Denmark’s capital, Copenhagen, is expected to return to pre-pandemic life as the country scraps most COVID-19 restrictions.

The world is “sick and tired” of COVID-19, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus acknowledged but warned that Omicron posed a substantial threat to global health, having caused 90 million infections in the past 10 weeks – more than all the cases recorded in 2021.

Tedros’s appeal came as Denmark lifted most COVID-19 restrictions including wearing masks this week despite registering over 40,000 new cases daily, with Norway and Sweden poised to follow suit. 

The UK eased many restrictions last month but kept masking, while South Africa’s Cabinet announced on Monday that people with asymptomatic COVID-19 no longer had to isolate and reduced quarantine days from 10 to seven.

Denmark’s rationale is that over 80% of its population is vaccinated, and that Omicron is substantially less infectious than previous variants.

But deaths in four of the WHO’s six regions have increased in the past week and Tedros urged countries to “protect their people using every tool in the toolkit” at a media briefing on Tuesday.

‘Premature to declare victory or surrender’

“It is premature for any country either to surrender or to declare victory. This virus is dangerous and it continues to evolve,” warned Tedros, adding that  the WHO is currently tracking for sub-variants of Omicron.

Dr Maria van Kerkhove, the WHO’s lead on COVID-19, cautioned that “now is not the time to lift everything all at once”.

“We have always urged caution in applying interventions as well as lifting those interventions in a steady and slow way,” said Van Kerkhove, although she acknowledged that countries are in very different situations around the world, and there was no “one solution”. 

Responding to South Africa’s changes to its isolation policies, Van Kerkhove said while the WHO recommended isolation is to prevent onward transmission some countries had so many cases they had to shorten isolation period and quarantine period “because they need to keep operating”.

“Most people still transmit the [Omicron] virus right around the time they develop symptoms from about two days before symptom onset up through the first five to nine days if you’re mild. It can be longer if you have severe disease,” added Van Kerkhove.

Dr Maria Van Kerkhove

Celebrate a new phase of disease control

Dr Michael Ryan, WHO Executive Director of Health Emergencies, said that the Scandinavian countries had a very high vaccination rates and strong health systems.

Every country in the world was trying to calculate “how do we have maximum protection of our population while minimising the impact on our society and our economy”, added Ryan.

He urged them not to “follow blindly” the decisions of other countries but to make decisions “based on your current epidemiology, your demographics, the population of risk, your vaccination levels, your population immunity, your access to tools, the strength of your health service”.

He also said that countries also needed to allow individual choice: “There are many, many people in my own personal view, who will be well advised to continue wearing masks in crowded situations and public transport even if it’s not mandated by government”.

In addition, “communities need to understand that measures may have to be reintroduced in order to moderate transmission if there is an unexpected rise in transmission or a new variant emerges”

Ryan urged “flexibility, agility, the ability to adjust, making good decisions based on your situation, and being ready to change that if needed”.

“We should be in some ways, celebrating when countries get to another stage of disease control, but at the same time being cautious and know that not all paths are straight,” he added.

Omicron sub-variants

Dr Tedros said that the WHO was researching four sub-variants of Omicron, including BA.2 which is more infectious that the original variant (BA.1).

Van Kerkhove said that there was some evidence that the prevalence of BA.2 was increasing in countries including Denmark and in India but that “there’s not a lot of information that we have on this particular sub-variant yet”.

“There is a suggestion from some of the initial data on BA.2 that there’s a slight increase in growth rate above BA.1. But what beyond that the data is really quite limited.”

New SARS-CoV2 origins group report weeks away

Van Kerkhove confirmed that the new Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) had already had six meetings since it was constituted in late November.

Made up of 27 people, the WHO Secretariat expected guidance from SAGO “in the next few weeks” on the way forward in trying to ascertain the origins of SARS-CO-V2.

They were working on three issues: developing a framework for the study of any emerging pathogen; looking at the origins of this particular pandemic, building upon previous missions that have gone to China, and thirdly, looking at all of the literature and evidence that exists to look at studies that have been conducted since the original team had returned form China last March. 

“This group is currently working on their first set of recommendations to WHO on what is needed next, focusing on the urgent needs in terms of the studies that are necessary,” said Van Kerkhove.

 

Image Credits: Febiyan/ Unsplash.

Gaudenz Silberschmidt, WHO Director of Health and Multilateral Partnerships.

The World Health Organization (WHO) is considering changing how it relates to non-state actors (NSAs), but some of these organisations are concerned that the changes envisaged by the global body may weaken their voices.

In 2016, the WHO’s World Health Assembly (WHA) adopted a Framework for Engagement with NSAs – known as FENSA –  to enable closer collaboration with a wide range of organisations to respond to national and global health challenges. An initial evaluation of its implementation was conducted in 2019, and a two-year timeframe was set to fully operationalise the framework.

Over the past weekend, the WHO Executive Board considered a report on progress to implement FENSA , as well as inputs from various NSAs on how their relationships with the global body could be improved.

According to the report, the WHO said it seeks to improve NSAs’ role, voice and contribution in its governance system including by introducing a global constituency for NSAs and grouping NSA statements accordingly. While welcoming the WHO’s intentions, a number of NSAs noted that the proposal could weaken and soften the NSAs’ contributions to WHO’s agenda. 

International humanitarian medical non-governmental organization Médecins Sans Frontières (MSF) expressed concern with the proposal, saying that it fails to acknowledge the value of diversity and expertise inherent in NSA. 

MSF’s Dr Maria Guevara

“The creation of a global constituency and the grouping of NSA statements risk diluting these voices and limiting their meaningful participation in the dialogue and in finding solutions to current health challenges,” MSF’s Dr Maria Guevara argued. 

The International Council of Nurses said that while it supports informal meetings before WHO meeting, it called for more notice and added that the selection of the agenda items must be agreed on between NSAsand WHO member states. 

“After testing [introducing] constituency statements at the 75th WHA, we strongly encourage consultation with NSAs before making a final decision on their implementation,” said the ICN, adding that constituency statements should not prevent individual statements.

In its submission, the European Society for Medical Oncology (ESMO) also called for the WHO to allow non-state actors to still be able to make individual statements on issues that are in line with their core areas of expertise. To accommodate the contribution of more non-state actors, the society called for the WHO to publish each non-state actor’s statement on its website and for these to be included in meetings’ official minutes.

“Non-state actors can submit individual statements on the WHO website and in a way that they are translated and reported in the official minutes of WHO meetings, allowing non-state actors for each agenda item,” ESMO’s Gracemarie Bricalli recommended.

