A month after a fourth dose of the Pfizer or Moderna vaccines was administered to hundreds of people in an Israeli clinical trial, authors of the new study on the extra booster say it provides “little protection, if any, from infection by COVID-19 among vaccinated young and healthy individuals in comparison to those vaccinated with only a third dose.”

Result of the open-label study, conducted at Israel’s Sheba Medical Center, were published Wednesday evening in the New England Journal of Medicine as a correspondence.

The findings contradict statements made by Pfizer CEO Albert Bourla over the weekend that a fourth booster dose could necessary for most people, due to waning immunity. Bourla made the statement as Pfizer seeks quick US Food and Drug Administration approval of a fourth dose, effectively a second booster, for people 65 and older.

The new Sheba study included approximately 600 volunteers, among them 270 who received a fourth shot of either the Moderna or Pfizer vaccine. All of the volunteers had received three shots of the Pfizer vaccine prior to the trial.

Sheba’s Professor Gili Regev-Yochay, lead author of the study, said in a statement that COVID infection rates among four-time vaccinated individuals were only slightly lower than those in the control group. However, she added that the fourth jab did provide moderate protection against symptomatic infection among young and healthy individuals, in comparison to those who had only received three jabs.

“We found no differences, both in terms of IgG antibody levels and in terms of neutralizing antibody levels,” added Regev-Yochay, referring to the impact of the fourth jab on the study group in comparison to the control.

“It should be emphasized that the third dose is extremely important for anyone who has not yet contracted COVID-19,” Regev-Yochay stressed, “and the fourth dose is most likely important for populations with risk factors, for which a fourth vaccine would protect from serious illness.”

The NEJM correspondence, however, said that the fourth dose was “immunogenic, safe and somewhat efficacious”, adding that “our results suggest that maximal immunogenicity of mRNA vaccines is achieved after three doses and that antibody levels can be restored by a fourth dose.”  The researchers added that they observed “low vaccine efficacy against infections in health care workers, as well as relatively high viral loads suggesting that those who were infected were infectious.”

Bourla: Fourth shot ‘necessary’

The release of the data comes at an awkward time for Pfizer, after a weekend when Bourla said in an interview with CBS’s Face the Nation that a fourth COVID-19 shot would be “necessary” for most people to prevent future infection.

Pfizer CEO Albert Bourla in a CBS interview on March 13, 2022.
Pfizer CEO Albert Bourla in a CBS interview on March 13, 2022.

“Right now, the way that we have seen, it is necessary, a fourth booster right now,” Bourla said in the interview. “The protection that you are getting from the third, it is good enough, actually quite good for hospitalizations and deaths. It’s not that good against infections, but doesn’t last very long.”

While Bourla said Pfizer had submitted data on the efficacy of the fourth shot to the US FDA, the data has not yet been publicly released.

The US Centers for Disease Control and Prevention currently recommends three jabs for everyone age 12 years and up, and two shots for children between the ages of five and 11. Individuals who are immunocompromised are encouraged to get an extra dose.

Fourth dose still protects against severe infection, separate study found

A separate Israeli study published, on February 1 by the Israeli Health Ministry, offered somewhat contradictory results to the Sheba findings – although the Ministry of Health study focused only on older people.  That study, released on the pre-print biomedical website MedRXiv, found that rates of confirmed COVID-19 infection, as well as severe illness, were lower following a fourth dose, when compared to only three doses.

Specifically, the team looked at data from 1,138,681 persons aged over 60 years and eligible for the fourth dose between January 15 and 27, 2022 – the height of the Omicron wave in Israel. They compared the rate of confirmed COVID infections and severe COVID illness between those who took a fourth jab at least 12 days earlier and those who only had three doses, or alternatively those who became ill less than a week after receiving the fourth dose.

“The rate of confirmed infection was lower in people 12 or more days after their fourth dose than among those who received only three doses and those 3 to 7 days after vaccination by factors of 2.0 and 1.9, respectively. The rate of severe illness was lower by factors of 4.3 and 4.0,” the authors wrote.

‘Vaccines don’t prevent infection’

Professor Cyrille Cohen, head of the immunology lab at Bar-Ilan University, said that the findings from the Sheba study are not surprising; “the vaccines are not good enough to prevent infection, and even more so with the Omicron variant,” he said.

