survival is now 95%, up from 50% less than a decade ago. “The defeat of meningitis A is one of Africa’s biggest health success stories with not a single case being reported on the continent in the past five years,” says Dr Matshidiso Moeti, director of WHO’s regional office for Africa. Now, that progress is in jeopardy because “the COVID-19 pandemic has delayed [MenAfriVac] vaccination campaigns targeting more than 50 million children” under 12 years of age in Benin, Guinea, Guinea Bissau, Nigeria and Togo, she told reporters in an online briefing. Meningitis A vaccination in Chad “I think most importantly what we are learning about vaccines repeatedly – the lessons learned for the MenAfriVac vaccine, the lessons we’re learning very much for the COVID-19 vaccinations – is that it’s very important to create the demand for vaccines in the population,” said Moeti. “It’s very important that people know the value of vaccines.” WHO officials say the pandemic severely disrupted meningitis prevention and control services by as much as 50% in 2020 compared to 2019, with disease surveillance, laboratory confirmation of cases and outbreak investigations all steeply declining. There was a slight improvement in 2021 but not enough to make much of a difference, according to Moeti. “Meningitis is taking an enormous toll on our countries with COVID-19 threatening some of the extensive gains that have been made in the past,” she said. “Major outbreaks caused by meningitis group C have been reported in seven of the African sub-Saharan meningitis belt countries in the past nine years.” Importance of ‘community acceptance’ in meningitis efforts Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks. The latest major outbreak in the Democratic Republic of Congo killed more than 200 people last year. As a result, WHO says it is in a race against time to fight the heightened risk of outbreaks of meningitis type A caused by inflammation of the membranes that surround the brain and spinal cord. It can lead to death within 24 hours; children under the age of five are particularly at risk. Four organisms are responsible for 50% of deaths: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus. Ahead of the start of the next meningitis season in January 2023, WHO is launching a US$1.5 billion global strategy to defeat bacterial meningitis in Africa by 2030. One of the priorities is to roll out a next-generation vaccine that has been shown in clinical trials to be safe and effective against multiple forms, Moeti told reporters on Thursday. “Community acceptance, which resulted in 95% coverage in affected countries for the MenAfriVac vaccine, is proof of what can be achieved,” said Moeti. “Following this example, the new framework aims to roll out the new vaccine to all 26 meningitis belt countries between 2023 and 2030 – aiming to achieve 90% coverage,” she said. “WHO is expected to prequalify the vaccine by the first quarter of next year.” The UN health agency wants to help countries shore up diagnosis, surveillance, care, advocacy and vaccination to eliminate outbreaks, curb deaths by 70% and halve infections, which it estimates would save more than 140,000 lives a year and significantly reduce disability. Dr. F. Marc LaForce, the Serum Institute of India’s technical services director Dr. F. Marc LaForce, the Serum Institute of India’s technical services director, emphasized the importance of the MenAfriVac vaccine in the fight against meningitis type A. “The disease has disappeared in every country where campaigns have been done,” said LaForce, a former director of the Meningitis Vaccine Project, a PATH/WHO/Serum Institute of India partnership funded by the Gates Foundation. “It is worth remembering that to this date, between 600,000 to a million cases of bacterial meningitis due to group A have been prevented. This is an enormous success and one I think we should all take great pride in,” he told the press briefing from his home in the United States. “A new vaccine again specifically designed for the African meningitis belt will hopefully be prequalified [by WHO] later this year or early next year,” said LaForce. “But this vaccines holds the promise of finishing what MenAfriVac began, such that Africa may be the first continent to be free of meningitis epidemics.” Image Credits: Gavi. 39,000 Test Kits for Africa – No Single Vaccine Dose, No Antiviral Treatment 09/09/2022 Paul Adepoju Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO More than a month after declaring Monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus – while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly. That was the key message emerging out of a briefing by WHO’s African Regional Office on Thursday by senior WHO officials in the agency’s African Regional Office. “Except for a small cohort study in the Central African Republic (CAR), Monkeypox vaccines [and treatments] are not yet available on the continent,” said WHO Regional Director, Matshidiso Moetiotshidiso. She was referring to the study of the anti-viral treatment Tecovirimat (TPOXX™), which has been ongoing amongst a small group of volunteers in CAR, under the direction of the University of Oxford, the Ministry of Health and SIGA, the drug manufacturer. See the full story here: Exclusive: Manufacturer of World’s Only Monkeypox Drug Says There’s No Shortage; Will Work with WHO on Supplies to LMICs Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO told Health Policy Watch, that in the absence of other tools the continent is relying more on non-pharmaceutical measures to control the spread of the disease – which seems to be transmitting more intensively person to person in Africa as well as abroad, after decades in which exposure was more limited to people in contact with infected animal populations. The infection control modalities being put in place, howver, stem from the experience of several countries in the region, such as CAR and the Democratic Republic of Congo, and Nigeria – that have been experiencing Monkeypox outbreaks since the 1970s. The modalities include ensuring that the local communities are aware of the diseases and that they protect themselves and those that are around them, and ensuring that there is no contact to avoid transmission. “It is spread by direct skin-to-skin or mouth-to-skin kind of contact. So it’s important that there is separation when it comes to infection. We also ensure that there is adequate surveillance in place to be able to detect these cases rapidly and provide the necessary management. So I think that it’s a collective use of strategies in the African region where vaccines and therapeutics are not very much available,” she said. Fighting the Scourge of Fake Medicines: Global Fund Replenishment is Moment of Truth 09/09/2022 Adam Aspinall One a number of fake batches of the anti-malaria drug, quinine sulphate, identified in a WHO medical product alert for the Central African Republic. The upcoming Global Fund Replenishment drive, 19-21 September, will be critical to holding onto and advancing progress against infectious diseases in multiple ways – among them ensuring the flow of quality-assured medicines to low-income countries and fighting falsified and substandard medicines that can comprise up to 70% of drugs on the market in some parts of Africa. At Rwanda’s Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) held in June on the margins of the Commonwealth Heads of Government meeting, world leaders and representatives from the private sector, civil society organisations, philanthropists and trusts recommitted to combat the scourge of malaria and Neglected Tropical Diseases (NTDs). Those commitments were made despite the unprecedented challenges facing the world from the COVID-19 pandemic, the war in Ukraine and the climate crisis. Commitments are encouraging and important, but to deliver real progress in the fight against NTDs they must be backed by funding. One of the biggest single-donor organisations in public health is the Global Fund to fight AIDs, Tuberculosis (TB) and Malaria, a partnership that has invested more than $55 billion to date to help defeat these three diseases and others in more than 100 countries through commodity procurement. It has helped to strengthen health systems and provided support for specific programmes, helping save an estimated 44 million lives, mostly vulnerable people. This month, the Global Fund meets for its 7th funding replenishment from donor governments, and the outcome will have a decisive impact on global public health in the coming years. Global Fund’s role fighting fake medicines is less well known While the Global Fund’s work is familiar to many, perhaps less well known is its critical role in protecting patients from fake medicines. Only quality-assured medicines may be procured with Global Fund financing – those cleared by stringent regulatory authorities, the World Health Organisation’s Prequalification Programme, or Global Fund’s Expert Review Panel. Why does this matter? Simple: because counterfeits are a global problem. Estimates suggest that in some parts of Africa, up to 70% of all medicines may be falsified or substandard. The World Health Organization (WHO) says 1-in-10 medicines in lower-and middle-income countries (LMICs) are falsified or substandard, particularly in sub-Saharan Africa. And according to one field survey in South-East Asia, 53% of all antimalarials sampled did not contain the correct level of active ingredients. These “medicines” can kill due to little to no active ingredients or toxic substances that are poisonous. If they don’t kill, they are likely to have little or no therapeutic impact. That results in additional morbidity from treatment failure and significant economic impact due to the costs of re-treatment, hospitalisation and lost working days. Fake Medicines can also foster antimicrobial resistance Causes, impacts and strategies for fighting fake and substandard medicines. There have been too many preventable deaths caused by falsified and substandard medicines. Falsified and substandard medicines can also facilitate the emergence of antimicrobial resistance through exposure of pathogens or parasites to sub-therapeutic doses of active pharmaceutical ingredients. This is a very serious problem that can result in drug failure and potentially millions more deaths. Producing and distributing counterfeits is not a victimless crime. Perpetrators are perfectly aware of the likely consequences and are criminally responsible for deaths on a potentially vast scale. Children and vulnerable people are disproportionately affected. Malaria medicines are among those most commonly counterfeited Children affected by Malaria Malaria control is one of the therapeutic areas most affected by falsified and substandard medicines. A WHO-commissioned study found counterfeit malarials cause an additional 72,000 to 267,000 deaths every year in sub-Saharan Africa. At the same time, a 2019 review showed up to 155,000 children a year die from falsified or substandard antimalarial drugs – a staggering figure that seems to have passed almost unnoticed. One cannot help but wonder what the public reaction would be in higher-income countries to a news headline such as this: “FAKE DRUG HORROR– 155,000 CHILDREN MURDERED.” Without a doubt it would capture the attention of news outlets and law enforcement agencies alike. In reality, of course, there is no simple solution to this issue. Combatting this scourge requires coordinated efforts between regulators, law enforcement and customs agencies. There must be stronger penalties for perpetrators, stronger regulatory systems, improved detection and verification technologies, better public and professional awareness of the issue, and action by drug manufacturers to incorporate anti-counterfeiting measures into packaging. And all of these efforts need to be supported with adequate funding for effective, high-quality medicines. Fake meds blocking achievement of the UN Sustainable Development Goals for 2030 One of the Sustainable Development Goals (SDGs), target 3.8, calls for “access to safe, effective, quality and affordable essential medicines and vaccines for all”. The widespread availability of falsified and substandard medicines is a substantial and important barrier to the achievement of this goal in the immediate future, and adequate funding for quality medicines is an essential prerequisite if it is to be delivered. Given that the Global Fund provides 56% of all international financing for malaria programmes alone, this is a critical safeguard against the scourge of counterfeits and reinforces the crucial importance of a full replenishment of its funding. The estimated total financing need for HIV, TB and malaria for the 2024-26 timeframe is US$130.2 billion, of which at least US$18 billion needs to be funded by the Global Fund. The minimum US$18 billion replenishment is, therefore, of huge importance, especially because the Global Fund only procures quality-assured medicines and medicinal products for low-and middle-income countries. If the replenishment is not met in full, it increases the likelihood that countries will procure non-quality assured medicines. That raises the likelihood of falsified and substandard medicines reaching patients through formal or informal supply pathways. This risks undermining the progress made so far in halting the progression of these diseases, and directly puts patients’ health and lives in jeopardy. With a successful replenishment, the Global Fund will also be able to increase its efforts to strengthen health systems more broadly over the next three years. Given the extraordinary financial strains placed on national governments by the COVID-19 pandemic and the economic consequences of the Ukraine war, it is understandable that governments have competing priorities and domestic pressures that may be viewed as more urgent than international aid and supporting the Global Fund. Nevertheless, disruptions caused by the pandemic to the legal supply chains and limited regulatory enforcement helped spawn a surge in fake medicines, according to the Organization for Economic Co-operation and Development. Interventions to support the fight against HIV, TB and malaria (stronger health systems, improved disease surveillance, more health care worker training, improved laboratory capacity for diagnosis, etc.) are also the foundation of future pandemic preparedness. Resourcing the battle against these diseases is also, therefore, equivalent to resourcing future health crisis readiness. And since pandemics, by definition, affect us all, this should be viewed as investment in future global health. Climate change is already affecting virtually every part of the world, with more extreme weather events recorded across our planet. The already record levels of internally displaced people and refugees will increase, and poverty, food and water insecurity will create immense negative pressures on health, increasing the risk of future pandemics and altering the dynamics of diseases such as HIV, TB and malaria. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths a year, including 60,000 from malaria alone. Business as usual is no longer good enough Someone far wiser than I once said: “Do what you’ve always done, and you’ll get what you’ve always got”. Business as usual isn’t going to cut it in the interconnected set of challenges posed by climate change, emerging pandemics and global public health that we will face over the coming years and decades. Neither is merely “responding” good enough – proactive planning and preemptive interventions are going to be crucial. That’s why the Fight the Fakes Alliance strongly endorses the Global Fund’s philosophy of a “One Health” ethos that envisions an integrated approach: “… positioning human health interventions within the context of a broader planetary health agenda, encompassing animal, human, plant health and the shared environment.” The question is not whether the world can afford to, but rather if we can afford not to support the crucial public health programmes that are financed by the Global Fund. Public health investments in LMICs have a direct impact on the quality of life in developed and high-income countries too. We are all in this together. As the global health challenges we face together continue to grow, so does the opportunity for counterfeiters and criminals. While the market size for fakes medicines is, by its very nature, difficult to quantify accurately, it is worth an estimated US$70-$200 billion. During a single operation (Action Against Counterfeit and Illicit Medicines, ACIM) carried out in 16 African countries in 2016, 113 million “suspect” medicines worth an estimated €52 million were seized over a 10-day period. Increased public awareness of the issue is clearly essential, and one positive consequence of the COVID-19 pandemic is the attention it brought to the problem of falsified and substandard medicines and PPE, including masks, gloves, hydroxychloroquine and vaccines. Almost any pharmaceutical product can be falsified, but those used to treat malaria, tuberculosis and HIV/AIDS are amongst the most widely abused. For this reason, the Fight the Fakes Alliance calls upon governments to be bold and increase pledges so the global programmes to tackle HIV, TB and malaria are fully funded. That will help avoid millions of preventable deaths, accomplish the SDGs, and ensure preparedness for future health crises. _________________________ The author of this article is Chair of the Fight the Fakes Alliance (commonly referred to as ‘Fight the Fakes’), a multi-stakeholder non-profit association based in Geneva, Switzerland, that aims to raise awareness and influence change about the proliferation of falsified and substandard medicines. He is also Senior Director, Access & Product Management at Medicines for Malaria Venture, a leading product development partnership engaged in the discovery, development and delivery of novel antimalarials. Image Credits: The Global Fund , WHO Medical Product Alert 10/2019, Pyzik, O.Z., Abubakar, I. Fighting the fakes: tackling substandard and falsified medicines. Nat Rev Dis Primers 8, 55 (2022)., Emmanuel Museruka/ MMV. Time to Invest in Preventing and Treating NCDs 08/09/2022 Kerry Cullinan Testing patients for diabetes at a World Health Organization event. If all countries significantly raise taxes on tobacco, alcohol and sugary beverages, this could prevent 50 million premature deaths over the next 50 years, according to Michael Bloomberg, World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries. “Plus, the taxes would raise more than $20 trillion in revenue to support public health programmes, helping to save even more lives,” Bloomberg told a virtual event convened to make a global appeal for more investment in NCDs. “Every year, 17 million people under the age of 70 die of non-communicable diseases, mostly in low and middle-income countries,” Dr Tedros Adhanom Ghebreyesus told the event, co-hosted by WHO, the NCD Alliance and the World Diabetes Foundation. “Nearly seven million lives could be saved by 2030 if low and lower middle-income countries invest an additional $1 per person per year on cost-effective interventions, like graphic warnings on cigarette packaging, food labelling and bicycle lanes,” said Tedros. Katie Dain, CEO of the NCD Alliance, decried the fact that “a multitude of political commitments have yet to really translate into adequate [financial] commitments”. “NCDs will cause more suffering in lives lost this decade than any other health issue. They wi’ll drain the global economy and impede human capital and undermine any effort to ensure the world is better prepared for future pandemics after COVID-19,” said Dain. Financing for NCDs has stagnated at around 2% of the development assistance for health for two decades. Paul Fife from the Norwegian Agency for Development Cooperation stressed that “the proper way to finance NCD action is in general through health system reform more broadly, as opposed to very focused disease control programme approaches, such as we have seen for some infectious diseases.” Fife added that “we need to be careful to not give the impression that donors and donor financing are the most instrumental in driving or not driving investments in NCDs”. “For all but the poorest countries and countries in conflict or humanitarian crises, the investments made by governments, insurance agencies, private companies – and the degree to which they are universal, meaning equitable – are far more important than donor aid,” Fife stressed. Preventing NCDs key to achieving universal health coverage From a luxury good to a part of daily diets, sugary drinks that increase the risks of diabetes have become highly popular in Africa. “The big challenge is actually to build a broader, more