Meanwhile, the Save the Children Fund called on WHO Member States to also prioritize interactions with NSAs, especially the civil society, by actively participating in informal sessions and systematically sharing draft documents and resolutions for civil society organizations to engage in policy making.

It also slammed the WHO Secretariat over lack of time and support provided to NSAs regarding new processes, including constituency statements. It said the process lacked transparency and open dialogue among the different actors.

“We welcome all opportunities to engage with member states and the Secretariat to ensure the meaningful engagement of NSAs including when it comes to the development of a civil society engagement strategy.”

IPPF’s Estelle Wagner

The International Planned Parenthood Federation (IPPF) urged Member States to compel the Secretariat to constitute a diverse working group of member states and civil society organizations to review and develop proposals and report back at the 152nd executive board meeting next year on more robust recommendations to involve NSAs at the WHO beyond making general statements on agenda items.

“More than ever, the pandemic has shown the essential role of NSAs in the work of the WHO and we look forward to a constructive and transparent process to define mechanisms for truly meaningful engagement with WHO governing bodies beyond generalized statements at the end of agenda items,” the federation’s Estelle Wagner stated. 

Canada, USA and UK side with NSAs

Canada’s Elizabeth King

The government of Canada noted that the positions of NSAs on topical issues need to be taken more seriously, adding member states need to hear from NSAs before positions are finalized. It pledged its continuous support for meeting with NSAs prior to the WHA in May, adding that sufficient notice should be provided.

Canada also supported that NSAs should continue to have the option to deliver individual statements on all agenda items to ensure that member states benefit from the diversity of NSAs’ views. 

“This could be combined with a reasonable limit to the number of individual statements an NSA can deliver,” Canada stated.

Canada and the United Kingdom also agreed that the WHO Secretariat should work with NSAs to identify the agenda items where constituency statements would be more valuable, rather than identifying them independently.

“We’d like to reaffirm that hearing and understanding the voices of non state actors in all of our efforts to more meaningfully engage will increase our chances of success,” Canada’s Elizabeth King concluded. 

The US said the priority should be on ensuring WHO’s engagements and involvement of NSAs in its agenda are more meaningful and routine.

It noted that NSAs were critical to the development of vaccines, therapeutics and other medical medical countermeasures, as well as their distribution and delivery to individuals across the globe. By working together with NSAs, the United States said the WHO and the global health community can become more effective, efficient and avoid duplication or miscommunications that could undermine joint aims and efforts. 

A concluding remark from Gaudenz Silberschmidt, Director of Health and Multilateral Partnerships at the WHO said the global health body is committed to making the engagements and interactions between NSAs, member states and the WHO Secretariat to be more meaningful.

The challenge, according to him, is that the increased number of agenda items and interest have put pressure on the time for interventions for NSAs and delegates. He announced plans to organize a meeting with NSAs in February 2022 to consult both on the planning of the informal pre-meeting and on the constituency statements.

“We propose to include a session on those engagement modalities in the informal pre-meeting of the World Health Assembly,” he added.

Amoth and Tedros
WHO Executive Board Chair Dr Patrick Amoth and Director-General Dr Tedros at Friday’s EB150 session.

An innovative WHO “Health for Peace Initiative” that aims to build bridges in conflict zone and humanitarian settings through global health initiatives ran into some rough waters at last week’s Executive Board meeting – with the United States saying that it should include a human rights element – while Russia warned WHO against “politicizing” its agenda.  

The initiative, conceived in 2019-2020, was planned and developed together with the International Labour Organization, the UN Peacebuilding Support Office, and the Swiss-based organization Interpeace, with some initial projects now being implemented in areas like the Ukraine. 

The initiative builds on earlier WHO “Bridges for Peace” projects that took place during the 1980s and 1990s. But this new GHPI edition also aims to “work on conflict” by ensuring that such programmes help address conflict’s underlying causes – while avoiding unintentionally fuelling of tensions. 

Other aims of the initiative include developing “innovative ways to address conflict, strengthen resilience to violence and empower people to (re)build peaceful relations with each other”.

It aims to covers a wide range of areas – from infectious diseases to maternal and child health, nutrition, tobacco use and health systems strengthening. 

Synopsis of the health for peace initiative.

Russia – don’t stray into other areas

However, some leading member states gave the initiative a mixed reception in a discussion WHO Executive Board on Friday, the day before the 150th session closed. 

Russia warned WHO that it needs to to avoid “politicising” its agenda, asking for more discussion about the nuts and bolts of the initiative.

It also warned WHO against “straying” into areas beyond its mandate, saying focusing on the core WHO mission of strengthening health systems already helps build trust between countries. 

“Russia continues to speak out against the politicization of the WHO agenda… We call upon WHO to strictly follow its mandate and not stray into other areas, those covered by other [United Nations] bodies, specialized agencies and so on,” Russia’s EB  representative said.

Russia also highlighted that the initiative had launched, based on discussion with only 24 countries and partners.

“This issue has not been investigated by governing bodies of the WHO at another stage,” the Russian representative said. “We believe that there should be more broad discussions.”

Representatives from WHO’s Eastern Mediterranean region also appeared hesitant, with one delegate stressing that “first and foremost, we should avoid causing any harm.”

“Many interventions of health for peace will only be successful if they are well prepared and well designed, and therefore we need to coordinate our experiences and expertise,” he said. 

US asks for human rights inclusion

Health for Peace Initiative as it was presented at the Paris Peace Conference in 2020.

In contrast, the United States asked that human rights be included as one of the pillars of the initiative. 

While the US supports the draft of the GHPI, it said that the country “regrets that the text … fails to incorporate human rights as a fundamental pillar in addition to peace and development.

“The WHO has an important role to play in promoting respect for human rights and fundamental freedoms in coordination with other UN agencies,” the US representative said.

Building vaccine confidence, including the need to address issues of vaccine misinformation and disinformation, could also be a valuable arena in which the new GHPI could act.  

In response to the concerns, WHO officials stated that discussions on the initiative with member states are ongoing, and would be managed in an open and inclusive manner.

“I think that we have been very open to date,” said a WHO emergencies official. “It’s not a political initiative. Obviously, political decisions do have an impact on health and on peace and we’re all aware of this.”

‘There cannot be health without peace’ 

“There cannot be health without peace, and there cannot be peace without health,” WHO Director-General Tedros Adhanom Ghebreyesus, who has championed the initiative, has explained. 