However, like Regev-Yochay, Cohen stressed that there is a growing body of data that shows there remains a substantial difference in the levels of protection acquired by people who are vaccinated with two doses and those who get three doses, when it comes to developing severe disease.

“Look at the ratio between people age 60 who got three doses and people that were not vaccinated and got two doses. Even with Omicron, the third dose can reduce the chance of developing severe disease by a factor of four or five and for people above 60 that number becomes 10 to 20,” Cohen said.

He also noted that a fourth dose also may help the most vulnerable, noting that today, the serious cases in Israel still tend to be older people with comorbidities or unvaccinated people.

“Based on that, a fourth dose for selected populations might demonstrate a benefit,” he said.

When asked about Bourla’s statement, Cohen said “it was not clear” and that perhaps the Pfizer CEO was referring to people receiving a shot of the Omicron-adapted vaccine, for which data has not yet been released. A multi-country clinical trial of that vaccine is now underway, including a trial arm in Israel.

“I am personally extremely curious to see those results,” Cohen said.

Image Credits: Screenshot.

Attacks on health facilities appear to be part of a deliberate war strategy in Ukraine and other recent conflicts, according to the head of the World Health Organization (WHO) health emergencies programme.

The WHO has verified 43 attacks on Ukrainian health facilities since Russia’s invasion on 24 February – and it expects further attacks as over 300 health facilities in conflict areas or under Russian control and a further 600 facilities within 10 kilometres of conflict.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday that there had also been 46 attacks on health facilities worldwide since the start of 2022, and people caught in conflicts in Tigray, Yemen and Syria were in extreme need of humanitarian assistance. 

Dr Mike Ryan, WHO Executive Director of Health Emergencies Programme, said that in these conflict zones, attacks on health facilities appeared to be deliberate – in complete violation of international law.

“We have never seen this rate of attacks on health care, and health care becoming a target in these situations. It’s becoming part of the strategy and tactics of war and it is entirely unacceptable,” said Ryan.

“Under international humanitarian law. conflicting parties are actually instructed to specifically take measures to avoid attacking or inadvertently destroying or hurting health workers or health facilities. They don’t bear responsibility not just to not attack. They actually bear responsibility to ensure that they don’t attack to identify those facilities, to deconflict those facilities and to ensure that they do not, as part of their prosecution of war, attack those facilities,”  he added.

Dr Mike Ryan, WHO Executive Director of Health Emergencies Programme.

Multiple conflicts out of the global eye

“Although Ukraine is the focus of the world’s attention, it’s far from the only crisis to which WHO is responding,” said Tedros.

“In Yemen, roughly two-thirds of the population – more than 20 million people – are estimated to be in need of health assistance. In Afghanistan, more than half the population is in need, with widespread malnutrition and a surge in measles among many other challenges. 

“And in Ethiopia, six million people in Tigray have been under blockade by Ethiopian and Eritrean forces for almost 500 days, sealed off from the outside world. There is almost no fuel, no cash and no communications. No food aid has been delivered since the middle of December and 83% of the population is food insecure,” said Tedros, who is from Tigray and added his family and friends were affected by the blockade.

Aid to Ukraine – but little for Tigray

WHO Director-General Dr Tedros Adhanom Ghebreyesus.

The WHO has been able to deliver about 100 metric tonnes of supplies to Ukraine, including oxygen, insulin, surgical supplies, anaesthetics and blood transfusion kits; oxygen generators, electrical generators and defibrillators.

However, it had only received $8million of the $57.5 million it needed to support Ukraine.

In contrast, however, it had only been able to airlift 33 metric tonnes of medicines and other supplies to Tigray in December – enough for 300,000 people – after being denied access to the territory since last July.

“We estimate that 2,200 metric tonnes of emergency health supplies are needed to respond to urgent health needs in Tigray,” said Tedros.

Treatment for 46,000 Tigrayan people living with HIV has been abandoned, as has treatment for people with cancer, diabetes, hypertension and tuberculosis.

“The situation in Tigray is catastrophic. The blockade on communications, including on journalists being able to report from Tigray, means it remains a forgotten crisis. Out of sight and out of mind,” added Tedros.

“Just as we continue to call on Russia to make peace in Ukraine, so we continue to call on Ethiopia and Eritrea to end the blockade, the siege, and allow safe access for humanitarian supplies and workers to save lives,” said Tedros.