equitable and efficient health system and integrate NCDs into the system. The path forward is the progressive realisation of universal health coverage.” Dr Omary Ubuguyu from Tanzania’s health ministry said that many of his citizens had to pay for their own NCD treatment as only 15% of the population had health insurance. “So 85% have to pay out of their pockets for health care services and this makes them very vulnerable,” said Ubuguyu. “At the moment, what we are paying for the dialysis, for example, is almost $400 per week, So we have seen a lot of people selling their assets, only to find after one year that they can’t afford to continue with this was a treatment and then dying,” he said, adding that his country was introducing a mandatory health insurance scheme for all – although there were significant financial challenges. “Integration of NCDs with other services, notably HIV and tuberculosis, is also on our agenda,” he added. Uruguay has implemented a number of policies to address NCDs including provisions to regulate tobacco and unhealthy food, according to health ministry official Luis Galicia. Citizens have universal health coverage with a “payment by performance system”, where suppliers are reimbursed if patients comply with targets linked to cancer, hypertension, diabetes, heart and cerebral vascular indicators, said Galicia. “We have allocated a part of the taxes on alcohol and sugary beverages to the prevention and control of NCDs,” he added. Funding targets Bente Mikkelsen Bente Mikkelsen, WHO director of NCDs, said that it is “a huge disappointment that many, many countries don’t realise the epidemiological shift that has happened from HIV, malaria, TB, to actually looking at that seven out of 10 deaths in the world is now linked to NCD”. Earlier in the meeting, South African HIV activist and academic Dr Vuyiseka Dubula, had called on people to put pressure on African countries to ensure that they spent more on health. Mikkelsen said that the NCD sector should set a global target for NCD expenditure as the HIV sector had. “I think we need a target for investment in NCDs, and we need to target for also including NCD into UHC. Part of that should be measures for domestic funding, which can very well be also linked to the health taxation,” said Mikkelsen. However, she also stressed that the demand for increased investment in NCDs had to come from WHO member countries. Despite a raft of global resolutions, policy options and implementation tools, a global roadmap “what we totally lack is the demand”. Demand creation “There is no demand to be seen when the proposal comes from a country that doesn’t include NCD. How can that be? So, even before the data, we are about demand creation.” Bloomberg Philanthropies’ Dr Kelly Henning warned that progress against NCDs was being hampered by “powerful stakeholders promoting and selling harmful products”. “It takes resolve at the highest levels of leadership to push back against these interests and requires effective public education so that the population can support and participate in the change that’s needed,” said Henning. In 2018, Bloomberg convened a task force on fiscal policy for health, which concluded that raising health taxes on tobacco, alcohol and sweetened beverages, “is highly underutilised and would save millions of lives and bring in much needed government revenue”, said Henning. “After reviewing the evidence, the task force found that tobacco taxes can do more to reduce premature mortality than any other single health policy. Unfortunately, since the taskforce report came out, we haven’t really made all that much progress,” said Henning. “And why is that? The task force concluded that implementing health taxes was a measure of government resolve because industry’s pushback against tax increases with false and misleading standards, and oftentimes, influences them.” The NCD Alliance is running a week-long awareness campaign about the need to invest in NCDs. Only 14 countries are on track to meet the WHO’s nine voluntary global targets for the prevention and control of NCDs, due to be assessed at the fourth High-level Meeting of the United Nations General Assembly (HLM4) in 2025. Image Credits: Twitter: @WHO, Heala_SA/Twitter. Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
New Pandemic Fund Created at World Bank 10/09/2022 John Heilprin Barbados receives 33,600 doses of COVID-19 vaccines, its first shipment through the COVAX facility, in April 2021 In one of the first concrete measures to attempt to redress huge inequities exposed by the COVID-19 pandemic, the Washington-based World Bank formally established a new billion-dollar financial intermediary fund (FIF) to invest in helping the world – particularly low- and middle-income countries – strengthen defenses against pandemics and epidemics. FIF’s governing board officially set up the new fund at a meeting in Washington, the World Health Organization announced on Friday. The new fund is hosted by the World Bank with technical leadership from Geneva-based WHO. Its main purpose is to provide long-term financing that fills critical gaps mainly in low- and middle-income countries. It also will serve as a platform to advocate for stronger health systems. FIF plans to start soliciting its first funding proposals in November. “COVID-19 has highlighted the pressing need for action to build stronger health systems,” said World Bank Group President David Malpass. “Investing now will save lives and resources for the years to come.” The World Bank’s board of directors approved FIF’s creation in late June. The World Bank serves as FIF’s trustee and hosts its Secretariat, which includes technical staff from WHO. A technical advisory panel chaired by WHO will help guide FIF’s governing board on the merits of funding proposals, ensuring linkages to the International Health Regulations (IHR), the legally binding rules among nations for responding to global health emergencies like the coronavirus pandemic. The new fund was developed with support from some of the Group of 20 major economies, and has lined up more than US$1.4 billion in financial commitments. The financing is intended to strengthen capacity in labs, emergency communication, zoonotic disease surveillance, pandemic coordination and management, workforce capacities and community engagement, according to WHO. “The COVID-19 pandemic has been a seismic shock to the world, but we also know that the next pandemic is a matter of when not if,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Nations that have made financial commitments to support the FIF include Australia, Canada, China, the European Commission, France, Germany, India, Indonesia, Italy, Japan, New Zealand, Norway, Singapore, South Africa, South Korea, Spain, the United Arab Emirates, the United Kingdom and the United States. Organizations that have promised support include the Bill and Melinda Gates Foundation, the Rockefeller Foundation and Wellcome Trust. Pandemic suffering ‘will be in vain’ unless there are lessons learned Tedros Adhanom Ghebreyesus, WHO Director-General Already, the world is grappling with a repeat of some of the same challenges it has faced during the pandemic as it navigates the monkeypox public health emergency – and rich nations’ continued stronghold on access to vaccines. And more than a month after declaring monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly. FIF aims to address the critical funding problems that already began to emerge a couple years ago. With COVID-19 vaccines, the multilateral COVAX financial facility was forced to the back of the line when trying to lock in advance purchases because it lacked the upfront funds to make legal commitments to drug makers. FIF’s governing board also is supposed to include equal representation from among sovereign donors, governments, foundations and civil society organizations. Tedros said the suffering and loss everyone has endured “will be in vain unless we learn the painful lessons from COVID-19 and put in place the measures to fill critical gaps in the world’s defences against epidemics and pandemics.” The new fund is one of those key measures, he said, and WHO “looks forward to fulfilling its technical leadership role in advising the FIF Board on where to make the most effective investments to protect health, especially in low- and middle-income countries.” Image Credits: PMO Barbados. WHO Submission Period for Development of International Instrument on Pandemic Prevention, Preparedness, and Response is Now Open 09/09/2022 Editorial team World Health Assembly The submission period for the second round of public hearings to inform the development of a new international instrument on pandemic prevention, preparedness and response is now open and will The World Health Organization (WHO) is inviting interested parties to submit a video statement in response to the question: Based on your experience with the COVID-19 pandemic, what do you believe should be addressed at the international level to better protect against future pandemics? The statements should be up to 90 seconds long and can be submitted in any six official WHO languages (Arabic, Chinese, English, French, Russian or Spanish). Public hearings inform the deliberations of the Interngovernmental Negotiating Body (INB) to help draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness, and response, as mandated by the World Health Assembly during its special session in December 2021. Read more about the submission process here at WHO COVID Threatens Meningitis Fight in Africa 09/09/2022 Paul Adepoju & John Heilprin Dr Matshidiso Moeti, director of WHO’s regional office for Africa The COVID-19 pandemic delayed plans to vaccinate more than 50 million African children with doses of MenAfriVac, a vaccine designed for the African meningitis belt. That could undo the progress in controlling a lethal form of meningitis in Africa, the World Health Organization warns. Until 12 years ago, meningitis type A made up 90% of the meningitis cases and deaths in Africa. One particularly deadly outbreak in 1996 infected a quarter million people, and killed 25,000. After African health ministers pleaded for a solution, the MenAfriVac was developed through a partnership between WHO, the Bill and Melinda Gates Foundation and PATH. Starting in 2010, more than 350 million people in 24 high-risk nations received the single-dose vaccine. The stunning result? Not a single new case of meningitis type A has been reported in Africa in the past five years, WHO reported on Thursday, and the chance of survival is now 95%, up from 50% less than a decade ago. “The defeat of meningitis A is one of Africa’s biggest health success stories with not a single case being reported on the continent in the past five years,” says Dr Matshidiso Moeti, director of WHO’s regional office for Africa. Now, that progress is in jeopardy because “the COVID-19 pandemic has delayed [MenAfriVac] vaccination campaigns targeting more than 50 million children” under 12 years of age in Benin, Guinea, Guinea Bissau, Nigeria and Togo, she told reporters in an online briefing. Meningitis A vaccination in Chad “I think most importantly what we are learning about vaccines repeatedly – the lessons learned for the MenAfriVac vaccine, the lessons we’re learning very much for the COVID-19 vaccinations – is that it’s very important to create the demand for vaccines in the population,” said Moeti. “It’s very important that people know the value of vaccines.” WHO officials say the pandemic severely disrupted meningitis prevention and control services by as much as 50% in 2020 compared to 2019, with disease surveillance, laboratory confirmation of cases and outbreak investigations all steeply declining. There was a slight improvement in 2021 but not enough to make much of a difference, according to Moeti. “Meningitis is taking an enormous toll on our countries with COVID-19 threatening some of the extensive gains that have been made in the past,” she said. “Major outbreaks caused by meningitis group C have been reported in seven of the African sub-Saharan meningitis belt countries in the past nine years.” Importance of ‘community acceptance’ in meningitis efforts Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks. The latest major outbreak in the Democratic Republic of Congo killed more than 200 people last year. As a result, WHO says it is in a race against time to fight the heightened risk of outbreaks of meningitis type A caused by inflammation of the membranes that surround the brain and spinal cord. It can lead to death within 24 hours; children under the age of five are particularly at risk. Four organisms are responsible for 50% of deaths: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus. Ahead of the start of the next meningitis season in January 2023, WHO is launching a US$1.5 billion global strategy to defeat bacterial meningitis in Africa by 2030. One of the priorities is to roll out a next-generation vaccine that has been shown in clinical trials to be safe and effective against multiple forms, Moeti told reporters on Thursday. “Community acceptance, which resulted in 95% coverage in affected countries for the MenAfriVac vaccine, is proof of what can be achieved,” said Moeti. “Following this example, the new framework aims to roll out the new vaccine to all 26 meningitis belt countries between 2023 and 2030 – aiming to achieve 90% coverage,” she said. “WHO is expected to prequalify the vaccine by the first quarter of next year.” The UN health agency wants to help countries shore up diagnosis, surveillance, care, advocacy and vaccination to eliminate outbreaks, curb deaths by 70% and halve infections, which it estimates would save more than 140,000 lives a year and significantly reduce disability. Dr. F. Marc LaForce, the Serum Institute of India’s technical services director Dr. F. Marc LaForce, the Serum Institute of India’s technical services director, emphasized the importance of the MenAfriVac vaccine in the fight against meningitis type A. “The disease has disappeared in every country where campaigns have been done,” said LaForce, a former director of the Meningitis Vaccine Project, a PATH/WHO/Serum Institute of India partnership funded by the Gates Foundation. “It is worth remembering that to this date, between 600,000 to a million cases of bacterial meningitis due to group A have been prevented. This is an enormous success and one I think we should all take great pride in,” he told the press briefing from his home in the United States. “A new vaccine again specifically designed for the African meningitis belt will hopefully be prequalified [by WHO] later this year or early next year,” said LaForce. “But this vaccines holds the promise of finishing what MenAfriVac began, such that Africa may be the first continent to be free of meningitis epidemics.” Image Credits: Gavi. 39,000 Test Kits for Africa – No Single Vaccine Dose, No Antiviral Treatment 09/09/2022 Paul Adepoju Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO More than a month after declaring Monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus – while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly. That was the key message emerging out of a briefing by WHO’s African Regional Office on Thursday by senior WHO officials in the agency’s African Regional Office. “Except for a small cohort study in the Central African Republic (CAR), Monkeypox vaccines [and treatments] are not yet available on the continent,” said WHO Regional Director, Matshidiso Moetiotshidiso. She was referring to the study of the anti-viral treatment Tecovirimat (TPOXX™), which has been ongoing amongst a small group of volunteers in CAR, under the direction of the University of Oxford, the Ministry of Health and SIGA, the drug manufacturer. See the full story here: Exclusive: Manufacturer of World’s Only Monkeypox Drug Says There’s No Shortage; Will Work with WHO on Supplies to LMICs Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO told Health Policy Watch, that in the absence of other tools the continent is relying more on non-pharmaceutical measures to control the spread of the disease – which seems to be transmitting more intensively person to person in Africa as well as abroad, after decades in which exposure was more limited to people in contact with infected animal populations. The infection control modalities being put in place, howver, stem from the experience of several countries in the region, such as CAR and the Democratic Republic of Congo, and Nigeria – that have been experiencing Monkeypox outbreaks since the 1970s. The modalities include ensuring that the local communities are aware of the diseases and that they protect themselves and those that are around them, and ensuring that there is no contact to avoid transmission. “It is spread by direct skin-to-skin or mouth-to-skin kind of contact. So it’s important that there is separation when it comes to infection. We also ensure that there is adequate surveillance in place to be able to detect these cases rapidly and provide the necessary management. So I think that it’s a collective use of strategies in the African region where vaccines and therapeutics are not very much available,” she said. Fighting the Scourge of Fake Medicines: Global Fund Replenishment is Moment of Truth 09/09/2022 Adam Aspinall One a number of fake batches of the anti-malaria drug, quinine sulphate, identified in a WHO medical product alert for the Central African Republic. The upcoming Global Fund Replenishment drive, 19-21 September, will be critical to holding onto and advancing progress against infectious diseases in multiple ways – among them ensuring the flow of quality-assured medicines to low-income countries and fighting falsified and substandard medicines that can comprise up to 70% of drugs on the market in some parts of Africa. At Rwanda’s Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) held in June on the margins of the Commonwealth Heads of Government meeting, world leaders and representatives from the private sector, civil society organisations, philanthropists and trusts recommitted to combat the scourge of malaria and Neglected Tropical Diseases (NTDs). Those commitments were made despite the unprecedented challenges facing the world from the COVID-19 pandemic, the war in Ukraine and the climate crisis. Commitments are encouraging and important, but to deliver real progress in the fight against NTDs they must be backed by funding. One of the biggest single-donor organisations in public health is the Global Fund to fight AIDs, Tuberculosis (TB) and Malaria, a partnership that has invested more than $55 billion to date to help defeat these three diseases and others in more than 100 countries through commodity procurement. It has helped to strengthen health systems and provided support for specific programmes, helping save an estimated 44 million lives, mostly vulnerable people. This month, the Global Fund meets for its 7th funding replenishment from donor governments, and the outcome will have a decisive impact on global public health in the coming years. Global Fund’s role fighting fake medicines is less well known While the Global Fund’s work is familiar to many, perhaps less well known is its critical role in protecting patients from fake medicines. Only quality-assured medicines may be procured with Global Fund financing – those cleared by stringent regulatory authorities, the World Health Organisation’s Prequalification Programme, or Global Fund’s Expert Review Panel. Why does this matter? Simple: because counterfeits are a global problem. Estimates suggest that in some parts of Africa, up to 70% of all medicines may be falsified or substandard. The World Health Organization (WHO) says 1-in-10 medicines in lower-and middle-income countries (LMICs) are falsified or substandard, particularly in sub-Saharan Africa. And according to one field survey in South-East Asia, 53% of all antimalarials sampled did not contain the correct level of active ingredients. These “medicines” can kill due to little to no active ingredients or toxic substances that are poisonous. If they don’t kill, they are likely to have little or no therapeutic impact. That results in additional morbidity from treatment failure and significant economic impact due to the costs of re-treatment, hospitalisation and lost working days. Fake Medicines can also foster antimicrobial resistance Causes, impacts and strategies for fighting fake and substandard medicines. There have been too many preventable deaths caused by falsified and substandard medicines. Falsified and substandard medicines can also facilitate the emergence of antimicrobial resistance through exposure of pathogens or parasites to sub-therapeutic doses of active pharmaceutical ingredients. This is a very serious problem that