“Health can also be a bridge to peace.  Health can contribute to peace by delivering services equitably to all people in society- especially disadvantaged groups,” he said in a recent message. “This can also help address the triggers of conflict, such as unequal access to health care, which can often leave to feelings of exclusion and resentment.

“Equitable health services strengthen community trust, which in turn contribute to health systems and peacebuilding efforts.” 

Data and technology sharing key to managing pandemics

In other discussions Friday, China, Singapore and Indonesia all stressed the need to address benefits and information sharing. 

“The current pandemic has shown us how important it is to make such information free and publicly available,” a representative from Singapore said, noting that the country “sees the sharing of such data … as part of ‘global public goods’” and that should be included in a larger conversation on the financing of such goods.

Singapore also recommended that WHO establish a global health threats fund, invested in by nations based on pre-agreed contributions as a means of being better prepared for the next pandemic. 

“We would like to caution against lies in the lack of levels of preparedness with regard to the response to pandemics around our region,” a second representative from the Eastern Mediterranean region said. “We would like to see the continuation of the support for our preparedness in this regard.”

He said that there should be better coordination among member states with regard to health, security, and preparation of emergency plans and plans with regard to specific diseases. 

Image Credits: WHO EB 150.

food
Food experts proposed a return to ‘real’ food over what is just ‘edible’

The explosion of unhealthy diets received considerable attention at last week’s WHO Executive Board meeting, as well as at last year’s UN Food Systems Summit – as key contributors to the global epidemic of chronic diseases such as obesity, diabetes, and cardiovascular diseases – which have also exacerbated the health risks of billions of people to COVID-19.

Now, what is really needed, post-pandemic, is a return to healthy and sustainable ‘real’ foods that both dimish these disease risks – as well as the risks of another pathogen escape from the wild into human societies as a result of unsafe and unsustainable food practices – particularly around both wild and domestic meat production and consumption.

This was a key message of a group of civil society experts at a recent panel – who also drew a distinction between what is merely “edible” food and what is “real”, healthy food.  

Making that seemingly simple distinction will be crucial post-COVID recovery to stem rising noncommunicable diseases while also ensuring that our planet remains within the boundaries of sustainable food production as well as making , nutrition experts emphasized during a recent Geneva Global Health Hub (G2H2) event. 

The event, “Sustainable healthy diets: Why are they so crucial after COVID-19?”, was hosted in collaboration with the Society for International Development (SID).

Featured speakers from Mexico, Brazil, and Colombia discussed a broad range of proposed solutions that would alter the way food is produced, distributed, and consumed.  

Exiting the corporate food system

Attaining healthier and more sustainable diets requires an ‘exit’ from the corporate food system, said Hernando Salcedo Fidalgo, of the Colombian NGO, FIAN. “The exit must make a distinction between real foods over what we call ‘edible products’”.

Fidalgo described solutions as a “continued process” that would have to begin at the very foundations of government – with approaches that distinguish between “real food and just edible products.” 

SID Director Nicoletta Dentico added: “If we don’t want to see things as they are, for the reality they represent, after years of the pandemic – this is going to be a kind of criminal blindness.” 

Mexico as a case study example of the need to return to traditional ‘real’ foods 

A sustainable healthy diet requires increased vegetable and fruit intake, as well more whole grains.

At the session, Mexico was cited as one example of a country in the crosshairs of pressures from corporate food manufactuers – who have undermined the once healthy diet of indigenous Mexican foods, leading to soaring problems with obesity and diabetes.

Reverting back to a traditional Mexican diet – rich in beans, fibre and micronutrients – is one way to both promote both sustainability and health,  said Juan Angel Rivera Dommarco, Director-General of the National Institute for Public Health in Mexico. 

“Our food system is really contributing to the degradation of the planet, and at the same time has created an epidemic of obesity and chronic illness without solving the undernutrition problems of the world.”

He bemoaned the gradual encroachment of meat, fat, and sugar-heavy  ‘American diets’ into Mexico.  

“We lost so many years of building healthy diets in Mexico as a result of trying to imitate the consumption of food in the north, which is not a good example at all,” he noted. 

The traditional Mexican diet means reverting to a diet high in vegetables, fruits, legumes, nuts or seeds, and whole grains – except in rural areas, where whole grains are already highly consumed. 

Milk and dairy intake also would need to be increased across rural populations, but decreased in urban ones. 

Substantial reductions in ultra-processed foods and reduced animal-source protein would also be needed to return back to the traditional Mexican diet. 

Average cost (MXN$) per capita per day of current Mexican diet vs Mexican healthy and sustainable diet

Moving towards this healthy diet would also be beneficial to the Mexican economy, Dommarco added.

The current average Mexican diet has been costed at $3.54 per day, whereas a traditionally healthy and sustainable Mexican diet would cost $3.06, while that proposed by the EAT-Lancet Commission would cost $2.52.

Shift government subsidies from ‘wrong foods’ to healthy ones 

Schools are one place to implement healthy food use.

Noting that the Mexican government currently offers too many subsidies for the “wrong foods”, he called on politcymakers to shift money and policy support to healthier foods – also providing  a model for other countries to follow.  

Working with GISAMAC (Inter-Sectoral Group for Health Agriculture Environment and Competitiveness), Dommarco has helped to develop a Mexican toolkit with a full set of policy proposals to address the need for healthy diets in the country. 

Their proposals included increasing the availability of healthy foods in underserved areas, prioritizing these foods for government subsidies and procurement, and prioritizing healthy, fresh foods in school nutrition programs. 

Taxes from sugar-sweetened beverages and ultra-processed junk food should be doubled, with tax revenues used to ensure drinking water in underserved communities, he added. 

Policies from the toolkit emphasize a multisectoral and multisystemic intervention, including not only food systems and the food environment, but education, nutrition, community, and health systems.

“The idea is that we really need a set of policies rather than one single policy that has a multi-systemic view,” said Dommarco. 

Image Credits: Noranna/Flickr, Juan Rivera Dommarco , Juan Rivera Dommarco, Flickr: Bart Verweij / World Bank.

National health systems are needed in tackling global health threats.

As the world enters the third year of the COVID-19 pandemic, an increasing number of important efforts are underway to strengthen global health security.  However, it is vital that, while strengthening our global health architecture, we do not lose sight of the fundamental role played by national level health systems in tackling global health threats.

Throughout this and previous pandemics, the strength of countries’ national health systems has been a critical success factor against pathogens. For example, even many countries with well-organised, well-financed and well-staffed health systems suffered throughout COVID-19. Viewed through these lenses, global health security may exist only as the sum total of the performance of all national health systems of all countries, rather than as a standalone and separate entity.