Global COVID-19 cases rise again

Meanwhile, after weeks of global decline COVID-19 cases are on the rise again, especially in parts of Asia. 

“In the last week, we saw an 8% increase in cases detected with more than 11 million cases reported to WHO despite a significant reduction in testing that’s occurring worldwide,” said WHO COVID-19 lead Dr Maria van Kerkhove.

She ascribed the increase to the spread of the Omicron variant – particularly the BA.2 lineage which is “the most transmissible variant we have seen of the SARS Co-V2 virus to date” – in a context where restrictions were being lifted globally.

Ryan added that the virus would move from one “pocket of susceptibility” where immunity was waning to another.

“The likelihood is that this virus will echo around the world,” said Ryan. “It will pick up pockets of susceptibility and will survive in those pockets for months and months until another pocket of susceptibility opens up,” said Ryan. 

“This is how viruses work. They establish themselves within a community and they will move quickly to the next community that’s unprotected. If communities around the virus are well protected, the virus can sustain itself, even in small communities. It can stay there, it can rest there, and then wait until susceptibility grows.”

Image Credits: Markus Spiske/ Unsplash.

WTO members last week in session at the TRIPS Council, which has been debating a controversial proposal for an IP waiver on COVID products for over a year.

The World Trade Organization’s (WTO) Director-Genera, Dr Ngozi Okonjo-Iweala has “warmly welcomed” the breakthrough reached this week over a waiver on intellectual property for the production of COVID-19 vaccines.

“This is a major step forward and this compromise is the result of many long and difficult hours of negotiations. But we are not there yet. We have more work to do to ensure that we have the support of the entire WTO Membership,” said Okonjo-Iweala, in a statement on Wednesday.

The agreement reached between the European Union, India, South Africa and the United States – referred to in some quarters as “the Quad” – still needs to be put to all 164 WTO members, which typically decides by consensus.

However, the compromise now has good chances of being approved since EU countries had been the major opponents to the proposal by South Africa and India, submitted in October 2020, to waive IP on COVID-19 vaccines and other pandemic-related health products for the duration of the pandemic. 

Major concessions

South Africa and India had to make major conceessions  – both narrowing the waiver to only vaccines, as well as narrowing the list of countries that would be eligible to take advantage of the waiver on patents and other IP.     

“My team and I have been working hard for the past three months and we are ready to roll up our sleeves again to work together with the TRIPS Council Chair Ambassador Lansana Gberie (Sierra Leone) to bring about a full agreement as quickly as possible. We are grateful to the four Members for the difficult work they have undertaken so far,” said Okonjo-Iweala.

The WTO’s Ministerial Council (MC12), postponed from late November to the week of June 13, could potentially approve the waiver move – although the date of that meeting has also been cast into doubt due to the recent outbreak of war in the Ukraine. 

However, the draft text of the proposed compromise, published by STAT News Tuesday evening, has elicited dismay from both health activists and the pharmaceutical industry – for not going far enough, or for going too far.

Restricted to vaccines and certain developing countries

In essence, the compromise does three things:

  • Most critically, the new waiver would allow developing countries to not only manufacture, but also to export, generic versions of COVID vaccines that are still under patent protection. Currently, Article 31.f of the WTO Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement restricts such generic manufacture to health products that are “predominantly for the supply of the domestic market” – leaving low-income countries with no manufacturing base unable to import cheaper generic versions of products from abroad. 
  • However, the waiver would be limited to countries that exported less than 10% of the world’s vaccines in 2021. That effectively excludes well-established manufacturers in China, but not India, from waiver eligibility. 
  • In contrast to the original Indian-South African proposal, the new IP flexibilities are restricted to COVID vaccines, thus excluding COVID treatments such as new antivirals that are particularly important for countries with low vaccination rates, as well as tests, personal protective equipment (PPE) and other pandemic-related goods.

Adam Hodge, spokesperson for US Trade Representative Ambassador Katherine Tai, said late Tuesday that the “compromise outcome that offers the most promising path toward achieving a concrete and meaningful outcome” after a “difficult and protracted process”.

He and others cautioned that details of a final text were yet to be concluded. 

“While no agreement on text has been reached and we are in the process of consulting on the outcome, the US will continue to engage with WTO Members as part of our comprehensive effort to get as many safe and effective vaccines to as many people as fast as possible,” added Hodge.