can result in drug failure and potentially millions more deaths. Producing and distributing counterfeits is not a victimless crime. Perpetrators are perfectly aware of the likely consequences and are criminally responsible for deaths on a potentially vast scale. Children and vulnerable people are disproportionately affected. Malaria medicines are among those most commonly counterfeited Children affected by Malaria Malaria control is one of the therapeutic areas most affected by falsified and substandard medicines. A WHO-commissioned study found counterfeit malarials cause an additional 72,000 to 267,000 deaths every year in sub-Saharan Africa. At the same time, a 2019 review showed up to 155,000 children a year die from falsified or substandard antimalarial drugs – a staggering figure that seems to have passed almost unnoticed. One cannot help but wonder what the public reaction would be in higher-income countries to a news headline such as this: “FAKE DRUG HORROR– 155,000 CHILDREN MURDERED.” Without a doubt it would capture the attention of news outlets and law enforcement agencies alike. In reality, of course, there is no simple solution to this issue. Combatting this scourge requires coordinated efforts between regulators, law enforcement and customs agencies. There must be stronger penalties for perpetrators, stronger regulatory systems, improved detection and verification technologies, better public and professional awareness of the issue, and action by drug manufacturers to incorporate anti-counterfeiting measures into packaging. And all of these efforts need to be supported with adequate funding for effective, high-quality medicines. Fake meds blocking achievement of the UN Sustainable Development Goals for 2030 One of the Sustainable Development Goals (SDGs), target 3.8, calls for “access to safe, effective, quality and affordable essential medicines and vaccines for all”. The widespread availability of falsified and substandard medicines is a substantial and important barrier to the achievement of this goal in the immediate future, and adequate funding for quality medicines is an essential prerequisite if it is to be delivered. Given that the Global Fund provides 56% of all international financing for malaria programmes alone, this is a critical safeguard against the scourge of counterfeits and reinforces the crucial importance of a full replenishment of its funding. The estimated total financing need for HIV, TB and malaria for the 2024-26 timeframe is US$130.2 billion, of which at least US$18 billion needs to be funded by the Global Fund. The minimum US$18 billion replenishment is, therefore, of huge importance, especially because the Global Fund only procures quality-assured medicines and medicinal products for low-and middle-income countries. If the replenishment is not met in full, it increases the likelihood that countries will procure non-quality assured medicines. That raises the likelihood of falsified and substandard medicines reaching patients through formal or informal supply pathways. This risks undermining the progress made so far in halting the progression of these diseases, and directly puts patients’ health and lives in jeopardy. With a successful replenishment, the Global Fund will also be able to increase its efforts to strengthen health systems more broadly over the next three years. Given the extraordinary financial strains placed on national governments by the COVID-19 pandemic and the economic consequences of the Ukraine war, it is understandable that governments have competing priorities and domestic pressures that may be viewed as more urgent than international aid and supporting the Global Fund. Nevertheless, disruptions caused by the pandemic to the legal supply chains and limited regulatory enforcement helped spawn a surge in fake medicines, according to the Organization for Economic Co-operation and Development. Interventions to support the fight against HIV, TB and malaria (stronger health systems, improved disease surveillance, more health care worker training, improved laboratory capacity for diagnosis, etc.) are also the foundation of future pandemic preparedness. Resourcing the battle against these diseases is also, therefore, equivalent to resourcing future health crisis readiness. And since pandemics, by definition, affect us all, this should be viewed as investment in future global health. Climate change is already affecting virtually every part of the world, with more extreme weather events recorded across our planet. The already record levels of internally displaced people and refugees will increase, and poverty, food and water insecurity will create immense negative pressures on health, increasing the risk of future pandemics and altering the dynamics of diseases such as HIV, TB and malaria. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths a year, including 60,000 from malaria alone. Business as usual is no longer good enough Someone far wiser than I once said: “Do what you’ve always done, and you’ll get what you’ve always got”. Business as usual isn’t going to cut it in the interconnected set of challenges posed by climate change, emerging pandemics and global public health that we will face over the coming years and decades. Neither is merely “responding” good enough – proactive planning and preemptive interventions are going to be crucial. That’s why the Fight the Fakes Alliance strongly endorses the Global Fund’s philosophy of a “One Health” ethos that envisions an integrated approach: “… positioning human health interventions within the context of a broader planetary health agenda, encompassing animal, human, plant health and the shared environment.” The question is not whether the world can afford to, but rather if we can afford not to support the crucial public health programmes that are financed by the Global Fund. Public health investments in LMICs have a direct impact on the quality of life in developed and high-income countries too. We are all in this together. As the global health challenges we face together continue to grow, so does the opportunity for counterfeiters and criminals. While the market size for fakes medicines is, by its very nature, difficult to quantify accurately, it is worth an estimated US$70-$200 billion. During a single operation (Action Against Counterfeit and Illicit Medicines, ACIM) carried out in 16 African countries in 2016, 113 million “suspect” medicines worth an estimated €52 million were seized over a 10-day period. Increased public awareness of the issue is clearly essential, and one positive consequence of the COVID-19 pandemic is the attention it brought to the problem of falsified and substandard medicines and PPE, including masks, gloves, hydroxychloroquine and vaccines. Almost any pharmaceutical product can be falsified, but those used to treat malaria, tuberculosis and HIV/AIDS are amongst the most widely abused. For this reason, the Fight the Fakes Alliance calls upon governments to be bold and increase pledges so the global programmes to tackle HIV, TB and malaria are fully funded. That will help avoid millions of preventable deaths, accomplish the SDGs, and ensure preparedness for future health crises. _________________________ The author of this article is Chair of the Fight the Fakes Alliance (commonly referred to as ‘Fight the Fakes’), a multi-stakeholder non-profit association based in Geneva, Switzerland, that aims to raise awareness and influence change about the proliferation of falsified and substandard medicines. He is also Senior Director, Access & Product Management at Medicines for Malaria Venture, a leading product development partnership engaged in the discovery, development and delivery of novel antimalarials. Image Credits: The Global Fund , WHO Medical Product Alert 10/2019, Pyzik, O.Z., Abubakar, I. Fighting the fakes: tackling substandard and falsified medicines. Nat Rev Dis Primers 8, 55 (2022)., Emmanuel Museruka/ MMV. Time to Invest in Preventing and Treating NCDs 08/09/2022 Kerry Cullinan Testing patients for diabetes at a World Health Organization event. If all countries significantly raise taxes on tobacco, alcohol and sugary beverages, this could prevent 50 million premature deaths over the next 50 years, according to Michael Bloomberg, World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries. “Plus, the taxes would raise more than $20 trillion in revenue to support public health programmes, helping to save even more lives,” Bloomberg told a virtual event convened to make a global appeal for more investment in NCDs. “Every year, 17 million people under the age of 70 die of non-communicable diseases, mostly in low and middle-income countries,” Dr Tedros Adhanom Ghebreyesus told the event, co-hosted by WHO, the NCD Alliance and the World Diabetes Foundation. “Nearly seven million lives could be saved by 2030 if low and lower middle-income countries invest an additional $1 per person per year on cost-effective interventions, like graphic warnings on cigarette packaging, food labelling and bicycle lanes,” said Tedros. Katie Dain, CEO of the NCD Alliance, decried the fact that “a multitude of political commitments have yet to really translate into adequate [financial] commitments”. “NCDs will cause more suffering in lives lost this decade than any other health issue. They wi’ll drain the global economy and impede human capital and undermine any effort to ensure the world is better prepared for future pandemics after COVID-19,” said Dain. Financing for NCDs has stagnated at around 2% of the development assistance for health for two decades. Paul Fife from the Norwegian Agency for Development Cooperation stressed that “the proper way to finance NCD action is in general through health system reform more broadly, as opposed to very focused disease control programme approaches, such as we have seen for some infectious diseases.” Fife added that “we need to be careful to not give the impression that donors and donor financing are the most instrumental in driving or not driving investments in NCDs”. “For all but the poorest countries and countries in conflict or humanitarian crises, the investments made by governments, insurance agencies, private companies – and the degree to which they are universal, meaning equitable – are far more important than donor aid,” Fife stressed. Preventing NCDs key to achieving universal health coverage From a luxury good to a part of daily diets, sugary drinks that increase the risks of diabetes have become highly popular in Africa. “The big challenge is actually to build a broader, more equitable and efficient health system and integrate NCDs into the system. The path forward is the progressive realisation of universal health coverage.” Dr Omary Ubuguyu from Tanzania’s health ministry said that many of his citizens had to pay for their own NCD treatment as only 15% of the population had health insurance. “So 85% have to pay out of their pockets for health care services and this makes them very vulnerable,” said Ubuguyu. “At the moment, what we are paying for the dialysis, for example, is almost $400 per week, So we have seen a lot of people selling their assets, only to find after one year that they can’t afford to continue with this was a treatment and then dying,” he said, adding that his country was introducing a mandatory health insurance scheme for all – although there were significant financial challenges. “Integration of NCDs with other services, notably HIV and tuberculosis, is also on our agenda,” he added. Uruguay has implemented a number of policies to address NCDs including provisions to regulate tobacco and unhealthy food, according to health ministry official Luis Galicia. Citizens have universal health coverage with a “payment by performance system”, where suppliers are reimbursed if patients comply with targets linked to cancer, hypertension, diabetes, heart and cerebral vascular indicators, said Galicia. “We have allocated a part of the taxes on alcohol and sugary beverages to the prevention and control of NCDs,” he added. Funding targets Bente Mikkelsen Bente Mikkelsen, WHO director of NCDs, said that it is “a huge disappointment that many, many countries don’t realise the epidemiological shift that has happened from HIV, malaria, TB, to actually looking at that seven out of 10 deaths in the world is now linked to NCD”. Earlier in the meeting, South African HIV activist and academic Dr Vuyiseka Dubula, had called on people to put pressure on African countries to ensure that they spent more on health. Mikkelsen said that the NCD sector should set a global target for NCD expenditure as the HIV sector had. “I think we need a target for investment in NCDs, and we need to target for also including NCD into UHC. Part of that should be measures for domestic funding, which can very well be also linked to the health taxation,” said Mikkelsen. However, she also stressed that the demand for increased investment in NCDs had to come from WHO member countries. Despite a raft of global resolutions, policy options and implementation tools, a global roadmap “what we totally lack is the demand”. Demand creation “There is no demand to be seen when the proposal comes from a country that doesn’t include NCD. How can that be? So, even before the data, we are about demand creation.” Bloomberg Philanthropies’ Dr Kelly Henning warned that progress against NCDs was being hampered by “powerful stakeholders promoting and selling harmful products”. “It takes resolve at the highest levels of leadership to push back against these interests and requires effective public education so that the population can support and participate in the change that’s needed,” said Henning. In 2018, Bloomberg convened a task force on fiscal policy for health, which concluded that raising health taxes on tobacco, alcohol and sweetened beverages, “is highly underutilised and would save millions of lives and bring in much needed government revenue”, said Henning. “After reviewing the evidence, the task force found that tobacco taxes can do more to reduce premature mortality than any other single health policy. Unfortunately, since the taskforce report came out, we haven’t really made all that much progress,” said Henning. “And why is that? The task force concluded that implementing health taxes was a measure of government resolve because industry’s pushback against tax increases with false and misleading standards, and oftentimes, influences them.” The NCD Alliance is running a week-long awareness campaign about the need to invest in NCDs. Only 14 countries are on track to meet the WHO’s nine voluntary global targets for the prevention and control of NCDs, due to be assessed at the fourth High-level Meeting of the United Nations General Assembly (HLM4) in 2025. Image Credits: Twitter: @WHO, Heala_SA/Twitter. Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
WHO Submission Period for Development of International Instrument on Pandemic Prevention, Preparedness, and Response is Now Open 09/09/2022 Editorial team World Health Assembly The submission period for the second round of public hearings to inform the development of a new international instrument on pandemic prevention, preparedness and response is now open and will The World Health Organization (WHO) is inviting interested parties to submit a video statement in response to the question: Based on your experience with the COVID-19 pandemic, what do you believe should be addressed at the international level to better protect against future pandemics? The statements should be up to 90 seconds long and can be submitted in any six official WHO languages (Arabic, Chinese, English, French, Russian or Spanish). Public hearings inform the deliberations of the Interngovernmental Negotiating Body (INB) to help draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness, and response, as mandated by the World Health Assembly during its special session in December 2021. Read more about the submission process here at WHO COVID Threatens Meningitis Fight in Africa 09/09/2022 Paul Adepoju & John Heilprin Dr Matshidiso Moeti, director of WHO’s regional office for Africa The COVID-19 pandemic delayed plans to vaccinate more than 50 million African children with doses of MenAfriVac, a vaccine designed for the African meningitis belt. That could undo the progress in controlling a lethal form of meningitis in Africa, the World Health Organization warns. Until 12 years ago, meningitis type A made up 90% of the meningitis cases and deaths in Africa. One particularly deadly outbreak in 1996 infected a quarter million people, and killed 25,000. After African health ministers pleaded for a solution, the MenAfriVac was developed through a partnership between WHO, the Bill and Melinda Gates Foundation and PATH. Starting in 2010, more than 350 million people in 24 high-risk nations received the single-dose vaccine. The stunning result? Not a single new case of meningitis type A has been reported in Africa in the past five years, WHO reported on Thursday, and the chance of survival is now 95%, up from 50% less than a decade ago. “The defeat of meningitis A is one of Africa’s biggest health success stories with not a single case being reported on the continent in the past five years,” says Dr Matshidiso Moeti, director of WHO’s regional office for Africa. Now, that progress is in jeopardy because “the COVID-19 pandemic has delayed [MenAfriVac] vaccination campaigns targeting more than 50 million children” under 12 years of age in Benin, Guinea, Guinea Bissau, Nigeria and Togo, she told reporters in an online briefing. Meningitis A vaccination in Chad “I think most importantly what we are learning about vaccines repeatedly – the lessons learned for the MenAfriVac vaccine, the lessons we’re learning very much for the COVID-19 vaccinations – is that it’s very important to create the demand for vaccines in the population,” said Moeti. “It’s very important that people know the value of vaccines.” WHO officials say the pandemic severely disrupted meningitis prevention and control services by as much as 50% in 2020 compared to 2019, with disease surveillance, laboratory confirmation of cases and outbreak investigations all steeply declining. There was a slight improvement in 2021 but not enough to make much of a difference, according to Moeti. “Meningitis is taking an enormous toll on our countries with COVID-19 threatening some of the extensive gains that have been made in the past,” she said. “Major outbreaks caused by meningitis group C have been reported in seven of the African sub-Saharan meningitis belt countries in the past nine years.” Importance of ‘community acceptance’ in meningitis efforts Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks. The latest major outbreak in the Democratic Republic of Congo killed more than 200 people last year. As a result, WHO says it is in a race against time to fight the heightened risk of outbreaks of meningitis type A caused by inflammation of the membranes that surround the brain and spinal cord. It can lead to death within 24 hours; children under the age of five are particularly at risk. Four organisms are responsible for 50% of deaths: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus. Ahead of the start of the next meningitis season in January 2023, WHO is launching a US$1.5 billion global strategy to defeat bacterial meningitis in Africa by 2030. One of the priorities is to roll out a next-generation vaccine that has been shown in clinical trials to be safe and effective against multiple forms, Moeti told reporters on Thursday. “Community acceptance, which resulted in 95% coverage in affected countries for the MenAfriVac vaccine, is proof of what can be achieved,” said Moeti. “Following this example, the new framework aims to roll out the new vaccine to all 26 meningitis belt countries between 2023 and 2030 – aiming to achieve 90% coverage,” she said. “WHO is expected to prequalify the vaccine by the first quarter of next year.” The UN health agency wants to help countries shore up diagnosis, surveillance, care, advocacy and vaccination to eliminate outbreaks, curb deaths by 70% and halve infections, which it estimates would save more than 140,000 lives a year and significantly reduce disability. Dr. F. Marc LaForce, the Serum Institute of India’s technical services director Dr. F. Marc LaForce, the Serum Institute of India’s technical services director, emphasized the importance of the MenAfriVac vaccine in the fight against meningitis type A. “The disease has disappeared in every country where campaigns have been done,” said LaForce, a former director of the Meningitis Vaccine Project, a PATH/WHO/Serum Institute of India partnership funded by the Gates Foundation. “It is worth remembering that to this date, between 600,000 to a million cases of bacterial meningitis due to group A