Since the onset of the pandemic, we have seen a plethora of new institutions and new ideas for improving global health governance. These include the Access to COVID-19 Tools (ACT) Accelerator and the COVAX Facility in April 2020, the Independent Panel on Pandemic Preparedness and Response proposal in May 2021 for a Global Health Threats Council and the World Health Assembly (WHA) agreement in December 2021 to proceed with the negotiation and drafting of a new international instrument to strengthen pandemic prevention, preparedness and response.

It is hoped that these new international institutions and platforms will support better pandemic governance and financing at the global level. However, although a strong global focus is essential for ensuring equitable distribution of those goods that are necessary for fighting COVID-19 and future pandemics, national efforts must be equally prioritised. 

In other words, global leaders must resist two great temptations: the desire to build new institutions instead of strengthening existing ones such as the WHO and the International Health Regulations, and the tendency to ‘securitize’ health at the global level instead of implementing strong public health measures at the national level.

Three functions to achieve resilient health systems

global health security
One interlocking function needed is resilient healthcare systems.

Global health security demands strong and resilient health systems that can prevent, detect and respond to infectious disease threats, wherever they occur in the world.  Therefore, we propose a new understanding that approaches this goal through the lens of three interlocking functions at the national level. 

The first key function is building resilient national healthcare systems. It is critical that they have built-in surge capacity (including for primary healthcare) to manage patients who have been infected and require care, while at the same time continuing and sustaining routine health services for those who have not been affected.  In addition to deaths from infection during the COVID-19 pandemic, there have been an excess of deaths of non-infected persons over what would be expected, likely due to the fact that they were not able to access routine health care, especially that which required frequent attention.  The same occurred in West Africa during outbreaks of Ebola in 2014 – health facilities could not accommodate most of the patients with Ebola infection resulting in a high level of death from Ebola virus diseases, and also, the number of deaths from children who could not get care for malaria and other childhood diseases because of the lack of resilience in the health system was documented as being higher than the number of deaths from Ebola virus disease.   

The second key function is developing strong core public health capacities that meet the WHO’s International Health Regulations. Countries with early detection surveillance systems that identified outbreaks rapidly at the start of the pandemic, and those that had strong response mechanisms including outbreak responses – especially Singapore, Japan, and South Korea – showed the importance of strong public health core capacities to manage pandemics.  And rather than using blunt lockdowns of the entire economies, they were able to save lives by outbreak investigation, identification of sources of infection and then shutting them down with precision, rather than blunt lockdowns.    

Thirdly, countries need to invest in broader supportive environments that enable the health and wellbeing of their populations. Infection with SAR CoV2, as with many other viral and bacterial infections, resulted in more serious illness and death among the elderly and those with comorbidities such as diabetes, cardiac disease and obesity.  By using smart regulations and other healthy-lifestyle-enabling measures, governments can ensure populations are healthier and more resistant to serious illness after infection, decreasing morbidity and mortality in an outbreak and/or pandemic. Healthy populations also require adequate health financing, strong health literacy and health-seeking behaviours, and improving the social determinants of health, like education, housing and working conditions.

Synergistic approach as opposed to mutually exclusive strategies

This synergistic approach to universal health coverage, health security, and health promotion is necessary to prepare for future pandemics. Currently, many countries seem to assume that public health, universal health coverage and creating the enabling environment for healthy populations are mutually exclusive strategies.  This can be due to limited resources and/or donor funding pushing governments towards “false choices”. 

Such false distinctions are further enhanced by the “global nature” of global health security with accountability towards the international community, contrasted with the domestic nature of universal health coverage and health promotion, with accountability towards local voters, taxpayers and citizens. 

A strategy focused on the three interlocking functions provides countries with a middle way – an integrated approach that equally prioritises national and global health security. Each of the functions has a strong conceptual framework and large body of evidence to support its positive impact on global health security.  Each is closely aligned with well-established and highly-visible health frameworks. 

 It will take political and health leaders with courage, vision and ambition to rethink some of the many vertical (albeit well-meaning) global implementation and funding streams to ensure that they serve to strengthen these three functions and not bypass or weaken them. They will need understanding and support from the global health community.

If implemented correctly, the three interlocking functions would be mutually synergistic, with progress in one function accelerating or enhancing progress in another. Taken together, they represent a more balanced approach to global health security and reduce the risk of over-globalizing, over-engineering or over-securitizing health. By better linking these three functions within WHO, and within its guidelines for epidemic and pandemic preparedness, WHO technical support to countries could provide better preparedness and response capacity for the next major outbreak or pandemic.

Biographies

Professor David Heymann is professor of infectious disease epidemiology, London School of Hygiene & Tropical Medicine.

Professor Ilona Kickbusch is the Founder of the Global Health Centre at the Graduate Institute in Geneva.

Chikwe Ihekweazu is the WHO assistant Director General of health emergency intelligence, the former Director General of the Nigeria Centre for Disease Control (NCDC) and was previously the Acting Director of the West Africa Regional Centre for Disease Control.

Doctor Swee Kheng Khor is a physician specializing in health systems & policies and global health, focusing on south-east Asia.

 

 

Image Credits: Nigeria Centre for Disease Control , Flickr: Maxim Malov/CDC.

17 January 2019 – Beni, North Kivu region, Democratic Republic of Congo.
Families go the Ebola Treatment Center to visit a family member who is held in quarantine in the centre.

WHO needs to reform lines of authority and responsibility across all aspects of its emergencies response operations in order to effectively prevent, report, and take measures against sexual exploitation and harrassment.  

Those were the highlights of a final report by an Independent Oversight Advisory Committee (IOAC) of the WHO Health Emergencies Programme, examining the claims of sexual exploitation and harrassment that first emerged in connection with WHO’s 2018-2020 Ebola response in the Democratic Republic of Congo. 

The report, presented in a Friday afternoon session of the WHO Executive Board, marked another milestone in the follow-up to reports of sexual exploitation and abuse claims by some 75 Congolese women against 25 WHO workers deployed to the Democratic Republic of Congo’s 2018-2020 Ebola response – which was first reported by the New Humanitarian in 2020. 

Following the reports, WHO initiated an independent investigation, as well as initial internal reforms to improve staff training in the prevention of sexual exploitation and harrassment (PRSEH); deployment of more training staff; and new recruitment standards that also consider any exploitation and abuse issues in a candidate’s background, the IOAC report states.