The informal discussions, led by the WTO Secretariat, have been trying to break the deadlock between the India-South Africa waiver proposal (supported by the Africa and Least Developed Nations groups and others) and the EU’s counter-proposal.  

India-South Africa proposal had sought a broad waiver on all vaccines, tests and treatments, while the EU had pushed for technical modifications in the existing TRIPS rules. 

Medicines access activists and pharma leaders both express dismay 

Both activists and industry reacted with dismay to news of the proposed agreement. For example, the US-based consumer advocacy group, Public Citizen, called on WTO member states to reject the proposal.

“Among its key limitations: the proposal appears to cover only vaccines (not tests and treatments), cover only patents (not other important intellectual property barriers), be limited geographically, and further undermine current WTO flexibilities for compulsory licenses,” according to Melinda St Louis, director of Public Citizen’s Global Trade Watch division.

“It would be a mistake for WTO members to prematurely agree to a weakened waiver that provides political cover to the US and EU while not making any meaningful difference in increasing access to vaccines, tests and treatments. No waiver is better than a weak waiver designed solely to save face,” added St Louis.

Knowledge Ecology International also expressed disquiet, saying that the waiver may even restrict certain flexibilities that are already allowed by Article 31 of the WTO Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), regarding a country’s rights to manufacture and export generic versions of drugs or vaccines during a health emergency. 

“Countries are required to follow Article 31 of the TRIPS [agreement], which of course, is an existing and not a new flexibility, but with ‘clarifications’,” noted KEI’s Director, James Love.

However, those “clarifications”, also come with new obligations that could make Article 31 “more restrictive and burdensome”, such as a new obligation for a country to identify all of the patents to which it is applying an IP waiver, and to notify the WTO of its use of the waiver –  something not required for the issuance of compulsory licenses in general.  

On the other hand, the draft agreement makes a first-ever reference to a 2005 WHO/UNDP guidance on payments by developing countries to the original patent-holder, which embraces the concept of “tiered royalties”, based on a country’s ability to pay, and authored by Love himself.

Pharma says agreement sends ‘wrong signal’

Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that “weakening patents now when it is widely acknowledged that there are no longer supply constraints of COVID-19 vaccines, sends the wrong signal”. 

“​​When the IP TRIPS Waiver was first proposed in 2020, it was to the wrong solution to the problem of scaling up manufacturing of potential COVID-19 vaccines which at the time had not yet even been authorized,” said the IFPMA.

“Now the problem of supply has been addressed thanks to unprecedented collaboration involving companies from industrialized and developing countries, the TRIPS Waiver is not only the wrong solution, it is also an outdated proposal, that has been overtaken by events.”

It added that the TRIPS waiver proposal is “political posturing that are at best a distraction, at worse creating uncertainty that can undermine innovation’s ability to respond to the current and future response to pandemics”. 

“The current proposals should be shelved; and the focus should be directed, to admittedly more difficult actions that will change lives for the better: supporting country readiness, contributing to equitable distribution, and driving innovation,” the IFPMA concluded.

The final text of any agreement would first need to be approved by the WTO TRIPS Council, and then go before the MC12 for final approval. 

The TRIPS Council last met on 9-10 March, but at the time failed to reach a compromise – although some sources noted that the were close to agreement as the “Quad” of India, South Africa, the United States and the EU scrambled to reach a deal.

According to a WTO statement on 10 March, the TRIPS Council had agreed to keep the agenda item on the IP waiver open – so as to enable the council to be “reconvened at short notice if substantial progress is made in the high-level talks”.  TRIPS Council approval would pave the way for a consensus agreement at the WTO’s Ministerial meeting, MC12. 

Mariupol Regional Hospital before it was bombed

Health workers, patients and civilians have been held hostage at the Mariupol regional intensive care hospital in Ukraine by Russian troops since Monday morning, according to the Media Initiative for Human Rights (MIHR).

Russian soldiers are using the hospital as a base to attack Ukrainian forces, and using the hostages as “human shields” according to MIHR, a respected human rights monitoring group in Ukraine.

“We received information from a doctor from the hospital. We can’t name him because of the threat to him. More information will be available after the person is safe,” the MIHR reported on its Facebook page.