have been prevented. This is an enormous success and one I think we should all take great pride in,” he told the press briefing from his home in the United States. “A new vaccine again specifically designed for the African meningitis belt will hopefully be prequalified [by WHO] later this year or early next year,” said LaForce. “But this vaccines holds the promise of finishing what MenAfriVac began, such that Africa may be the first continent to be free of meningitis epidemics.” Image Credits: Gavi. 39,000 Test Kits for Africa – No Single Vaccine Dose, No Antiviral Treatment 09/09/2022 Paul Adepoju Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO More than a month after declaring Monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus – while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly. That was the key message emerging out of a briefing by WHO’s African Regional Office on Thursday by senior WHO officials in the agency’s African Regional Office. “Except for a small cohort study in the Central African Republic (CAR), Monkeypox vaccines [and treatments] are not yet available on the continent,” said WHO Regional Director, Matshidiso Moetiotshidiso. She was referring to the study of the anti-viral treatment Tecovirimat (TPOXX™), which has been ongoing amongst a small group of volunteers in CAR, under the direction of the University of Oxford, the Ministry of Health and SIGA, the drug manufacturer. See the full story here: Exclusive: Manufacturer of World’s Only Monkeypox Drug Says There’s No Shortage; Will Work with WHO on Supplies to LMICs Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO told Health Policy Watch, that in the absence of other tools the continent is relying more on non-pharmaceutical measures to control the spread of the disease – which seems to be transmitting more intensively person to person in Africa as well as abroad, after decades in which exposure was more limited to people in contact with infected animal populations. The infection control modalities being put in place, howver, stem from the experience of several countries in the region, such as CAR and the Democratic Republic of Congo, and Nigeria – that have been experiencing Monkeypox outbreaks since the 1970s. The modalities include ensuring that the local communities are aware of the diseases and that they protect themselves and those that are around them, and ensuring that there is no contact to avoid transmission. “It is spread by direct skin-to-skin or mouth-to-skin kind of contact. So it’s important that there is separation when it comes to infection. We also ensure that there is adequate surveillance in place to be able to detect these cases rapidly and provide the necessary management. So I think that it’s a collective use of strategies in the African region where vaccines and therapeutics are not very much available,” she said. Fighting the Scourge of Fake Medicines: Global Fund Replenishment is Moment of Truth 09/09/2022 Adam Aspinall One a number of fake batches of the anti-malaria drug, quinine sulphate, identified in a WHO medical product alert for the Central African Republic. The upcoming Global Fund Replenishment drive, 19-21 September, will be critical to holding onto and advancing progress against infectious diseases in multiple ways – among them ensuring the flow of quality-assured medicines to low-income countries and fighting falsified and substandard medicines that can comprise up to 70% of drugs on the market in some parts of Africa. At Rwanda’s Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) held in June on the margins of the Commonwealth Heads of Government meeting, world leaders and representatives from the private sector, civil society organisations, philanthropists and trusts recommitted to combat the scourge of malaria and Neglected Tropical Diseases (NTDs). Those commitments were made despite the unprecedented challenges facing the world from the COVID-19 pandemic, the war in Ukraine and the climate crisis. Commitments are encouraging and important, but to deliver real progress in the fight against NTDs they must be backed by funding. One of the biggest single-donor organisations in public health is the Global Fund to fight AIDs, Tuberculosis (TB) and Malaria, a partnership that has invested more than $55 billion to date to help defeat these three diseases and others in more than 100 countries through commodity procurement. It has helped to strengthen health systems and provided support for specific programmes, helping save an estimated 44 million lives, mostly vulnerable people. This month, the Global Fund meets for its 7th funding replenishment from donor governments, and the outcome will have a decisive impact on global public health in the coming years. Global Fund’s role fighting fake medicines is less well known While the Global Fund’s work is familiar to many, perhaps less well known is its critical role in protecting patients from fake medicines. Only quality-assured medicines may be procured with Global Fund financing – those cleared by stringent regulatory authorities, the World Health Organisation’s Prequalification Programme, or Global Fund’s Expert Review Panel. Why does this matter? Simple: because counterfeits are a global problem. Estimates suggest that in some parts of Africa, up to 70% of all medicines may be falsified or substandard. The World Health Organization (WHO) says 1-in-10 medicines in lower-and middle-income countries (LMICs) are falsified or substandard, particularly in sub-Saharan Africa. And according to one field survey in South-East Asia, 53% of all antimalarials sampled did not contain the correct level of active ingredients. These “medicines” can kill due to little to no active ingredients or toxic substances that are poisonous. If they don’t kill, they are likely to have little or no therapeutic impact. That results in additional morbidity from treatment failure and significant economic impact due to the costs of re-treatment, hospitalisation and lost working days. Fake Medicines can also foster antimicrobial resistance Causes, impacts and strategies for fighting fake and substandard medicines. There have been too many preventable deaths caused by falsified and substandard medicines. Falsified and substandard medicines can also facilitate the emergence of antimicrobial resistance through exposure of pathogens or parasites to sub-therapeutic doses of active pharmaceutical ingredients. This is a very serious problem that can result in drug failure and potentially millions more deaths. Producing and distributing counterfeits is not a victimless crime. Perpetrators are perfectly aware of the likely consequences and are criminally responsible for deaths on a potentially vast scale. Children and vulnerable people are disproportionately affected. Malaria medicines are among those most commonly counterfeited Children affected by Malaria Malaria control is one of the therapeutic areas most affected by falsified and substandard medicines. A WHO-commissioned study found counterfeit malarials cause an additional 72,000 to 267,000 deaths every year in sub-Saharan Africa. At the same time, a 2019 review showed up to 155,000 children a year die from falsified or substandard antimalarial drugs – a staggering figure that seems to have passed almost unnoticed. One cannot help but wonder what the public reaction would be in higher-income countries to a news headline such as this: “FAKE DRUG HORROR– 155,000 CHILDREN MURDERED.” Without a doubt it would capture the attention of news outlets and law enforcement agencies alike. In reality, of course, there is no simple solution to this issue. Combatting this scourge requires coordinated efforts between regulators, law enforcement and customs agencies. There must be stronger penalties for perpetrators, stronger regulatory systems, improved detection and verification technologies, better public and professional awareness of the issue, and action by drug manufacturers to incorporate anti-counterfeiting measures into packaging. And all of these efforts need to be supported with adequate funding for effective, high-quality medicines. Fake meds blocking achievement of the UN Sustainable Development Goals for 2030 One of the Sustainable Development Goals (SDGs), target 3.8, calls for “access to safe, effective, quality and affordable essential medicines and vaccines for all”. The widespread availability of falsified and substandard medicines is a substantial and important barrier to the achievement of this goal in the immediate future, and adequate funding for quality medicines is an essential prerequisite if it is to be delivered. Given that the Global Fund provides 56% of all international financing for malaria programmes alone, this is a critical safeguard against the scourge of counterfeits and reinforces the crucial importance of a full replenishment of its funding. The estimated total financing need for HIV, TB and malaria for the 2024-26 timeframe is US$130.2 billion, of which at least US$18 billion needs to be funded by the Global Fund. The minimum US$18 billion replenishment is, therefore, of huge importance, especially because the Global Fund only procures quality-assured medicines and medicinal products for low-and middle-income countries. If the replenishment is not met in full, it increases the likelihood that countries will procure non-quality assured medicines. That raises the likelihood of falsified and substandard medicines reaching patients through formal or informal supply pathways. This risks undermining the progress made so far in halting the progression of these diseases, and directly puts patients’ health and lives in jeopardy. With a successful replenishment, the Global Fund will also be able to increase its efforts to strengthen health systems more broadly over the next three years. Given the extraordinary financial strains placed on national governments by the COVID-19 pandemic and the economic consequences of the Ukraine war, it is understandable that governments have competing priorities and domestic pressures that may be viewed as more urgent than international aid and supporting the Global Fund. Nevertheless, disruptions caused by the pandemic to the legal supply chains and limited regulatory enforcement helped spawn a surge in fake medicines, according to the Organization for Economic Co-operation and Development. Interventions to support the fight against HIV, TB and malaria (stronger health systems, improved disease surveillance, more health care worker training, improved laboratory capacity for diagnosis, etc.) are also the foundation of future pandemic preparedness. Resourcing the battle against these diseases is also, therefore, equivalent to resourcing future health crisis readiness. And since pandemics, by definition, affect us all, this should be viewed as investment in future global health. Climate change is already affecting virtually every part of the world, with more extreme weather events recorded across our planet. The already record levels of internally displaced people and refugees will increase, and poverty, food and water insecurity will create immense negative pressures on health, increasing the risk of future pandemics and altering the dynamics of diseases such as HIV, TB and malaria. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths a year, including 60,000 from malaria alone. Business as usual is no longer good enough Someone far wiser than I once said: “Do what you’ve always done, and you’ll get what you’ve always got”. Business as usual isn’t going to cut it in the interconnected set of challenges posed by climate change, emerging pandemics and global public health that we will face over the coming years and decades. Neither is merely “responding” good enough – proactive planning and preemptive interventions are going to be crucial. That’s why the Fight the Fakes Alliance strongly endorses the Global Fund’s philosophy of a “One Health” ethos that envisions an integrated approach: “… positioning human health interventions within the context of a broader planetary health agenda, encompassing animal, human, plant health and the shared environment.” The question is not whether the world can afford to, but rather if we can afford not to support the crucial public health programmes that are financed by the Global Fund. Public health investments in LMICs have a direct impact on the quality of life in developed and high-income countries too. We are all in this together. As the global health challenges we face together continue to grow, so does the opportunity for counterfeiters and criminals. While the market size for fakes medicines is, by its very nature, difficult to quantify accurately, it is worth an estimated US$70-$200 billion. During a single operation (Action Against Counterfeit and Illicit Medicines, ACIM) carried out in 16 African countries in 2016, 113 million “suspect” medicines worth an estimated €52 million were seized over a 10-day period. Increased public awareness of the issue is clearly essential, and one positive consequence of the COVID-19 pandemic is the attention it brought to the problem of falsified and substandard medicines and PPE, including masks, gloves, hydroxychloroquine and vaccines. Almost any pharmaceutical product can be falsified, but those used to treat malaria, tuberculosis and HIV/AIDS are amongst the most widely abused. For this reason, the Fight the Fakes Alliance calls upon governments to be bold and increase pledges so the global programmes to tackle HIV, TB and malaria are fully funded. That will help avoid millions of preventable deaths, accomplish the SDGs, and ensure preparedness for future health crises. _________________________ The author of this article is Chair of the Fight the Fakes Alliance (commonly referred to as ‘Fight the Fakes’), a multi-stakeholder non-profit association based in Geneva, Switzerland, that aims to raise awareness and influence change about the proliferation of falsified and substandard medicines. He is also Senior Director, Access & Product Management at Medicines for Malaria Venture, a leading product development partnership engaged in the discovery, development and delivery of novel antimalarials. Image Credits: The Global Fund , WHO Medical Product Alert 10/2019, Pyzik, O.Z., Abubakar, I. Fighting the fakes: tackling substandard and falsified medicines. Nat Rev Dis Primers 8, 55 (2022)., Emmanuel Museruka/ MMV. Time to Invest in Preventing and Treating NCDs 08/09/2022 Kerry Cullinan Testing patients for diabetes at a World Health Organization event. If all countries significantly raise taxes on tobacco, alcohol and sugary beverages, this could prevent 50 million premature deaths over the next 50 years, according to Michael Bloomberg, World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries. “Plus, the taxes would raise more than $20 trillion in revenue to support public health programmes, helping to save even more lives,” Bloomberg told a virtual event convened to make a global appeal for more investment in NCDs. “Every year, 17 million people under the age of 70 die of non-communicable diseases, mostly in low and middle-income countries,” Dr Tedros Adhanom Ghebreyesus told the event, co-hosted by WHO, the NCD Alliance and the World Diabetes Foundation. “Nearly seven million lives could be saved by 2030 if low and lower middle-income countries invest an additional $1 per person per year on cost-effective interventions, like graphic warnings on cigarette packaging, food labelling and bicycle lanes,” said Tedros. Katie Dain, CEO of the NCD Alliance, decried the fact that “a multitude of political commitments have yet to really translate into adequate [financial] commitments”. “NCDs will cause more suffering in lives lost this decade than any other health issue. They wi’ll drain the global economy and impede human capital and undermine any effort to ensure the world is better prepared for future pandemics after COVID-19,” said Dain. Financing for NCDs has stagnated at around 2% of the development assistance for health for two decades. Paul Fife from the Norwegian Agency for Development Cooperation stressed that “the proper way to finance NCD action is in general through health system reform more broadly, as opposed to very focused disease control programme approaches, such as we have seen for some infectious diseases.” Fife added that “we need to be careful to not give the impression that donors and donor financing are the most instrumental in driving or not driving investments in NCDs”. “For all but the poorest countries and countries in conflict or humanitarian crises, the investments made by governments, insurance agencies, private companies – and the degree to which they are universal, meaning equitable – are far more important than donor aid,” Fife stressed. Preventing NCDs key to achieving universal health coverage From a luxury good to a part of daily diets, sugary drinks that increase the risks of diabetes have become highly popular in Africa. “The big challenge is actually to build a broader, more equitable and efficient health system and integrate NCDs into the system. The path forward is the progressive realisation of universal health coverage.” Dr Omary Ubuguyu from Tanzania’s health ministry said that many of his citizens had to pay for their own NCD treatment as only 15% of the population had health insurance. “So 85% have to pay out of their pockets for health care services and this makes them very vulnerable,” said Ubuguyu. “At the moment, what we are paying for the dialysis, for example, is almost $400 per week, So we have seen a lot of people selling their assets, only to find after one year that they can’t afford to continue with this was a treatment and then dying,” he said, adding that his country was introducing a mandatory health insurance scheme for all – although there were significant financial challenges. “Integration of NCDs with other services, notably HIV and tuberculosis, is also on our agenda,” he added. Uruguay has implemented a number of policies to address NCDs including provisions to regulate tobacco and unhealthy food, according to health ministry official Luis Galicia. Citizens have universal health coverage with a “payment by performance system”, where suppliers are reimbursed if patients comply with targets linked to cancer, hypertension, diabetes, heart and cerebral vascular indicators, said Galicia. “We have allocated a part of the taxes on alcohol and sugary beverages to the prevention and control of NCDs,” he added. Funding targets Bente Mikkelsen Bente Mikkelsen, WHO director of NCDs, said that it is “a huge disappointment that many, many countries don’t realise the epidemiological shift that has happened from HIV, malaria, TB, to actually looking at that seven out of 10 deaths in the world is now linked to NCD”. Earlier in the meeting, South African HIV activist and academic Dr Vuyiseka Dubula, had called on people to put pressure on African countries to ensure that they spent more on health. Mikkelsen said that the NCD sector should set a global target for NCD expenditure as the HIV sector had. “I think we need a target for investment in NCDs, and we need to target for also including NCD into UHC. Part of that should be measures for domestic funding, which can very well be also linked to the health taxation,” said Mikkelsen. However, she also stressed that the demand for increased investment in NCDs had to come from WHO member countries. Despite a raft of global resolutions, policy options and implementation tools, a global roadmap “what we totally lack is the demand”. Demand creation “There is no demand to be seen when the proposal comes from a country that doesn’t include NCD. How can that be? So, even before the data, we are about demand creation.” Bloomberg Philanthropies’ Dr Kelly Henning warned that progress against NCDs was being hampered by “powerful stakeholders promoting and selling harmful products”. “It takes resolve at the highest levels of leadership to push back against these interests and requires effective public education so that the population can support and participate in the change that’s needed,” said Henning. In 2018, Bloomberg convened a task force on fiscal policy for health, which concluded that raising health taxes on tobacco, alcohol and sweetened beverages, “is highly underutilised and would save millions of lives and bring in much needed government revenue”, said Henning. “After reviewing the evidence, the task force found that tobacco taxes can do more to reduce premature mortality than any other single health policy. Unfortunately, since the taskforce report came out, we haven’t really made all that much progress,” said Henning. “And why is that? The task force concluded that implementing health taxes was a measure of government resolve because industry’s pushback against tax increases with false and misleading standards, and oftentimes, influences them.” The NCD Alliance is running a week-long awareness campaign about the need to invest in NCDs. Only 14 countries are on track to meet the WHO’s nine voluntary global targets for the prevention and control of NCDs, due to be assessed at the fourth High-level Meeting of the United Nations General Assembly (HLM4) in 2025. Image Credits: Twitter: @WHO, Heala_SA/Twitter. Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