But there remains “ deep, lingering frustration expressed by Member States and staff about the lack of transparency, delays in responding to incidents and holding perpetrators accountable, and the defensiveness with which the Organization has dealt with SEAH in the past,” states the report, presented to the EB. 

response to drc claims
Felicity Harvey, co-chair IOAC

And more comprehensive cultural and structural changes need to occur across WHO to reduce the risks of abuse from ever occurring in the first place, said Felicity Harvey, co-chair of the IOAC committee, in her presentation of the report to the WHO Executive Board on Friday. 

“The second edition of The WHO Emergency Response framework should be further revised to provide greater clarity on the accountabilities and lines of authority across offices, regional offices and headquarters with explicit roles and responsibilities given to each player and updated procedures for all hazards emergency risk management,” she said. 

The IOAC report outlines five priority areas where more action is needed. Those include: 

  • Clarifying the lines of responsibility and delegation of authority across the three levels of the organization; Strengthening the accountability framework for emergency response and other field teams; 
  • Reform the organization’s PRSEH management structure, and accelerate  organizational capacity to implement a “victim survivor-centered” approach to PRSEH; 
  • Financial investment in PRSEH programmes as an essential WHO function – and particularly in field operations, where WHO is currently responding to some 80 emergencies around the world; 
  • Periodic assessments of PRSEH in acute emergency response settings, including a mapping of community and local resources; identification of trusted local partners for PRSEH incident management; ensuring that field operations include a balance of  experienced male and female personnel. 
  • Building a culture of equity, diversity and transparency 

“WHO needs to promote or advocate for institutionalized culture change to strengthen PRSEH,  including greater gender and racial diversity, improved performance management, and a renewed commitment to WHO values – to build a culture of equity, diversity and transparency,” said Harvey, a former director-general of international health in the United Kingdom Department of Health.  

DG Proposal – separate line of investigation for sex abuse complaints

WHO Director General Dr Tedros Adhanom Ghebreyesus

Responding to the IOAC report, WHO Director General Dr Tedros Adhanom Ghebreyesus noted that WHO has recently engaged an external investigator to follow up on further on the abuse allegations – and their perpetrators.

“This is the first time a UN Organization has installed an independent investigation, opening up to an external investigator,” he noted.  

“One of the things that our member states emphasized is transparency; we are doing that, and we will continue to do more. We will continue to build on this, because more should be done,” Tedros said. 

Tedros also asked the EB to approve a draft decision that would create a separate line of authority to the investigator heading up the Organization’s investigations of sexual exploitation and abuse allegations – and reporting directly to the Director General.  

All sexual exploitation and abuse allegations would thus be treated separately from other WHO internal justice investigations, at least temporarily, according to the draft WHO proposal. 

The WHO DG also noted that in the last two weeks, the Organization had received three new complaints of alleged sexual harrassment and exploitation from the Central African Republic, DR Brazzavile, and the Democratic Republic of Congo (DRC) – the latter where Tedros also said that WHO was creating a model for rehabilitation and support to victims, helping them access livelihoods as well as other means of support. 

“We support zero tolerance and we will do everything to build a better culture,” he said. 

The DG’s proposal to create a separate chain of authority for sexual exploitation and harrassment cases churned up some initial resistance among some EB members – who said that it should have been discussed even before the EB convened, at a meeting of member states’ Planning and Budget Advisory Committee (PBAC).  

Harvey, however, said that the IOAC would “strongly endorse the decision to keep the PRSEH Investigation Unit separate from general investigations,” att least for the moment until progress has been made on the investigations still ongoing in the DR Congo and elsewhere.  

The EB members deferred debate on the draft WHO decision until Saturday morning.

Country responses commend WHO and emphasize survivor-centered approach and ‘zero tolerance’ policy

WHO Representative of France

Representatives across Member States otherwise commended the WHO for its efforts towards prevention of sexual exploitation, abuse, and harrassment, with some emphasing the need to adopt a survivor-centered approach in responding to the allegations. 

“It is important that we create an environment conducive to effectively preventing sexual exploitation and abuse, and that means asking ourselves hard questions about responsibility,” said Tunisia, on behalf of the WHO Eastern Meditterean Region. 

Tunisia, and many other Member States noted that a zero tolerance policy is needed, and proposed that a common UN database be created. The database would be consulted before staff recruitment, ensuring that the necessary checks can be made. 

“We need to do this, making effective and efficient use of the resources we have available on gender equality.”

France, on behalf of the European Union, echoed these sentiments, and also reiterated the need for “accountable culture within the organization.”

“We think it is better to have people providing the information because peace is being swept under the carpet.”

Concern and clarification needed on transparency and accountability 

Bathsheba Nell Crocker, US Ambassador to the United Nations

However, some representatives continued to express their concern regarding the WHO’s work on sexual exploitation and abuse, including China and the United States. 

China noted the need for clarification from the WHO on the interim report and “transparency and accountability of the related work.”

“We hope that WHO will further clarify on how it will communicate on concrete action taken both within and outside of the organization.” 

The US representative, Bathsheba Nell Crocker, acknowledged the recent progress of the WHO, but added that “broader organization reforms are needed, as well as the dedicated effort now required to translate division laid out for WHO’s work in this area into concrete results on the ground.”

She also pointed out that WHO’s efforts to increase awareness, conduct training, and fill capacity are “essential but insufficient.” 

“[There is] absence of investment in evidence-driven survivor centered prevention, risk mitigation, and response protocols.”  

Crocker noted that WHO must encourage prompt reporting and delivery of survivor centered services. 

“Organizational change starts at the top with leadership. We call on WHO to ensure that roles and expectations are clear and to enforce whistleblower protections.”

Image Credits: Flickr: World Bank / Vincent Tremeau, WHO EB 150.

lassa fever
Nigeria has set up an emergency response centre to deal with outbreaks of the deadly Lassa fever in parts of the country.

Following reports of an unusually large number of cases in January 2022 across some 12 states, Nigeria is stepping up its surveillance of Lassa fever, the deadly viral hemorrhagic illness transmitted by infected rodents, or through other infected people or tainted food. 

This year marks the fourth year in a row in which large outbreaks of the  disease are being reported by Africa’s most populous state..   

According to the Nigeria Center for Disease Control (NCDC), there have been a total of 759 suspected cases, 170 confirmed cases and 32 confirmed deaths in January – following the emergence of the first cluster of new LF cases in December.

In a worrisome trend,  January’s cases were reported from 37 local government areas (LGAs) spread across 12 states. 

That is about twice the number of LGAs and states where cases of Lassa fever were reported within the same period in 2021 (17 and 6 respectively).