Pavlo Kyrylenko, head of the Donetsk regional administration, also reported the hostage situation on his Telegram account.

Kyrylenko reported that a hostage had told him: “It is impossible to leave the hospital. There is heavy shelling. We sit in the basement. Cars have not been able to drive into the hospital for two days. High-rise buildings are burning around… Russians rushed 400 people from neighbouring houses to our hospital. We can’t leave. “

While the 550-bed tertiary hospital, the biggest in the Donetsk region, has suffered extensive damage, health workers have continued to attend to patients from the basement.

“I appeal to international human rights organizations to respond to these vicious violations of the norms and customs of war, to these egregious crimes against humanity,” said Kyrylenko.

Humanitarian groups have been appealing for days for a safe passage corridor to and from Mariupol. Some private cars were finally able to leave the city on Monday and Tuesday, the first time in 10 days. But Russian troops that have beseiged the city on all sides have not allowed relief workers to bring in desperately needed medical supplies, food or water.

Last week, Russian troops bombed the Mariupol maternity hospital, reportedly killing at least three people. A pregnant woman evacuated from the hospital and her baby later died from their injuries.

Mariupol’s deputy mayor, Sergey Orlov, told France24 on Tuesday that at least 2,358 people had been killed during the 11-day siege of the south-eastern city, and he had been fielding desperate calls from people trapped in basements without food or water.

‘Act of unconscionable cruelty’

The World Health Organization (WHO) has verified 31 attacks on health facilities between the start of the Russian invasion on 24 February and 11 March, resulting in 12 deaths and 34 injuries, of which 8 of the injured and 2 of those killed were health workers. 

“We call for an immediate cessation of all attacks on health care in Ukraine. These horrific attacks are killing and causing serious injuries to patients and health workers, destroying vital health infrastructure and forcing thousands to forgo accessing health services despite catastrophic needs,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus,  UNICEF Executive Director Catherine Russell and UNFPA Executive Director Dr Natalia Kanem, in a joint statement on Sunday.

“To attack the most vulnerable – babies, children, pregnant women, and those already suffering from illness and disease, and health workers risking their own lives to save lives – is an act of unconscionable cruelty,” they added.

“We must be able to safely deliver emergency medical supplies – including those required for obstetric and neonatal care – to health centers, temporary facilities and underground shelters.”

Intentionally attacking health facilities is prohibited under international humanitarian law. 

Unusual position of surrogates

Since the start of the war, more than 4,300 Ukrainian women have given birth, and  80,000 others are expected to give birth in the next three months. 

“Oxygen and medical supplies, including for the management of pregnancy complications, are running dangerously low,” according to the three leaders.

“Many pregnant women may need health care, medication and assistance on a daily basis or when complications with pregnancy occur. When medical facilities are not accessible, are destroyed, or health care personnel and medical product are scarce or unavailable, maternal health can be endangered,” according to Eszther Kisomodi and Emma Pitchford, the chief executive and executive editor respectively of the journal, Sexual and Reproductive Health Matters.

They also warned that many pregnant women might be in “particular and unusual situations” as Ukraine “is an international surrogacy hub, one of only a handful of countries in the world that legally allows foreigners to enter into surrogacy arrangements”.

https://twitter.com/thedalstonyears/status/1501861609446289410

“Being a surrogate is a job in Ukraine for many women, but not one that they can quit, or even put on hold. Very serious questions occur for all parties in this arrangement – for the pregnant women, the newborn child and the intended parents.”

The authors also highlight the precarious position of people with disabilities who cannot move easily, LBGTQ people in the face of hostile Russian forces, and people living with HIV in Ukraine, which has the second-highest infection rate in Europe.

Unconscious and intubated Covid-19 patients are treated in Vila Penteado Hospital’s ICU, in Sao Paulo, Brazil.

The first session of the newly constituted Intergovernmental Negotiating Body (INB) to draft a “pandemic preparedness instrument” for the World Health Organization (WHO) began on Monday.

The six-member body, representing all WHO regions, is made up of Precious Matsoso (South Africa), Roland Driece (the Netherlands), Ambassador Tovar da Silva Nunes (Brazil), Ahmed Salama Soliman (Egypt), Kazuho Taguchi (Japan) and Viroj Tangcharoensathien (Thailand).