COVID Threatens Meningitis Fight in Africa 09/09/2022 Paul Adepoju & John Heilprin Dr Matshidiso Moeti, director of WHO’s regional office for Africa The COVID-19 pandemic delayed plans to vaccinate more than 50 million African children with doses of MenAfriVac, a vaccine designed for the African meningitis belt. That could undo the progress in controlling a lethal form of meningitis in Africa, the World Health Organization warns. Until 12 years ago, meningitis type A made up 90% of the meningitis cases and deaths in Africa. One particularly deadly outbreak in 1996 infected a quarter million people, and killed 25,000. After African health ministers pleaded for a solution, the MenAfriVac was developed through a partnership between WHO, the Bill and Melinda Gates Foundation and PATH. Starting in 2010, more than 350 million people in 24 high-risk nations received the single-dose vaccine. The stunning result? Not a single new case of meningitis type A has been reported in Africa in the past five years, WHO reported on Thursday, and the chance of survival is now 95%, up from 50% less than a decade ago. “The defeat of meningitis A is one of Africa’s biggest health success stories with not a single case being reported on the continent in the past five years,” says Dr Matshidiso Moeti, director of WHO’s regional office for Africa. Now, that progress is in jeopardy because “the COVID-19 pandemic has delayed [MenAfriVac] vaccination campaigns targeting more than 50 million children” under 12 years of age in Benin, Guinea, Guinea Bissau, Nigeria and Togo, she told reporters in an online briefing. Meningitis A vaccination in Chad “I think most importantly what we are learning about vaccines repeatedly – the lessons learned for the MenAfriVac vaccine, the lessons we’re learning very much for the COVID-19 vaccinations – is that it’s very important to create the demand for vaccines in the population,” said Moeti. “It’s very important that people know the value of vaccines.” WHO officials say the pandemic severely disrupted meningitis prevention and control services by as much as 50% in 2020 compared to 2019, with disease surveillance, laboratory confirmation of cases and outbreak investigations all steeply declining. There was a slight improvement in 2021 but not enough to make much of a difference, according to Moeti. “Meningitis is taking an enormous toll on our countries with COVID-19 threatening some of the extensive gains that have been made in the past,” she said. “Major outbreaks caused by meningitis group C have been reported in seven of the African sub-Saharan meningitis belt countries in the past nine years.” Importance of ‘community acceptance’ in meningitis efforts Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks. The latest major outbreak in the Democratic Republic of Congo killed more than 200 people last year. As a result, WHO says it is in a race against time to fight the heightened risk of outbreaks of meningitis type A caused by inflammation of the membranes that surround the brain and spinal cord. It can lead to death within 24 hours; children under the age of five are particularly at risk. Four organisms are responsible for 50% of deaths: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus. Ahead of the start of the next meningitis season in January 2023, WHO is launching a US$1.5 billion global strategy to defeat bacterial meningitis in Africa by 2030. One of the priorities is to roll out a next-generation vaccine that has been shown in clinical trials to be safe and effective against multiple forms, Moeti told reporters on Thursday. “Community acceptance, which resulted in 95% coverage in affected countries for the MenAfriVac vaccine, is proof of what can be achieved,” said Moeti. “Following this example, the new framework aims to roll out the new vaccine to all 26 meningitis belt countries between 2023 and 2030 – aiming to achieve 90% coverage,” she said. “WHO is expected to prequalify the vaccine by the first quarter of next year.” The UN health agency wants to help countries shore up diagnosis, surveillance, care, advocacy and vaccination to eliminate outbreaks, curb deaths by 70% and halve infections, which it estimates would save more than 140,000 lives a year and significantly reduce disability. Dr. F. Marc LaForce, the Serum Institute of India’s technical services director Dr. F. Marc LaForce, the Serum Institute of India’s technical services director, emphasized the importance of the MenAfriVac vaccine in the fight against meningitis type A. “The disease has disappeared in every country where campaigns have been done,” said LaForce, a former director of the Meningitis Vaccine Project, a PATH/WHO/Serum Institute of India partnership funded by the Gates Foundation. “It is worth remembering that to this date, between 600,000 to a million cases of bacterial meningitis due to group A have been prevented. This is an enormous success and one I think we should all take great pride in,” he told the press briefing from his home in the United States. “A new vaccine again specifically designed for the African meningitis belt will hopefully be prequalified [by WHO] later this year or early next year,” said LaForce. “But this vaccines holds the promise of finishing what MenAfriVac began, such that Africa may be the first continent to be free of meningitis epidemics.” Image Credits: Gavi. 39,000 Test Kits for Africa – No Single Vaccine Dose, No Antiviral Treatment 09/09/2022 Paul Adepoju Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO More than a month after declaring Monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus – while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly. That was the key message emerging out of a briefing by WHO’s African Regional Office on Thursday by senior WHO officials in the agency’s African Regional Office. “Except for a small cohort study in the Central African Republic (CAR), Monkeypox vaccines [and treatments] are not yet available on the continent,” said WHO Regional Director, Matshidiso Moetiotshidiso. She was referring to the study of the anti-viral treatment Tecovirimat (TPOXX™), which has been ongoing amongst a small group of volunteers in CAR, under the direction of the University of Oxford, the Ministry of Health and SIGA, the drug manufacturer. See the full story here: Exclusive: Manufacturer of World’s Only Monkeypox Drug Says There’s No Shortage; Will Work with WHO on Supplies to LMICs Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO told Health Policy Watch, that in the absence of other tools the continent is relying more on non-pharmaceutical measures to control the spread of the disease – which seems to be transmitting more intensively person to person in Africa as well as abroad, after decades in which exposure was more limited to people in contact with infected animal populations. The infection control modalities being put in place, howver, stem from the experience of several countries in the region, such as CAR and the Democratic Republic of Congo, and Nigeria – that have been experiencing Monkeypox outbreaks since the 1970s. The modalities include ensuring that the local communities are aware of the diseases and that they protect themselves and those that are around them, and ensuring that there is no contact to avoid transmission. “It is spread by direct skin-to-skin or mouth-to-skin kind of contact. So it’s important that there is separation when it comes to infection. We also ensure that there is adequate surveillance in place to be able to detect these cases rapidly and provide the necessary management. So I think that it’s a collective use of strategies in the African region where vaccines and therapeutics are not very much available,” she said. Fighting the Scourge of Fake Medicines: Global Fund Replenishment is Moment of Truth 09/09/2022 Adam Aspinall One a number of fake batches of the anti-malaria drug, quinine sulphate, identified in a WHO medical product alert for the Central African Republic. The upcoming Global Fund Replenishment drive, 19-21 September, will be critical to holding onto and advancing progress against infectious diseases in multiple ways – among them ensuring the flow of quality-assured medicines to low-income countries and fighting falsified and substandard medicines that can comprise up to 70% of drugs on the market in some parts of Africa. At Rwanda’s Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) held in June on the margins of the Commonwealth Heads of Government meeting, world leaders and representatives from the private sector, civil society organisations, philanthropists and trusts recommitted to combat the scourge of malaria and Neglected Tropical Diseases (NTDs). Those commitments were made despite the unprecedented challenges facing the world from the COVID-19 pandemic, the war in Ukraine and the climate crisis. Commitments are encouraging and important, but to deliver real progress in the fight against NTDs they must be backed by funding. One of the biggest single-donor organisations in public health is the Global Fund to fight AIDs, Tuberculosis (TB) and Malaria, a partnership that has invested more than $55 billion to date to help defeat these three diseases and others in more than 100 countries through commodity procurement. It has helped to strengthen health systems and provided support for specific programmes, helping save an estimated 44 million lives, mostly vulnerable people. This month, the Global Fund meets for its 7th funding replenishment from donor governments, and the outcome will have a decisive impact on global public health in the coming years. Global Fund’s role fighting fake medicines is less well known While the Global Fund’s work is familiar to many, perhaps less well known is its critical role in protecting patients from fake medicines. Only quality-assured medicines may be procured with Global Fund financing – those cleared by stringent regulatory authorities, the World Health Organisation’s Prequalification Programme, or Global Fund’s Expert Review Panel. Why does this matter? Simple: because counterfeits are a global problem. Estimates suggest that in some parts of Africa, up to 70% of all medicines may be falsified or substandard. The World Health Organization (WHO) says 1-in-10 medicines in lower-and middle-income countries (LMICs) are falsified or substandard, particularly in sub-Saharan Africa. And according to one field survey in South-East Asia, 53% of all antimalarials sampled did not contain the correct level of active ingredients. These “medicines” can kill due to little to no active ingredients or toxic substances that are poisonous. If they don’t kill, they are likely to have little or no therapeutic impact. That results in additional morbidity from treatment failure and significant economic impact due to the costs of re-treatment, hospitalisation and lost working days. Fake Medicines can also foster antimicrobial resistance Causes, impacts and strategies for fighting fake and substandard medicines. There have been too many preventable deaths caused by falsified and substandard medicines. Falsified and substandard medicines can also facilitate the emergence of antimicrobial resistance through exposure of pathogens or parasites to sub-therapeutic doses of active pharmaceutical ingredients. This is a very serious problem that can result in drug failure and potentially millions more deaths. Producing and distributing counterfeits is not a victimless crime. Perpetrators are perfectly aware of the likely consequences and are criminally responsible for deaths on a potentially vast scale. Children and vulnerable people are disproportionately affected. Malaria medicines are among those most commonly counterfeited Children affected by Malaria Malaria control is one of the therapeutic areas most affected by falsified and substandard medicines. A WHO-commissioned study found counterfeit malarials cause an additional 72,000 to 267,000 deaths every year in sub-Saharan Africa. At the same time, a 2019 review showed up to 155,000 children a year die from falsified or substandard antimalarial drugs – a staggering figure that seems to have passed almost unnoticed. One cannot help but wonder what the public reaction would be in higher-income countries to a news headline such as this: “FAKE DRUG HORROR– 155,000 CHILDREN MURDERED.” Without a doubt it would capture the attention of news outlets and law enforcement agencies alike. In reality, of course, there is no simple solution to this issue. Combatting this scourge requires coordinated efforts between regulators, law enforcement and customs agencies. There must be stronger penalties for perpetrators, stronger regulatory systems, improved detection and verification technologies, better public and professional awareness of the issue, and action by drug manufacturers to incorporate anti-counterfeiting measures into packaging. And all of these efforts need to be supported with adequate funding for effective, high-quality medicines. Fake meds blocking achievement of the UN Sustainable Development Goals for 2030 One of the Sustainable Development Goals (SDGs), target 3.8, calls for “access to safe, effective, quality and affordable essential medicines and vaccines for all”. The widespread availability of falsified and substandard medicines is a substantial and important barrier to the achievement of this goal in the immediate future, and adequate funding for quality medicines is an essential prerequisite if it is to be delivered. Given that the Global Fund provides 56% of all international financing for malaria programmes alone, this is a critical safeguard against the scourge of counterfeits and reinforces the crucial importance of a full replenishment of its funding. The estimated total financing need for HIV, TB and malaria for the 2024-26 timeframe is US$130.2 billion, of which at least US$18 billion needs to be funded by the Global Fund. The minimum US$18 billion replenishment is, therefore, of huge importance, especially because the Global Fund only procures quality-assured medicines and medicinal products for low-and middle-income countries. If the replenishment is not met in full, it increases the likelihood that countries will procure non-quality assured medicines. That raises the likelihood of falsified and substandard medicines reaching patients through formal or informal supply pathways. This risks undermining the progress made so far in halting the progression of these diseases, and directly puts patients’ health and lives in jeopardy. With a successful replenishment, the Global Fund will also be able to increase its efforts to strengthen health systems more broadly over the next three years. Given the extraordinary financial strains placed on national governments by the COVID-19 pandemic and the economic consequences of the Ukraine war, it is understandable that governments have competing priorities and domestic pressures that may be viewed as more urgent than international aid and supporting the Global Fund. Nevertheless, disruptions caused by the pandemic to the legal supply chains and limited regulatory enforcement helped spawn a surge in fake medicines, according to the Organization for Economic Co-operation and Development. Interventions to support the fight against HIV, TB and malaria (stronger health systems, improved disease surveillance, more health care worker training, improved laboratory capacity for diagnosis, etc.) are also the foundation of future pandemic preparedness. Resourcing the battle against these diseases is also, therefore, equivalent to resourcing future health crisis readiness. And since pandemics, by definition, affect us all, this should be viewed as investment in future global health. Climate change is already affecting virtually every part of the world, with more extreme weather events recorded across our planet. The already record levels of internally displaced people and refugees will increase, and poverty, food and water insecurity will create immense negative pressures on health, increasing the risk of future pandemics and altering the dynamics of diseases such as HIV, TB and malaria. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths a year, including 60,000 from malaria alone. Business as usual is no longer good enough Someone far wiser than I once said: “Do what you’ve always done, and you’ll get what you’ve always got”. Business as usual isn’t going to cut it in the interconnected set of challenges posed by climate change, emerging pandemics and global public health that we will face over the coming years and decades. Neither is merely “responding” good enough – proactive planning and preemptive interventions are going to be crucial. That’s why the Fight the Fakes Alliance strongly endorses the Global Fund’s philosophy of a “One Health” ethos that envisions an integrated approach: “… positioning human health interventions within the context of a broader planetary health agenda, encompassing animal, human, plant health and the shared environment.” The question is not whether the world can afford to, but rather if we can afford not to support the crucial public health programmes that are financed by the Global Fund. Public health investments in LMICs have a direct impact on the quality of life in developed and high-income countries too. We are all in this together. As the global health challenges we face together continue to grow, so does the opportunity for counterfeiters and criminals. While the market size for fakes medicines is, by its very nature, difficult to quantify accurately, it is worth an estimated US$70-$200 billion. During a single operation (Action Against Counterfeit and Illicit Medicines, ACIM) carried out in 16 African countries in 2016, 113 million “suspect” medicines worth an estimated €52 million were seized over a 10-day period. Increased public awareness of the issue is clearly essential, and one positive consequence of the COVID-19 pandemic is the attention it brought to the problem of falsified and substandard medicines and PPE, including masks, gloves, hydroxychloroquine and vaccines. Almost any pharmaceutical product can be falsified, but those used to treat malaria, tuberculosis and HIV/AIDS are amongst the most widely abused. For this reason, the Fight the Fakes Alliance calls upon governments to be bold and increase pledges so the global programmes to tackle HIV, TB and malaria are fully funded. That will help avoid millions of preventable deaths, accomplish the SDGs, and ensure preparedness for future health crises. _________________________ The author of this article is Chair of the Fight the Fakes Alliance (commonly referred to as ‘Fight the Fakes’), a multi-stakeholder non-profit association based in Geneva, Switzerland, that aims to raise awareness and influence change about the proliferation of falsified and substandard medicines. He is also Senior Director, Access & Product Management at Medicines for Malaria Venture, a leading product development partnership engaged in the discovery, development and delivery of novel antimalarials. Image Credits: The Global Fund , WHO Medical Product Alert 10/2019, Pyzik, O.Z., Abubakar, I. Fighting the fakes: tackling substandard and falsified medicines. Nat Rev Dis Primers 8, 55 (2022)., Emmanuel Museruka/ MMV. Time to Invest in Preventing and Treating NCDs 08/09/2022 Kerry Cullinan Testing patients for diabetes at a World Health Organization event. If all countries significantly raise taxes on tobacco, alcohol and sugary beverages, this could prevent 50 million premature deaths over the next 50 years, according to Michael Bloomberg, World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries. “Plus, the taxes would raise more than $20 trillion in revenue to support public health programmes, helping to save even more lives,” Bloomberg told a virtual event convened to make a global appeal for more investment in NCDs. “Every year, 17 million people under the age of 70 die of non-communicable diseases, mostly in low and middle-income countries,” Dr Tedros Adhanom Ghebreyesus told the event, co-hosted by WHO, the NCD Alliance and the World Diabetes Foundation. “Nearly seven million lives could be saved by 2030 if low and lower middle-income countries invest an additional $1 per person per year on cost-effective interventions, like graphic warnings on cigarette packaging, food labelling and bicycle