While the number of cases and states so far affected by the 2022 Lassa fever outbreak are higher, the case fatality rate of 18.8% remains lower than that of the  2021 outbreak where one out of four confirmed cases resulted in death (CFR — 25%).

Notably, is also about 16 times higher than the CFR for COVID-19 in Nigeria (1.2%), Nigerian health authorities underline.

Although cases have been reported from 12 states, three states (Edo, Ondo and Bauchi) are the epicenters for the outbreak, accounting for 74% of all confirmed cases.

Expanding range nationally and global health threats

This year mark’s the fourth in a row when large clusters of cases have been reported in Nigeria, “raising concerns about an ongoing, systematic emergence of LF nationally,” according to a recent Nature Communications review of the disease’s gradual expansion country-wide.

In 2019, there were 833 confirmed cases of Lassa fever in Nigeria with 174 deaths (CFR — 20.9%). In 2020, Nigeria recorded a total of 1181 confirmed cases of Lassa fever and 244 deaths (a CFR of 20.7%) but the following year (2021), the number of confirmed cases reduced to 510 with 102 deaths among confirmed cases (CFR - 20%). 

In addition to the national and regional risks, Lassa Fever is a “WHO-listed priority pathogen and a major focus of international vaccine development funding3 and, although often framed as a global health threat.”

Lassa fever is an acute viral illness and a viral haemorrhagic fever that is associated with high morbidity and mortality, and it thus has both economic and health security consequences.

Some cases, however, can be mild and thus go undetected or be confused with other common febrile conditions, like malaria - underlining the need for surveillance and vigilance to stop its spread. 

First reported in Nigeria’s state of Borno in 1969 when two missionary nurses died from an unusual febrile illness, Lassa fever cases and outbreaks continue to be reported in Nigeria and the diseases is increasingly recognised to be endemic in many parts of West Africa, including Nigeria, Benin, Ghana, Mali and the Mano River region (Sierra Leone, Liberia and Guinea).

The disease has typically been characterised as having two main endemic foci in West Africa, one centered around Sierra Leone and Liberia, and the other in Nigeria, but in recent years, Nigeria, in particular, has continued to record a trend of increasing numbers of cases - although most countries in the region have reported regular or sporadic cases, researchers report.


Response measures

In a statement this week, NCDC said it has activated the country’s national multi-sectoral and multi-disciplinary Lassa fever Emergency Operations Centre (EOC) in response to the Lassa fever outbreak in some parts of the country. 

“This became necessary given the increase in the number of confirmed Lassa fever cases across the country and a joint risk assessment with partners and sister agencies,” the center said in the statement.

It described the reports in weeks 1 and 2 as the highest number of confirmed cases recorded in Nigeria in the last four years for the same period. It however reassured Nigerians of its preparedness which hinged on the center’s experience in responding to Lassa fever outbreaks. 

“Since 2016, NCDC has worked hard to improve diagnostic capacity for the disease. Currently, seven laboratories can conduct confirmatory tests for Lassa fever in Nigeria and are coordinated by the NCDC National Reference Laboratory (NRL). This has improved active case detection for the disease,” NCDC stated. 

In the same vein, care for affected individuals has improved. NCDC said it is providing support to states including the provision of emergency medical and laboratory supplies as well as oral and intravenous Ribavirin for preventive and curative treatment to treatment centres across the country. 

“In addition, Nigeria through NCDC is participating in the largest-ever Lassa fever study that aims to provide an accurate assessment of the incidence of the disease in West Africa. This will also accelerate the development of vaccines and therapeutics for Lassa fever,” NCDC added.

It has also commenced training for healthcare workers in Nigeria’s tertiary health institutions on Lassa fever case management and infection prevention control.

Risk factors for exposure 

Contact with the rodent Mastomys natalensis is thought to be the reason for Lassa fever.

According to a research report published in Nature Communications in October, 2021, the significant majority of observed LF cases—including those from recent years in Nigeria—are thought to arise directly from contact with the rodent rodent Mastomys natalensis, the main viral reservoir host and a common agricultural pest. Other cases have occured, however, via hospital-acquired infections and potentially, in other small clusters of human-to-human transmission.

Risk factors for spillover of the virus, while not well understood, are thought to include factors that increase direct and indirect contact between rodents and people through poor food storage and housing quality, as well as certain crop processing practices.

Correlations between human case surges and seasonal rainfall patterns “suggests that LF is a climate-sensitive disease whose incidence may be increasing with regional climatic change,” according to the Nature Communications study, led by David Redding of University College London and and Chikwe Ihekweazu, of the Nigerian Centre for Disease Control (NCDC). 

Image Credits: Channel Africa/Twitter, Sahara Reporters/Nigeria.

Neglected Tropical Diseases remain stagnant in their funding

Despite the strains of COVID-19, global funding for poverty-related infectious diseases, such as HIV/AIDS, TB, and malaria, remains virtually unchanged at US $3.937 billion, with investment dropping only 4% in 2020, according to the fourteenth annual G-FINDER Report.

The report, released by Australia-based Policy Cures Research group on Thursday, showed a drop of only US $172 million from 2019. This year’s funding remains the third highest ever seen by the group for neglected diseases. 

Funding for neglected diseases declined only 4% in 2020

But though the decline may be a marginal one, funding for neglected tropical diseases (NTDs) continued a decade of relative stagnation, with only snakebite envenoming seeing an increased investment in 2020. 

Resilient funding may be impacted by COVID-19 in the future 

Nick Chapman, CEO of Policy Cures Research

The G-FINDER report is a comprehensive analysis of global investment of R&D for poverty-related neglected diseases. It is widely used by national governments, industry, civil society, and the World Health Organization to identify gaps in progress and areas where investments would be needed.

Reactions to the report were cautiously optimistic regarding the sustained investment in global R&D, with concerns that COVID-19 still could shift the direction of funding. 

“These figures are reassuring for the neglected disease research and development community as they indicate continued commitment to advancing health innovations for some of the world’s most vulnerable populations,” said Nick Chapman, CEO of Policy Cures Research.

“However, we can’t assume that resilient funding in the first year of the pandemic means that we are safe from impacts on funding in the future.”

Paul Barnsley, senior analyst at Policy Cures Research, also expressed his concerns during the Thursday launch event of the report. 

“We’re still worried that a focus on COVID might capture some of the attention and resources of traditional funders, and that the cost of stimulus during the pandemic will lead to future reductions in overall government spending flowing through to neglected disease R&D,” he said. 