lanes,” said Tedros. Katie Dain, CEO of the NCD Alliance, decried the fact that “a multitude of political commitments have yet to really translate into adequate [financial] commitments”. “NCDs will cause more suffering in lives lost this decade than any other health issue. They wi’ll drain the global economy and impede human capital and undermine any effort to ensure the world is better prepared for future pandemics after COVID-19,” said Dain. Financing for NCDs has stagnated at around 2% of the development assistance for health for two decades. Paul Fife from the Norwegian Agency for Development Cooperation stressed that “the proper way to finance NCD action is in general through health system reform more broadly, as opposed to very focused disease control programme approaches, such as we have seen for some infectious diseases.” Fife added that “we need to be careful to not give the impression that donors and donor financing are the most instrumental in driving or not driving investments in NCDs”. “For all but the poorest countries and countries in conflict or humanitarian crises, the investments made by governments, insurance agencies, private companies – and the degree to which they are universal, meaning equitable – are far more important than donor aid,” Fife stressed. Preventing NCDs key to achieving universal health coverage From a luxury good to a part of daily diets, sugary drinks that increase the risks of diabetes have become highly popular in Africa. “The big challenge is actually to build a broader, more equitable and efficient health system and integrate NCDs into the system. The path forward is the progressive realisation of universal health coverage.” Dr Omary Ubuguyu from Tanzania’s health ministry said that many of his citizens had to pay for their own NCD treatment as only 15% of the population had health insurance. “So 85% have to pay out of their pockets for health care services and this makes them very vulnerable,” said Ubuguyu. “At the moment, what we are paying for the dialysis, for example, is almost $400 per week, So we have seen a lot of people selling their assets, only to find after one year that they can’t afford to continue with this was a treatment and then dying,” he said, adding that his country was introducing a mandatory health insurance scheme for all – although there were significant financial challenges. “Integration of NCDs with other services, notably HIV and tuberculosis, is also on our agenda,” he added. Uruguay has implemented a number of policies to address NCDs including provisions to regulate tobacco and unhealthy food, according to health ministry official Luis Galicia. Citizens have universal health coverage with a “payment by performance system”, where suppliers are reimbursed if patients comply with targets linked to cancer, hypertension, diabetes, heart and cerebral vascular indicators, said Galicia. “We have allocated a part of the taxes on alcohol and sugary beverages to the prevention and control of NCDs,” he added. Funding targets Bente Mikkelsen Bente Mikkelsen, WHO director of NCDs, said that it is “a huge disappointment that many, many countries don’t realise the epidemiological shift that has happened from HIV, malaria, TB, to actually looking at that seven out of 10 deaths in the world is now linked to NCD”. Earlier in the meeting, South African HIV activist and academic Dr Vuyiseka Dubula, had called on people to put pressure on African countries to ensure that they spent more on health. Mikkelsen said that the NCD sector should set a global target for NCD expenditure as the HIV sector had. “I think we need a target for investment in NCDs, and we need to target for also including NCD into UHC. Part of that should be measures for domestic funding, which can very well be also linked to the health taxation,” said Mikkelsen. However, she also stressed that the demand for increased investment in NCDs had to come from WHO member countries. Despite a raft of global resolutions, policy options and implementation tools, a global roadmap “what we totally lack is the demand”. Demand creation “There is no demand to be seen when the proposal comes from a country that doesn’t include NCD. How can that be? So, even before the data, we are about demand creation.” Bloomberg Philanthropies’ Dr Kelly Henning warned that progress against NCDs was being hampered by “powerful stakeholders promoting and selling harmful products”. “It takes resolve at the highest levels of leadership to push back against these interests and requires effective public education so that the population can support and participate in the change that’s needed,” said Henning. In 2018, Bloomberg convened a task force on fiscal policy for health, which concluded that raising health taxes on tobacco, alcohol and sweetened beverages, “is highly underutilised and would save millions of lives and bring in much needed government revenue”, said Henning. “After reviewing the evidence, the task force found that tobacco taxes can do more to reduce premature mortality than any other single health policy. Unfortunately, since the taskforce report came out, we haven’t really made all that much progress,” said Henning. “And why is that? The task force concluded that implementing health taxes was a measure of government resolve because industry’s pushback against tax increases with false and misleading standards, and oftentimes, influences them.” The NCD Alliance is running a week-long awareness campaign about the need to invest in NCDs. Only 14 countries are on track to meet the WHO’s nine voluntary global targets for the prevention and control of NCDs, due to be assessed at the fourth High-level Meeting of the United Nations General Assembly (HLM4) in 2025. Image Credits: Twitter: @WHO, Heala_SA/Twitter. Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
39,000 Test Kits for Africa – No Single Vaccine Dose, No Antiviral Treatment 09/09/2022 Paul Adepoju Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO More than a month after declaring Monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus – while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly. That was the key message emerging out of a briefing by WHO’s African Regional Office on Thursday by senior WHO officials in the agency’s African Regional Office. “Except for a small cohort study in the Central African Republic (CAR), Monkeypox vaccines [and treatments] are not yet available on the continent,” said WHO Regional Director, Matshidiso Moetiotshidiso. She was referring to the study of the anti-viral treatment Tecovirimat (TPOXX™), which has been ongoing amongst a small group of volunteers in CAR, under the direction of the University of Oxford, the Ministry of Health and SIGA, the drug manufacturer. See the full story here: Exclusive: Manufacturer of World’s Only Monkeypox Drug Says There’s No Shortage; Will Work with WHO on Supplies to LMICs Dr Fiona Braka, Team Lead, Emergency Operations at WHO AFRO told Health Policy Watch, that in the absence of other tools the continent is relying more on non-pharmaceutical measures to control the spread of the disease – which seems to be transmitting more intensively person to person in Africa as well as abroad, after decades in which exposure was more limited to people in contact with infected animal populations. The infection control modalities being put in place, howver, stem from the experience of several countries in the region, such as CAR and the Democratic Republic of Congo, and Nigeria – that have been experiencing Monkeypox outbreaks since the 1970s. The modalities include ensuring that the local communities are aware of the diseases and that they protect themselves and those that are around them, and ensuring that there is no contact to avoid transmission. “It is spread by direct skin-to-skin or mouth-to-skin kind of contact. So it’s important that there is separation when it comes to infection. We also ensure that there is adequate surveillance in place to be able to detect these cases rapidly and provide the necessary management. So I think that it’s a collective use of strategies in the African region where vaccines and therapeutics are not very much available,” she said. Fighting the Scourge of Fake Medicines: Global Fund Replenishment is Moment of Truth 09/09/2022 Adam Aspinall One a number of fake batches of the anti-malaria drug, quinine sulphate, identified in a WHO medical product alert for the Central African Republic. The upcoming Global Fund Replenishment drive, 19-21 September, will be critical to holding onto and advancing progress against infectious diseases in multiple ways – among them ensuring the flow of quality-assured medicines to low-income countries and fighting falsified and substandard medicines that can comprise up to 70% of drugs on the market in some parts of Africa. At Rwanda’s Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) held in June on the margins of the Commonwealth Heads of Government meeting, world leaders and representatives from the private sector, civil society organisations, philanthropists and trusts recommitted to combat the scourge of malaria and Neglected Tropical Diseases (NTDs). Those commitments were made despite the unprecedented challenges facing the world from the COVID-19 pandemic, the war in Ukraine and the climate crisis. Commitments are encouraging and important, but to deliver real progress in the fight against NTDs they must be backed by funding. One of the biggest single-donor organisations in public health is the Global Fund to fight AIDs, Tuberculosis (TB) and Malaria, a partnership that has invested more than $55 billion to date to help defeat these three diseases and others in more than 100 countries through commodity procurement. It has helped to strengthen health systems and provided support for specific programmes, helping save an estimated 44 million lives, mostly vulnerable people. This month, the Global Fund meets for its 7th funding replenishment from donor governments, and the outcome will have a decisive impact on global public health in the coming years. Global Fund’s role fighting fake medicines is less well known While the Global Fund’s work is familiar to many, perhaps less well known is its critical role in protecting patients from fake medicines. Only quality-assured medicines may be procured with Global Fund financing – those cleared by stringent regulatory authorities, the World Health Organisation’s Prequalification Programme, or Global Fund’s Expert Review Panel. Why does this matter? Simple: because counterfeits are a global problem. Estimates suggest that in some parts of Africa, up to 70% of all medicines may be falsified or substandard. The World Health Organization (WHO) says 1-in-10 medicines in lower-and middle-income countries (LMICs) are falsified or substandard, particularly in sub-Saharan Africa. And according to one field survey in South-East Asia, 53% of all antimalarials sampled did not contain the correct level of active ingredients. These “medicines” can kill due to little to no active ingredients or toxic substances that are poisonous. If they don’t kill, they are likely to have little or no therapeutic impact. That results in additional morbidity from treatment failure and significant economic impact due to the costs of re-treatment, hospitalisation and lost working days. Fake Medicines can also foster antimicrobial resistance Causes, impacts and strategies for fighting fake and substandard medicines. There have been too many preventable deaths caused by falsified and substandard medicines. Falsified and substandard medicines can also facilitate the emergence of antimicrobial resistance through exposure of pathogens or parasites to sub-therapeutic doses of active pharmaceutical ingredients. This is a very serious problem that can result in drug failure and potentially millions more deaths. Producing and distributing counterfeits is not a victimless crime. Perpetrators are perfectly aware of the likely consequences and are criminally responsible for deaths on a potentially vast scale. Children and vulnerable people are disproportionately affected. Malaria medicines are among those most commonly counterfeited Children affected by Malaria Malaria control is one of the therapeutic areas most affected by falsified and substandard medicines. A WHO-commissioned study found counterfeit malarials cause an additional 72,000 to 267,000 deaths every year in sub-Saharan Africa. At the same time, a 2019 review showed up to 155,000 children a year die from falsified or substandard antimalarial drugs – a staggering figure that seems to have passed almost unnoticed. One cannot help but wonder what the public reaction would be in higher-income countries to a news headline such as this: “FAKE DRUG HORROR– 155,000 CHILDREN MURDERED.” Without a doubt it would capture the attention of news outlets and law enforcement agencies alike. In reality, of course, there is no simple solution to this issue. Combatting this scourge requires coordinated efforts between regulators, law enforcement and customs agencies. There must be stronger penalties for perpetrators, stronger regulatory systems, improved detection and verification technologies, better public and professional awareness of the issue, and action by drug manufacturers to incorporate anti-counterfeiting measures into packaging. And all of these efforts need to be supported with adequate funding for effective, high-quality medicines. Fake meds blocking achievement of the UN Sustainable Development Goals for 2030 One of the Sustainable Development Goals (SDGs), target 3.8, calls for “access to safe, effective, quality and affordable essential medicines and vaccines for all”. The widespread availability of falsified and substandard medicines is a substantial and important barrier to the achievement of this goal in the immediate future, and adequate funding for quality medicines is an essential prerequisite if it is to be delivered. Given that the Global Fund provides 56% of all international financing for malaria programmes alone, this is a critical safeguard against the scourge of counterfeits and reinforces the crucial importance of a full replenishment of its funding. The estimated total financing need for HIV, TB and malaria for the 2024-26 timeframe is US$130.2 billion, of which at least US$18 billion needs to be funded by the Global Fund. The minimum US$18 billion replenishment is, therefore, of huge importance, especially because the Global Fund only procures quality-assured medicines and medicinal products for low-and middle-income countries. If the replenishment is not met in full, it increases the likelihood that countries will procure non-quality assured medicines. That raises the likelihood of falsified and substandard medicines reaching patients through formal or informal supply pathways. This risks undermining the progress made so far in halting the progression of these diseases, and directly puts patients’ health and lives in jeopardy. With a successful replenishment, the Global Fund will also be able to increase its efforts to strengthen health systems more broadly over the next three years. Given the extraordinary financial strains placed on national governments by the COVID-19 pandemic and the economic consequences of the Ukraine war, it is understandable that governments have competing priorities and domestic pressures that may be viewed as more urgent than international aid and supporting the Global Fund. Nevertheless, disruptions caused by the pandemic to the legal supply chains and limited regulatory enforcement helped spawn a surge in fake medicines, according to the Organization for Economic Co-operation and Development. Interventions to support the fight against HIV, TB and malaria (stronger health systems, improved disease surveillance, more health care worker training, improved laboratory capacity for diagnosis, etc.) are also the foundation of future pandemic preparedness. Resourcing the battle against these diseases is also, therefore, equivalent to resourcing future health crisis readiness. And since pandemics, by definition, affect us all, this should be viewed as investment in future global health. Climate change is already affecting virtually every part of the world, with more extreme weather events recorded across our planet. The already record levels of internally displaced people and refugees will increase, and poverty, food and water insecurity will create immense negative pressures on health, increasing the risk of future pandemics and altering the dynamics of diseases such as HIV, TB and malaria. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths a year, including 60,000 from malaria alone. Business as usual is no longer good enough Someone far wiser than I once said: “Do what you’ve always done, and you’ll get what you’ve always got”. Business as usual isn’t going to cut it in the interconnected set of challenges posed by climate change, emerging pandemics and global public health that we will face over the coming years and decades. Neither is merely “responding” good enough – proactive planning and preemptive interventions are going to be crucial. That’s why the Fight the Fakes Alliance strongly endorses the Global Fund’s philosophy of a “One Health” ethos that envisions an integrated approach: “… positioning human health interventions within the context of a broader planetary health agenda, encompassing animal, human, plant health and the shared environment.” The question is not whether the world can afford to, but rather if we can afford not to support the crucial public health programmes that are financed by the Global Fund. Public health investments in LMICs have a direct impact on the quality of life in developed and high-income countries too. We are all in this together. As the global health challenges we face together continue to grow, so does the opportunity for counterfeiters and criminals. While the market size for fakes medicines is, by its very nature, difficult to quantify accurately, it is worth an estimated US$70-$200 billion. During a single operation (Action Against Counterfeit and Illicit Medicines, ACIM) carried out in 16 African countries in 2016, 113 million “suspect” medicines worth an estimated €52 million were seized over a 10-day period. Increased public awareness of the issue is clearly essential, and one positive consequence of the COVID-19 pandemic is the attention it brought to the problem of falsified and substandard medicines and PPE, including masks, gloves, hydroxychloroquine and vaccines. Almost any pharmaceutical product can be falsified, but those used to treat malaria, tuberculosis and HIV/AIDS are amongst the most widely abused. For this reason, the Fight the Fakes Alliance calls upon governments to be bold and increase pledges so the global programmes to tackle HIV, TB and malaria are fully funded. That will help avoid millions of preventable deaths, accomplish the SDGs, and ensure preparedness for future health crises. _________________________ The author of this article is Chair of the Fight the Fakes Alliance (commonly referred to as ‘Fight the Fakes’), a multi-stakeholder non-profit association based in Geneva, Switzerland, that aims to raise awareness and influence change about the proliferation of falsified and substandard medicines. He is also Senior Director, Access & Product Management at Medicines for Malaria Venture, a leading product development partnership engaged in the discovery, development and delivery of novel antimalarials. Image Credits: The Global Fund , WHO Medical Product Alert 10/2019, Pyzik, O.Z., Abubakar, I. Fighting the fakes: tackling substandard and falsified medicines. Nat Rev Dis Primers 8, 55 (2022)., Emmanuel Museruka/ MMV. Time to Invest in Preventing and Treating NCDs 08/09/2022 Kerry Cullinan Testing patients for diabetes at a World Health Organization event. If all countries significantly raise taxes on tobacco, alcohol and sugary beverages, this could prevent 50 million premature deaths over the next 50 years, according to Michael Bloomberg, World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries. “Plus, the taxes would raise more than $20 trillion in revenue to support public health programmes, helping to save even more lives,” Bloomberg told a virtual event convened to make a global appeal for more investment in NCDs. “Every year, 17 million people under the age of 70 die of non-communicable diseases, mostly in low and middle-income countries,” Dr Tedros Adhanom Ghebreyesus told the event, co-hosted by WHO, the NCD Alliance and the World Diabetes Foundation. “Nearly seven million lives could be saved by 2030 if low and lower middle-income countries invest an additional $1 per person per year on cost-effective interventions, like graphic warnings on cigarette packaging, food labelling and bicycle lanes,” said Tedros. Katie Dain, CEO of the NCD Alliance, decried the fact that “a multitude of political commitments have yet to really translate into adequate [financial] commitments”. “NCDs will cause more suffering in lives lost this decade than any other health issue. They wi’ll drain the global economy and impede human capital and undermine any effort to ensure the world is better prepared for future pandemics after COVID-19,” said Dain. Financing for NCDs has stagnated at around 2% of the development assistance for health for two decades. Paul Fife from the Norwegian Agency for Development Cooperation stressed that “the proper way to finance NCD action is in general through health system reform more broadly, as opposed to very focused disease control programme approaches, such as we have seen for some infectious diseases.” Fife added that “we need to be careful to not give the impression that donors and donor financing are the most instrumental in driving or not driving investments in NCDs”. “For all but the poorest countries and countries in conflict or humanitarian crises, the investments made by governments, insurance agencies, private companies – and the degree to which they are universal, meaning equitable – are far more important than donor aid,” Fife stressed. Preventing NCDs key to achieving universal health coverage From a luxury good to a part of daily diets, sugary drinks that increase the risks of diabetes have become highly popular in Africa. “The big challenge is actually to build a broader, more equitable and efficient health system and integrate NCDs into the system. The path forward is the progressive realisation of universal health coverage.” Dr Omary Ubuguyu from Tanzania’s health ministry said that many of his citizens had to pay for their own NCD treatment as only 15% of the population had health insurance. “So 85% have to pay out of their pockets for health care services and this makes them very vulnerable,” said Ubuguyu. “At the moment, what we are paying for the dialysis, for example, is almost $400 per week, So we have seen a lot of people selling their assets, only to find after one year that they can’t afford to continue with this was a treatment and then dying,” he said, adding that his country was introducing a mandatory health insurance scheme for all – although there were significant financial challenges. “Integration of NCDs with other services, notably HIV and tuberculosis, is also on our agenda,” he added. Uruguay has implemented a number of policies to address NCDs including provisions to regulate tobacco and unhealthy food, according to health ministry official Luis Galicia. Citizens have universal health coverage with a “payment by performance system”, where suppliers are reimbursed if patients comply with targets linked to cancer, hypertension, diabetes, heart and cerebral vascular indicators, said Galicia. “We have allocated a part of the taxes on alcohol and sugary beverages to the prevention and control of NCDs,” he added. Funding targets Bente Mikkelsen Bente Mikkelsen, WHO director of NCDs, said that it is “a huge disappointment that many, many countries don’t realise the epidemiological shift that has happened from HIV, malaria, TB, to actually looking at that seven out of 10 deaths in the world is now linked to NCD”. Earlier in the meeting, South African HIV activist and academic Dr Vuyiseka Dubula, had called on people to put pressure on African countries to ensure that they spent more on health. Mikkelsen said that the NCD sector should set a global target for NCD expenditure as the HIV sector had. “I think we need a target for investment in NCDs, and we need to target for also including NCD into UHC. Part of that should be measures for domestic funding, which can very well be also linked to the health taxation,” said Mikkelsen. However, she also stressed that the demand for increased investment in NCDs had to come from WHO member countries. Despite a raft of global resolutions, policy options and implementation tools, a global roadmap “what we totally lack is the demand”. Demand creation “There is no demand to be seen when the proposal comes from a country that doesn’t include NCD. How can that be? So, even before the data, we are about demand creation.” Bloomberg Philanthropies’ Dr Kelly Henning warned that progress against NCDs was being hampered by “powerful stakeholders promoting and selling harmful products”. “It takes resolve at the highest levels of leadership to push back against these interests and requires effective public education so that the population can support and participate in the change that’s needed,” said Henning. In 2018, Bloomberg convened a task force on fiscal policy for health, which concluded that raising health taxes on tobacco, alcohol and sweetened beverages, “is highly underutilised and would save millions of lives and bring in much needed government revenue”, said Henning. “After reviewing the evidence, the task force found that tobacco taxes can do more to reduce premature mortality than any other single health policy. Unfortunately, since the taskforce report came out, we haven’t really made all that much progress,” said Henning. “And why is that? The task force concluded that implementing health taxes was a measure of government resolve because industry’s pushback against tax increases with false and misleading standards, and oftentimes, influences them.” The NCD Alliance is running a week-long awareness campaign about the need to invest in NCDs. Only 14 countries are on track to meet the WHO’s nine voluntary global targets for the prevention and control of NCDs, due to be assessed at the fourth High-level Meeting of the United Nations General Assembly (HLM4) in 2025. Image Credits: Twitter: @WHO, Heala_SA/Twitter. Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
Fighting the Scourge of Fake Medicines: Global Fund Replenishment is Moment of Truth 09/09/2022 Adam Aspinall One a number of fake batches of the anti-malaria drug, quinine sulphate, identified in a WHO medical product alert for the Central African Republic. The upcoming Global Fund Replenishment drive, 19-21 September, will be critical to holding onto and advancing progress against infectious diseases in multiple ways – among them ensuring the flow of quality-assured medicines to low-income countries and fighting falsified and substandard medicines that can comprise up to 70% of drugs on the market in some parts of Africa. At Rwanda’s Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) held in June on the margins of the Commonwealth Heads of Government meeting, world leaders and representatives from the private sector, civil society organisations, philanthropists and trusts recommitted to combat the scourge of malaria and Neglected Tropical Diseases (NTDs). Those commitments were made despite the unprecedented challenges facing the world from the COVID-19 pandemic, the war in Ukraine and the climate crisis. Commitments are encouraging and important, but to deliver real progress in the fight against NTDs they must be backed by funding. One of the biggest single-donor organisations in public health is the Global Fund to fight AIDs, Tuberculosis (TB) and Malaria, a partnership that has invested more than $55 billion to date to help defeat these three diseases and others in more than 100 countries through commodity procurement. It has helped to strengthen health systems and provided support for specific programmes, helping save an estimated 44 million lives, mostly vulnerable people. This month, the Global Fund meets for its 7th funding replenishment from donor governments, and the outcome will have a decisive impact on global public health in the coming years. Global Fund’s role fighting fake medicines is less well known While the Global Fund’s work is familiar to many, perhaps less well known is its critical role in protecting patients from fake medicines. Only quality-assured medicines may be procured with Global Fund financing – those cleared by stringent regulatory authorities, the World Health Organisation’s Prequalification Programme, or Global Fund’s Expert Review Panel. Why does this matter? Simple: because counterfeits are a global problem. Estimates suggest that in some parts of Africa, up to 70% of all medicines may be falsified or substandard. The World Health Organization (WHO) says 1-in-10 medicines in lower-and middle-income countries (LMICs) are falsified or substandard, particularly in sub-Saharan Africa. And according to one field survey in South-East Asia, 53% of all antimalarials sampled did not contain the correct level of active ingredients. These “medicines” can kill due to little to no active ingredients or toxic substances that are poisonous. If they don’t kill, they are likely to have little or no therapeutic impact. That results in additional morbidity from treatment failure and significant economic impact due to the costs of re-treatment, hospitalisation and lost working days. Fake Medicines can also foster antimicrobial resistance Causes, impacts and strategies for fighting fake and substandard medicines. There have been too many preventable deaths caused by falsified and substandard medicines. Falsified and substandard medicines can also facilitate the emergence of antimicrobial resistance through exposure of pathogens or parasites to sub-therapeutic doses of active pharmaceutical ingredients. This is a very serious problem that can result in drug failure and potentially millions more deaths. Producing and distributing counterfeits is not a victimless crime. Perpetrators are perfectly aware of the likely consequences and are criminally responsible for deaths on a potentially vast scale. Children and vulnerable people are disproportionately affected. Malaria medicines are among those most commonly counterfeited Children affected by Malaria Malaria control is one of the therapeutic areas most affected by falsified and substandard medicines. A WHO-commissioned study found counterfeit malarials cause an additional 72,000 to 267,000 deaths every year in sub-Saharan Africa. At the same time, a 2019 review showed up to 155,000 children a year die from falsified or substandard antimalarial drugs – a staggering figure that seems to have passed almost unnoticed. One cannot help but wonder what the public reaction would be in higher-income countries to a news headline such as this: “FAKE DRUG HORROR– 155,000 CHILDREN MURDERED.” Without a doubt it would capture the attention of news outlets and law enforcement agencies alike. In reality, of course, there is no simple solution to this issue. Combatting this scourge requires coordinated efforts between regulators, law enforcement and customs agencies. There must be stronger penalties for perpetrators, stronger regulatory systems, improved detection and verification technologies, better public and professional awareness of the issue, and action by drug manufacturers to incorporate anti-counterfeiting measures into packaging. And all of these efforts need to be supported with adequate funding for effective, high-quality medicines. Fake meds blocking achievement of the UN Sustainable Development Goals for 2030 One of the Sustainable Development Goals (SDGs), target 3.8, calls for “access to safe, effective, quality and affordable essential medicines and vaccines for all”. The widespread availability of falsified and substandard medicines is a substantial and important barrier to the achievement of this goal in the immediate future, and adequate funding for quality medicines is an essential prerequisite if it is to be delivered. Given that the Global Fund provides 56% of all international financing for malaria programmes alone, this is a critical safeguard against the scourge of counterfeits and reinforces the crucial importance of a full replenishment of its funding. The estimated total financing need for HIV, TB and malaria for the 2024-26 timeframe is US$130.2 billion, of which at least US$18 billion needs to be funded by the Global Fund. The minimum US$18 billion replenishment is, therefore, of huge importance, especially because the Global Fund only procures quality-assured medicines and medicinal products for low-and middle-income countries. If the replenishment is not met in full, it increases the likelihood that countries will procure non-quality assured medicines. That raises the likelihood of falsified and substandard medicines reaching patients through formal or informal supply pathways. This risks undermining the progress made so far in halting the progression of these diseases, and directly puts patients’ health and lives in jeopardy. With a successful replenishment, the Global Fund will also be able to increase its efforts to strengthen health systems more broadly over the next three years. Given the extraordinary financial strains placed on national governments by the COVID-19 pandemic and the economic consequences of the Ukraine war, it is understandable that governments have competing priorities and domestic pressures that may be viewed as more urgent than international aid and supporting the Global Fund. Nevertheless, disruptions caused by the pandemic to the legal supply chains and limited regulatory enforcement helped spawn a surge in fake medicines, according to the Organization for Economic Co-operation and Development. Interventions to support the fight against HIV, TB and malaria (stronger health systems, improved disease surveillance, more health care worker training, improved laboratory capacity for diagnosis, etc.) are also the foundation of future pandemic preparedness. Resourcing the battle against these diseases is also, therefore, equivalent to resourcing future health crisis readiness. And since pandemics, by definition, affect us all, this should be viewed as investment in future global health. Climate change is already affecting virtually every part of the world, with more extreme weather events recorded across our planet. The already record levels of internally displaced people and refugees will increase, and poverty, food and water insecurity will create immense negative pressures on health, increasing the risk of future pandemics and altering the dynamics of diseases such as HIV, TB and malaria. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths a year, including 60,000 from malaria alone. Business as usual is no longer good enough Someone far wiser than I once said: “Do what you’ve always done, and you’ll get what you’ve always got”. Business as usual isn’t going to cut it in the interconnected set of challenges posed by climate change, emerging pandemics and global public health that we will face over the coming years and decades. Neither is merely “responding” good enough – proactive planning and preemptive interventions are going to be crucial. That’s why the Fight the Fakes Alliance strongly endorses the Global Fund’s philosophy of a “One Health” ethos that envisions an integrated approach: “… positioning human health interventions within the context of a broader planetary health agenda, encompassing animal, human, plant health and the shared environment.” The question is not whether the world can afford to, but rather if we can afford not to support the crucial public health programmes that are financed by the Global Fund. Public health investments in LMICs have a direct impact on the quality of life in developed and high-income countries too. We are all in this together. As the global health challenges we face together continue to grow, so does the opportunity for counterfeiters and criminals. While the market size for fakes medicines is, by its very nature, difficult to quantify accurately, it is worth an estimated US$70-$200 billion. During a single operation (Action Against Counterfeit and Illicit Medicines, ACIM) carried out in 16 African countries in 2016, 113 million “suspect” medicines worth an estimated €52 million were seized over a 10-day period. Increased public awareness of the issue is clearly essential, and one positive consequence of the COVID-19 pandemic is the attention it brought to the problem of falsified and substandard medicines and PPE, including masks, gloves, hydroxychloroquine and vaccines. Almost any pharmaceutical product can be falsified, but those used to treat malaria, tuberculosis and HIV/AIDS are amongst the most widely abused. For this reason, the Fight the Fakes Alliance calls upon governments to be bold and increase pledges so the global programmes to tackle HIV, TB and malaria are fully funded. That will help avoid millions of preventable deaths, accomplish the SDGs, and ensure preparedness for future health crises. _________________________ The author of this article is Chair of the Fight the Fakes Alliance (commonly referred to as ‘Fight the Fakes’), a multi-stakeholder non-profit association based in Geneva, Switzerland, that aims to raise awareness and influence change about the proliferation of falsified and substandard medicines. He is also Senior Director, Access & Product Management at Medicines for Malaria Venture, a leading product development partnership engaged in the discovery, development and delivery of novel antimalarials. Image Credits: The Global Fund , WHO Medical Product Alert 10/2019, Pyzik, O.Z., Abubakar, I. Fighting the fakes: tackling substandard and falsified medicines. Nat Rev Dis Primers 8, 55 (2022)., Emmanuel Museruka/ MMV. Time to Invest in Preventing and Treating NCDs 08/09/2022 Kerry Cullinan Testing patients for diabetes at a World Health Organization event. If all countries significantly raise taxes on tobacco, alcohol and sugary beverages, this could prevent 50 million premature deaths over the next 50 years, according to Michael Bloomberg, World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries. “Plus, the taxes would raise more than $20 trillion in revenue to support public health programmes, helping to save even more lives,” Bloomberg told a virtual event convened to make a global appeal for more investment in NCDs. “Every year, 17 million people under the age of 70 die of non-communicable diseases, mostly in low and middle-income countries,” Dr Tedros Adhanom Ghebreyesus told the event, co-hosted by WHO, the NCD Alliance and the World Diabetes Foundation. “Nearly seven million lives could be saved by 2030 if low and lower middle-income countries invest an additional $1 per person per year on cost-effective interventions, like graphic warnings on cigarette packaging, food labelling and bicycle lanes,” said Tedros. Katie Dain, CEO of the NCD Alliance, decried the fact that “a multitude of political commitments have yet to really translate into adequate [financial] commitments”. “NCDs will cause more suffering in lives lost this decade than any other health issue. They wi’ll drain the global economy and impede human capital and undermine any effort to ensure the world is better prepared for future pandemics after COVID-19,” said Dain. Financing for NCDs has stagnated at around 2% of the development assistance for health for two decades. Paul Fife from the Norwegian Agency for Development Cooperation stressed that “the proper way to finance NCD action is in general through health system reform more broadly, as opposed to very focused disease control programme approaches, such as we have seen for some infectious diseases.” Fife added that “we need to be careful to not give the impression that donors and donor financing are the most instrumental in driving or not driving investments in NCDs”. “For all but the poorest countries and countries in conflict or humanitarian crises, the investments made by governments, insurance agencies, private companies – and the degree to which they are universal, meaning equitable – are far more important than donor aid,” Fife stressed. Preventing NCDs key to achieving universal health coverage From a luxury good to a part of daily diets, sugary drinks that increase the risks of diabetes have become highly popular in Africa. “The big challenge is actually to build a broader, more equitable and efficient health system and integrate NCDs into the system. The path forward is the progressive realisation of universal health coverage.” Dr Omary Ubuguyu from Tanzania’s health ministry said that many of his citizens had to pay for their own NCD treatment as only 15% of the population had health insurance. “So 85% have to pay out of their pockets for health care services and this makes them very vulnerable,” said Ubuguyu. “At the moment, what we are paying for the dialysis, for example, is almost $400 per week, So we have seen a lot of people selling their assets, only to find after one year that they can’t afford to continue with this was a treatment and then dying,” he said, adding that his country was introducing a mandatory health insurance scheme for all – although there were significant financial challenges. “Integration of