Funding for top three infectious diseases declines 

The top three infectious diseases – HIV/AIDS, tuberculosis, and malaria – received the largest shares of funding, as they have every year, accounting for more than two-thirds of reported global investment. 

However, funding for all three of these diseases fell in 2020, taking their share of global funding to 68% to the usual annual average of 75%. 

In the case of HIV/AIDS, the vast majority of the decline was attributed to decreased investment from the US National Institutes of Health (NIH), the Gates Foundation, and industry. 

Tuberculosis also experienced a decrease in funding from the NIH, but recond-high funding from the European Commission, a result of new funding for the European Regimen Accelerator for Tuberculosis, an initiative dedicated to new treatments for TB. 

Disruptions in clinical trials due to pandemic 

While investments in neglected disease R&D stayed near their historic highs, despite the turbulent first year of the COVID-19 pandemic, the pandemic hindered product developers’ ability to conduct clinical trials in 2020. 

Barnsley anticipates these disruptions to have continued into 2021. 

In line with this trend, multinational pharmaceutical companies’ (MNC) investments in clinical development decreased for the second consecutive year in 2020. 

The previous G-FINDER report attributed this to normal fluctuations and the conclusion of late-stage trials in treatments. However, the report does warn that “another year of decreases in MNC funding could signal a trend.”

“Although the 2020 decline is most likely due to pandemic-disrupted trials, it could indicate that half a decade of soaring MNC funding is coming to an end.”  

Philanthropic funding increases

funding
Philanthropies such as Wellcome Trust and Open Philanthropy have increased their infectious disease R&D

Contributions from public and private sectors both dropped slightly in 2020 but funding from philanthropies saw record high levels of funding, an increase of US $28 million over the previous year.

Both established and new philanthropies such as Wellcome Trust and Open Philanthropy, were the primary reason for this new increase, with Open Philanthropy nearly tripling its funding for neglected disease R&D between 2017 and 2020. 

Increased investment in platform technologies 

Funding for platform technologies continues to increase

A key reason that overall funding to infectious diseases remained relatively stable, despite cuts to clinical development, was the US $33 million increase in total funding in platform technologies.

The Bill and Melinda Gates Foundation was the largest funder of platform technologies, providing 40% of investment, followed by US government agencies, the US NIH and the US Department of defense. 

Though the increase predates the pandemic, a number of grants for platform technologies in fact cite COVID-19 as the reason for accelerated interest. 

“In light of that, we predict that the already hastened pace of investment in platform technologies we saw in 2019 and 2020 will continue in the neglected disease R&D space, at least in the immediate years to come,” said Chapman. 

Funding cannot rely on ‘coattails of the pandemic’ 

Though the response to COVID-19 has demonstrated the potential for new funding mechanisms, strategies, and technologies, the report does note that this is a “stark reminder that neglected diseases persist because of insufficient funding and momentum”. 

“The next challenge for global health stakeholders will be to ensure that neglected diseases benefit from opportunities and innovations that have emerged from the pandemic.” 

Barnsley pointed out how it “may be tempting to ride on the coattails of the pandemic” in order to increase investment, and instead addressed the need to craft a message of genuine self-interest in eliminating neglected diseases. 

“We need to be able to defend neglected disease funding during periods of austerity.”

Image Credits: Policy Cures Research, Policy Cures Research.

Zsuzsanna Jakab

Only 14 countries are on track to achieve the Sustainable Development Goals to reduce premature mortality from non-communicable diseases (NCDs) by one third by 2030, the World Health Organization (WHO) revealed at its executive board meeting on Wednesday.

After listening for over three hours to countries’ views on the WHO roadmap 2023–2030 to prevent and control NCDs, WHO Deputy Director-General Dr Zsuzsanna Jakab, warned that countries had less than 10 years to meet targets.

The agenda item on NCDs was especially onerous as member countries had to consider a political declaration, that included the roadmap, plus 11 annexures – including one on curbing alcohol consumption.

Alcohol lobby exerted undue influence on WHO draft global action plan – critics charge

Last week, the Foundation for Alcohol and Research Education (Fare) accused the WHO of watering down proposals to contain alcohol consumption despite two years of negotiations.

The WHO’s draft Action Plan to Reduce the Harmful Use of Alcohol (2022-2030) has been revised in response to lobbying by alcohol companies to water down key provisions, according to the Fare analysis.

The analysis compared the first WHO working document with the final draft of the global action plan being presented to the EB this week.

Critical changes introduced include reduced emphasis on policies that target the pricing, availability and promotion of alcohol products to moderate consumption – all reflecting the fingerprints of alcohol industry influence, Fare charged.

Last week, another Fare-commissioned report prepared by the Centre for Alcohol Policy Research at La Trobe University, Australia, described how alcohol companies had worked to undermine the draft action plan, in the two year period since the WHO’s Executive Board first recommended accelerated action” against alcohol harm.   

Unhealthy environments

Aside from the focus on alcohol, a number of member states and NGOs made calls for countries to step up action on “unhealthy environments” that are the norm in many polluted, traffic clogged cities, as well as “commercial” risk factors, like the proliferation of junk food and tobacco promotion, which together contribute to unhealthy lifestyles and the development of NCDs. 

Such risks are highlighted in a draft WHO Road Map (2023-2030) for implementing a Global Action Plan for Prevention and Control of Noncommunicable diseases, under consideration by the EB. 

A new WHO “implementation framework” for improving the health and well-being of 1 billion people by 2030 also targets a wide range of risks and prevention opportunities – from promoting clean and active transport to healthier and more sustainable food systems – which in turn can blunt rising antimicrobial resistance (AMR) as well as food safety risks associated with the emergence of new pathogens and pandemics. 

Slovenia’s Kerstin Petrič

Slovenia’s Kerstin Petrič lamented the lack of member state investment in primary NCD prevention, addressing key risk factors. 

“More cost-effective measures such as rising taxes, bans on advertising and limiting access to for example tobacco, alcohol, transfats and sugar are difficult to adopt due to aggressive lobbying of industry and despite the bulk of evidence that these measures work, particularly in the most vulnerable population,” Petrič noted.

“This is the case in my country, and I believe in many other countries. Many lives could be saved if there would not be constant wavering in our member states between business opportunities and health,” she added, appealing to the WHO to “provide appropriate recommendations, including economic calculations, to generate support for public measures in political discussions”. 

Latin American countries, many of which have made substantial progress in addressing junk food consumption that is fueling NCDs including diabetes and cardiovascular disease.

Argentina told board members about its “healthy environments programme” that included  establishing smoke-free workplaces, and raising awareness of the dangers of alcohol, safe water and the importance of healthy eating and physical activity. 