NCDs with other services, notably HIV and tuberculosis, is also on our agenda,” he added. Uruguay has implemented a number of policies to address NCDs including provisions to regulate tobacco and unhealthy food, according to health ministry official Luis Galicia. Citizens have universal health coverage with a “payment by performance system”, where suppliers are reimbursed if patients comply with targets linked to cancer, hypertension, diabetes, heart and cerebral vascular indicators, said Galicia. “We have allocated a part of the taxes on alcohol and sugary beverages to the prevention and control of NCDs,” he added. Funding targets Bente Mikkelsen Bente Mikkelsen, WHO director of NCDs, said that it is “a huge disappointment that many, many countries don’t realise the epidemiological shift that has happened from HIV, malaria, TB, to actually looking at that seven out of 10 deaths in the world is now linked to NCD”. Earlier in the meeting, South African HIV activist and academic Dr Vuyiseka Dubula, had called on people to put pressure on African countries to ensure that they spent more on health. Mikkelsen said that the NCD sector should set a global target for NCD expenditure as the HIV sector had. “I think we need a target for investment in NCDs, and we need to target for also including NCD into UHC. Part of that should be measures for domestic funding, which can very well be also linked to the health taxation,” said Mikkelsen. However, she also stressed that the demand for increased investment in NCDs had to come from WHO member countries. Despite a raft of global resolutions, policy options and implementation tools, a global roadmap “what we totally lack is the demand”. Demand creation “There is no demand to be seen when the proposal comes from a country that doesn’t include NCD. How can that be? So, even before the data, we are about demand creation.” Bloomberg Philanthropies’ Dr Kelly Henning warned that progress against NCDs was being hampered by “powerful stakeholders promoting and selling harmful products”. “It takes resolve at the highest levels of leadership to push back against these interests and requires effective public education so that the population can support and participate in the change that’s needed,” said Henning. In 2018, Bloomberg convened a task force on fiscal policy for health, which concluded that raising health taxes on tobacco, alcohol and sweetened beverages, “is highly underutilised and would save millions of lives and bring in much needed government revenue”, said Henning. “After reviewing the evidence, the task force found that tobacco taxes can do more to reduce premature mortality than any other single health policy. Unfortunately, since the taskforce report came out, we haven’t really made all that much progress,” said Henning. “And why is that? The task force concluded that implementing health taxes was a measure of government resolve because industry’s pushback against tax increases with false and misleading standards, and oftentimes, influences them.” The NCD Alliance is running a week-long awareness campaign about the need to invest in NCDs. Only 14 countries are on track to meet the WHO’s nine voluntary global targets for the prevention and control of NCDs, due to be assessed at the fourth High-level Meeting of the United Nations General Assembly (HLM4) in 2025. Image Credits: Twitter: @WHO, Heala_SA/Twitter. Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
Time to Invest in Preventing and Treating NCDs 08/09/2022 Kerry Cullinan Testing patients for diabetes at a World Health Organization event. If all countries significantly raise taxes on tobacco, alcohol and sugary beverages, this could prevent 50 million premature deaths over the next 50 years, according to Michael Bloomberg, World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries. “Plus, the taxes would raise more than $20 trillion in revenue to support public health programmes, helping to save even more lives,” Bloomberg told a virtual event convened to make a global appeal for more investment in NCDs. “Every year, 17 million people under the age of 70 die of non-communicable diseases, mostly in low and middle-income countries,” Dr Tedros Adhanom Ghebreyesus told the event, co-hosted by WHO, the NCD Alliance and the World Diabetes Foundation. “Nearly seven million lives could be saved by 2030 if low and lower middle-income countries invest an additional $1 per person per year on cost-effective interventions, like graphic warnings on cigarette packaging, food labelling and bicycle lanes,” said Tedros. Katie Dain, CEO of the NCD Alliance, decried the fact that “a multitude of political commitments have yet to really translate into adequate [financial] commitments”. “NCDs will cause more suffering in lives lost this decade than any other health issue. They wi’ll drain the global economy and impede human capital and undermine any effort to ensure the world is better prepared for future pandemics after COVID-19,” said Dain. Financing for NCDs has stagnated at around 2% of the development assistance for health for two decades. Paul Fife from the Norwegian Agency for Development Cooperation stressed that “the proper way to finance NCD action is in general through health system reform more broadly, as opposed to very focused disease control programme approaches, such as we have seen for some infectious diseases.” Fife added that “we need to be careful to not give the impression that donors and donor financing are the most instrumental in driving or not driving investments in NCDs”. “For all but the poorest countries and countries in conflict or humanitarian crises, the investments made by governments, insurance agencies, private companies – and the degree to which they are universal, meaning equitable – are far more important than donor aid,” Fife stressed. Preventing NCDs key to achieving universal health coverage From a luxury good to a part of daily diets, sugary drinks that increase the risks of diabetes have become highly popular in Africa. “The big challenge is actually to build a broader, more equitable and efficient health system and integrate NCDs into the system. The path forward is the progressive realisation of universal health coverage.” Dr Omary Ubuguyu from Tanzania’s health ministry said that many of his citizens had to pay for their own NCD treatment as only 15% of the population had health insurance. “So 85% have to pay out of their pockets for health care services and this makes them very vulnerable,” said Ubuguyu. “At the moment, what we are paying for the dialysis, for example, is almost $400 per week, So we have seen a lot of people selling their assets, only to find after one year that they can’t afford to continue with this was a treatment and then dying,” he said, adding that his country was introducing a mandatory health insurance scheme for all – although there were significant financial challenges. “Integration of NCDs with other services, notably HIV and tuberculosis, is also on our agenda,” he added. Uruguay has implemented a number of policies to address NCDs including provisions to regulate tobacco and unhealthy food, according to health ministry official Luis Galicia. Citizens have universal health coverage with a “payment by performance system”, where suppliers are reimbursed if patients comply with targets linked to cancer, hypertension, diabetes, heart and cerebral vascular indicators, said Galicia. “We have allocated a part of the taxes on alcohol and sugary beverages to the prevention and control of NCDs,” he added. Funding targets Bente Mikkelsen Bente Mikkelsen, WHO director of NCDs, said that it is “a huge disappointment that many, many countries don’t realise the epidemiological shift that has happened from HIV, malaria, TB, to actually looking at that seven out of 10 deaths in the world is now linked to NCD”. Earlier in the meeting, South African HIV activist and academic Dr Vuyiseka Dubula, had called on people to put pressure on African countries to ensure that they spent more on health. Mikkelsen said that the NCD sector should set a global target for NCD expenditure as the HIV sector had. “I think we need a target for investment in NCDs, and we need to target for also including NCD into UHC. Part of that should be measures for domestic funding, which can very well be also linked to the health taxation,” said Mikkelsen. However, she also stressed that the demand for increased investment in NCDs had to come from WHO member countries. Despite a raft of global resolutions, policy options and implementation tools, a global roadmap “what we totally lack is the demand”. Demand creation “There is no demand to be seen when the proposal comes from a country that doesn’t include NCD. How can that be? So, even before the data, we are about demand creation.” Bloomberg Philanthropies’ Dr Kelly Henning warned that progress against NCDs was being hampered by “powerful stakeholders promoting and selling harmful products”. “It takes resolve at the highest levels of leadership to push back against these interests and requires effective public education so that the population can support and participate in the change that’s needed,” said Henning. In 2018, Bloomberg convened a task force on fiscal policy for health, which concluded that raising health taxes on tobacco, alcohol and sweetened beverages, “is highly underutilised and would save millions of lives and bring in much needed government revenue”, said Henning. “After reviewing the evidence, the task force found that tobacco taxes can do more to reduce premature mortality than any other single health policy. Unfortunately, since the taskforce report came out, we haven’t really made all that much progress,” said Henning. “And why is that? The task force concluded that implementing health taxes was a measure of government resolve because industry’s pushback against tax increases with false and misleading standards, and oftentimes, influences them.” The NCD Alliance is running a week-long awareness campaign about the need to invest in NCDs. Only 14 countries are on track to meet the WHO’s nine voluntary global targets for the prevention and control of NCDs, due to be assessed at the fourth High-level Meeting of the United Nations General Assembly (HLM4) in 2025. Image Credits: Twitter: @WHO, Heala_SA/Twitter. Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
Pan-American Region Secures First Monkeypox Vaccines Deal 08/09/2022 Raisa Santos & Stefan Anderson Carissa Etienne, PAHO Director In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean. That will allow PAHO to start delivering the doses to the 12 countries that requested them in September. The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort. PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO). WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably. A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.” “WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.” The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.” Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then a second batch in November and a third batch in December — making for 100,000 doses in all. PAHO did not disclose how much it is paying for the doses. The Americas – highest burden of monkeypox worldwide More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. The fraction of monkeypox cases that do not involve any recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well. Due to the shortage, WHO does not recommend mass vaccinations. “Vaccination, when available, can be deployed as a preventative measure,” said Etienne. “With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.” Monkeypox response must involve affected communities Ciro Ugarte, PAHO Director of Health Emergencies The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement. “Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.” To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. “LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.” Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale. “We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said. “The pandemic is not behind us” Marcos Espinal, Interim Assistant Director, PAHO Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. “COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.” Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. “We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.” China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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.
China Maintains “zero-COVID” Policy in Chengdu Despite Fatal 6.8 Magnitude Earthquake 07/09/2022 Raisa Santos China’s Chengdu enforces strict lockdown despite earthquake Authorities in China’s southwestern city of Chengdu are sticking to the nation’s “zero-COVID” policy demanding a lockdown on the city’s 21 million inhabitants even in the face of a major earthquake that has killed at least 66 people in the region. Chengdu, the capital of China’s Sichuan province, has been beset by a heatwave and drought this summer and last week was plunged into a lockdown after an increase in COVID cases. Some in Chengdu say they were ordered to stay inside while the 6.8 magnitude earthquake struck a mountainous area in Luding County, about 200 km (125 miles) from Chengdu, while those that ran outside say their movements were severely restricted due to the pandemic. Videos shared on Douyin, China’s TikTok platform, show panicked residents behind chained gates, shouting to be let out. In one, a man swears at a security guard, rattling what appears to be his apartment gates and trying to open it, then shouts: “Hurry up, open the door, it’s an earthquake!” In response, the guards say: “It’s over, the earthquake’s already over.” Another video claims to be an audio recording of a loudspeaker message: “Go back home and do not gather here, it’s just an earthquake. We [here in Sichuan] have a lot of experience [when it comes to earthquakes]. The 6.8-magnitude earthquake on Monday was the strongest Sichuan has seen since 2017. Provincial authorities said at least 66 people were dead, 253 people were injured and 15 others were missing as of Tuesday afternoon. Chengdu lockdown most severe since Shanghai Citizens in Chengdu, China, rush to gather necessities before city-wide lockdown. Chengdu’s lockdown is the most severe since China’s largest city of Shanghai was placed in isolation over the spring and summer. Starting last week, 1 September, residents were no longer allowed to leave their homes without special permission. Authorities also began citywide testing. Nationwide, China reported 1,499 new cases of local infection, most of them asymptomatic, on Tuesday. Sichuan province accounted for 138 of those cases. In all, 65 million people across China in 33 cities are grappling with partial or full lockdowns, according to Chinese media, from Chengdu to the southern economic powerhouse of Shenzhen to the oil-producing city of Daqing, near Russia. Chengdu, which reported 121 cases, is showing signs of tightening restrictions. At least one district in Chengdu has banned even the ordering of takeout meals and coffee, according to a notice posted on the internet. Business owners are preparing for the worst. Eli Sweet, an American who runs a chain of dance studios in Chengdu, told Bloomberg his business was already hit by power cuts across Sichuan province in recent weeks before the COVID lockdown. “We’re definitely teetering on the brink of dying,” he said of his chain of dance studios, “which is pretty sad considering we built this business from scratch to a pretty significant scale.” The atmosphere in Chengdu, he added, has become one of “fatigue, annoyance and general compliance.” Chinese president Xi Jinping’s “zero-COVID” strategy tested before October re-election China’s Xi Jinping in 18 May address before the World Health Assembly China has stuck to its “zero-COVID” policy of compulsory testing, lockdowns, quarantines and masking despite moves from the rest of the world to open up again since the virus was first detected in the central Chinese city of Wuhan in 2019. World Health Organization Director General Dr Tedros Adhanom Ghebreyesus has called this strategy unsustainable in the face of the more infectious but less lethal Omicron variant that emerged in May. For China’s President Xi Jinping, his nation’s strategy may seem like evidence that the Communist Party’s system of governance has distinct advantages over Western democracy. But for George Magnus, a research associate at Oxford University, the situation may be masking a hard truth: China still isn’t in a position to handle a COVID-19 outbreak. “Its hospital system is not up to it, mRNA vaccines are not yet widely available, and the elderly vaccination rate is still low,” Magnus told Bloomberg. “This is a problem for the 2020s and for Xi, whose opponents in the party, sensing all this, and also Xi’s risky foreign policies, may not be as docile in the future as now,” he said. With the Communist Party’s twice-a-decade leadership summit coming up in October, in which Jinping is expected to be re-elected as China’s top leader for another five years, the evolving situation in Chengdu, alongside the outbreaks in other cities, may in fact undermine Jinping’s proclamation that the “zero-COVID” strategy is a winning one. “The more cities get locked down, the more Chinese will turn against COVID-zero,” said Frank Tsai, founder of consulting firm China Crossroads. “The party knows that there is a tipping point,” he said, “and it would be smart to get ahead of this tipping point and declare victory before it comes.” Image Credits: Global News/Twitter , Manya Koetse/Twitter. WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” 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
WHO Warns Against ‘Complacency’ over COVID-19 and Monkeypox 07/09/2022 Kerry Cullinan Maria van Kerkhove Although COVID-19 and monkeypox cases are declining globally, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus warned against complacency on Wednesday. Although COVID-19 cases were down by 80% since February, “last week, one person died with COVID-19 every 44 seconds and most of those those those deaths are avoidable,” said Tedros. “There is no guarantee these trends will persist. The most dangerous thing is to assume they will,” he added. “You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.” On monkeypox, Tedros said that there was a downward trend in Europe and although cases in the Americas also appeared to decline, it was “harder to draw firm conclusions about the epidemic in that region”. “Some countries in the Americas continue to report increasing number of cases and in some, there is likely to be under-reporting due to stigma and discrimination or a lack of information for those who need it most. “But as I said earlier, a downward trend can be the most dangerous time if it opens the door to complacency,” stressed Tedros. “WHO continues to recommend that all countries persist with a tailored combination of public health measures: Testing, research and targeted vaccination where vaccines are available.” He added that community engagement is vital, and that the WHO had consulted with community leaders from all over the world to listen to their views and concerns and to “emphasise the informed importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health”. Tedros also stressed the importance of the global negotiations on an appropriate global instrument to address future pandemics, adding that more public hearings on this would be held by the WHO’s intergovernmental negotiating body (INB) later this month. COVID vaccine schedule? Meanwhile, WHO Executive Director of Health Emergencies, Dr Mike Ryan said that he hoped that it would be possible for the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) to develop a vaccination schedule for COVID-19. “Many countries now are offering people third and fourth doses of vaccine and we will have to come to a point where there’s some kind of schedule created that’s beyond the idea of a primary schedule,” said Ryan. ‘Obviously, it’s tough for countries to deal with ad hoc policy where you’re adding an extra booster on for certain people after so many months, and it’s very easy to become incoherent,” he added. “I think governments are making the best decisions they can, based on the data that they have, but ultimately we need to settle down into some acceptable pattern of vaccination boosting.” However, WHO technical lead on COVID-19, Maria van Kerkhove, said that while many people were hoping that SARS CoV2 would “fall into some kind of a seasonal pattern like we see with influenza, right now we don’t have that predictability”. “The reason for that is because we’re seeing this virus continue to evolve quite rapidly.” Posts navigation Older postsNewer posts