Argentina has implemented front-of-package labelling on ultra-processed food that contain excessive sugars and saturated fats. 

Conflict-of-interest guidelines

Colombia also stressed health promotion strategies, including collaboration with civil society and academics, as “a vital aspect of prevention of NCDs”,  which should also include addressing  unhealthy environments that in turn create obstacles to healthy lifestyles. 

Meanwhile, Uruguay welcomed the proposed specific targets to respond to diabetes in the prevention and treatment of obesity. 

“We would once again ask the secretariat to give member state clear guidelines on the prevention of conflict of interest in the development of public policies and carry out all necessary efforts to support countries, particularly low and middle-income countries to get the necessary resources for NCD control and monitoring systems,” said Uruguay.

Meanwhile, the US appealed for stronger clauses to address air pollution.

“We would like to see the roadmap provide a more robust response related to air pollution,” said US delegate Loyce Pace. She added that mental health should also receive greater focus: 

“As other delegates have said, the COVID-19 pandemic continues to have a profound effect on availability of mental health services, including for pregnant women, children and adolescents. Greater focus is needed in expanding coverage of mental health and substance use disorders, services delivered via telehealth and similar mechanisms to help mitigate the impacts of COVID-19.” said Pace.

The Executive Board will continue to discuss NCDs on Thursday, as it struggles to catch up with its backlogged agenda.

EB chairperson Dr Patrick Amoth

While three independent review panels concur that the response of the World Health Organization (WHO) to COVID-19 was inadequate, member states made slow progress in charting better alternatives at the executive board meeting on Wednesday.

WHO members are considering three main proposals to improve the global body’s future pandemic preparedness: 

Amid the repetitive hot air that characterised much of Wednesday’s pandemic discussion, US representative Loyce Pace’s clarity and brevity made a welcome change.

“All of the review panels recognise the slow response globally in the early days of this pandemic, and establishing a standing committee is in our view, a commonsense way for the executive board to be more prepared for both current and future health emergencies,” said Pace.

She identified four priorities to prepare the WHO for future pandemics: first, targeted IHR amendments; second, a review of recommendations made by the Working Group on Pandemic Response (WGPR); third, setting up the intergovernmental negotiating body to develop an instrument on pandemic preparedness and finally improving WHO governance “starting with an informal group and then establishing a task team of Member States to work with the Secretariat”. 

“We call upon all member states to dedicate time, resources and efforts to improve WHO governance issues,” she added.

Standing Committee is Stalled

Australia’s Travis Power

The proposed standing committee, reporting to the board, would kick in automatically as soon as the Director-General declared a health emergency, and it could facilitate the immediate transfer of information between the Secretariat and member states, said Austria’s Dr Clemens Martin Auer.

Australia stressed that the standing committee “should focus on governance for the health emergencies programme, allowing for in-depth discussion and reporting to the EB” and it “should not encroach on the technical advisory and leadership roles of the Director-General and the IHR Emergency Committee”.

In response, Director-General Dr Tedros Adhanom Ghebreyesus said that such a committee would be helpful, particularly as the board only meets twice a year. However, a handful of countries indicated that they weren’t yet ready to support the resolution so it was stalled.

Agreement to amend International Health Regulations

The Working Ground on Pandemic Response (WGPR), chaired by the US and Indonesia, has been charged with overseeing the process of discussing targeted amendments to the IHR. IHR amendments are expected to address equity, technology governance other gaps.

“The US led an exclude inclusive and transparent process to develop this decision as we are mindful that updating and modernising the IHR is critical to ensuring the world is better prepared for and can respond to the next pandemic,” said Pace.

“The United States formally transmitted its proposals for targeted amendments to the IHS last updated in 2005 to the Director General consistent with IHR article 55 for circulation to states parties at least four months in advance of the World Health Assembly.”

While supporting IHR amendments, Russia’s delegate, Mikhail Murashko, said that these “should not undermine the sovereignty of countries or regions in ensuring health and or biological security”. 

“We reject any proposals which could be used as grounds for interfering in the international affairs of nations, including the holding of international investigations on the basis of rumours and information unconfirmed by states,” said Russia, a reiteration of China’s concerns.

Russia wants IHR amendments to address “improving the priority infrastructure, developing regional and global networks, increasing cooperation between countries on implementing the rules and ensuring free movement of medical staff and technology to fight infections”.

Russia also called for member states to “work harder to fight the distribution of false and unreliable information because this prevents effective scientifically based measures being taken to fight epidemic outbreaks and it undermines international cooperation.” Ironically, Russia has been identified as a key source of COVID-19 misinformation aimed at undermining “Western” vaccines.

Reality check from civil society

KEI’s Thiru Balasubramaniam

The key discussions on an effective pandemic instrument will take place in the intergovernmental negotiating body, which is in the process of being set up. The EU announced that a Dutch official would lead its region, while South Africa indicated it had been nominated for this task by the Africa region.

A wide range of civil society groups breathed some reality into Wednesday’s discussions, reminding delegates that the world was still in the grips of a pandemic and that citizens of the world had been failed by inadequate sharing of rights and know-how on government-funded technologies; bottlenecks in vaccine delivery; and more broadly by health services that have been unable to deliver sexual and reproductive health services and ongoing treatment for people with non-communicable diseases.

“The WHO negotiations on a pandemic treaty are not a quick fix to the current pandemic, but they offer a much more comprehensive and potentially useful response going forward, including for the next pandemics,” said Knowledge Ecology International’s Thiru Balasubramaniam.

He called for delegates to “address policy failures that have accompanied the current pandemic response, and create a better global framework for cooperation”, including “sharing of rights and know-how from government-funded technologies, mandatory intellectual property exceptions, global norms for financing R&D in both the preparatory and crisis stages, and concrete obligations for transparency”.

KEI also called for reforms to the funding and management of clinical trials “so that the public has transparent and unbiased information on the relative effectiveness and safety of countermeasures”.

Pharma leaders, from their side, acknowledged: “society needs to do more and go further, urgently addressing the bottlenecks in vaccine administration while, reflecting on how to achieve ore equitable allocation faster in the future. Manufacturers, governments, academia, NGOs and other global health institutions have a collective responsibility to ensure that no one is left behind in this pandemic and the next outbreak.”

But the statement by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) stressed that private sector collaborations had been critical to the rapid development of new vaccines and treatments, adding that the world should “enhance not hinder the thriving innovation eco-system while building a resilient, sufficiently-resourced, health infrastructure.”