The two-day session will elect two co-chairs, as well as agree on the working methods and timelines of body “based on the principles of inclusiveness, transparency, efficiency, Member State leadership and consensus”, according to the agenda.

Meanwhile, almost 200 civil society leaders have asked the six negotiators to protect the process from any “undue influence of the private sector and its powerful lobbyists”.

In an open letter addressed the six negotiators, the leaders have asked the INB to pay attention to a number of issues including:

  • The multiple determinants of potential future pandemics, including the inherent injustice and structural inequities exacerbated by such crises
  • The interconnected dynamics of issues, including the unsustainable food production and livestock breeding, wildlife trading, resource-intensive lifestyles and consumption, destruction of ecosystems, antimicrobial resistance and soaring figures of cancer
  • The state of universal public health systems and their workforce 
  • Incoherent policymaking by Member States and the lack of international cooperation
  • Ensuring more inclusive engagement in the treaty-making process that balance the Member State-driven delicate diplomatic process and protect it from the undue influence of the private sector and its powerful lobbyists.

The letter has been facilitated by the Geneva Global Health Hub (G2H2), as a service to its members involved in this process.

Image Credits: Adnan Abidi/Flickr, Ninian Reid/Flickr.

2nd Anniversary of COVID-19

Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. 

Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. 

While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever.

And at the same time, as global health leaders point out, the pandemic is not over…. yet. 

Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. 

And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned.

“This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing.

Ukraine conflict ‘perfect storm’ for COVID surge 

The conflict in Ukraine is likely to lead to a surge in COVID cases.

The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn.  

The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. 

“It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.”

A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems.  Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease.  

Low testing rates also create opportunities for new variants to spread 

WHO Director General Dr Tedros Adhanom Ghebreyesus

Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve.

Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.”

He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services.

“This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros.

Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants.  

In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. 

However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. 

Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address.

Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems.   

That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.”  (see related Health Policy Watch story).

Attempts to return to normalcy amidst rising cases in some regions

Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . 

Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions.

“From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads.

Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. 

“It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated.  

This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago.

“Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing.

The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again.

Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. 

However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10.

“I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.”

South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day.

Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. 

Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March.

Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline.

One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years.  Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure.

.COVID-19 Delta-Omicron ‘recombinant’ in Europe

Dr Maria van Kerkhove

Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark.

“The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove.

“There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants.

“We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway.

The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. 

Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.”

Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin.

lviv
A volunteer helping a woman at the train station in Lviv.

(LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states.

The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. 

There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data.

Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. 

Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed.   

The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. 

Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. 

In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. 

He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly.  

He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.”

The volunteer response 

On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. 

There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country.

So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. 

It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. 

This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. 

“This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people.

Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy.

Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. 

The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war.

This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to.

The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate.

Need for a professional response

While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine.

Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian.

HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. 

While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response.

“Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added.

For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. 

“We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added.

An uncertain future

While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. 

Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. 

People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine.

For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. 

Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” 

There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland.

Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. 

“I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said.  

Edited by Eric Reidy.

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This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe

Image Credits: Sam Mednick/TNH.

pandemic
Personal protective equipment was essential to protect healthcare workers during the pandemic

The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses.  Two years into the COVID-19 pandemic, governments need to offer better solutions.

On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath.

As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. 

But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it.

Pandemic happened during pre-existing health workforce crisis 

A nurse in full PPE completes patient forms at the Tehran Heart Centre

Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. 

The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone.

The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies.

Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years.

Before the storm – shortage of six million nurses 

By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. 

A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one.

Findings included a  global shortage of almost six million nurses, mainly in poorer countries.

Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas.  Nine out of ten were women. 

The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. 

Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions.

Inequalities income-driven

“Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads.

This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. 

The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs).

The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth.

When the storm hit

But when the pandemic hit, those longer-term strategies and plans were once again put aside.  

Issues that had to be faced were much more immediate. 

Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water.

While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. 

Dreadful toll 

Nurses working at the isolation ward in Daegu, South Korea

Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. 

ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. 

It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. 

There are also more nurses who intend to, or are considering leaving the profession altogether. 

Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses.

ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years.

In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone.

On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. 

Brighter side of the crisis 

Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients.

But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before.  

In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic.

So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and  support for nurses’ wellbeing and mental health needs.

As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’

But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams.

Preparing for the next pandemic – workforce investments

The training of nurse anesthetists in Kenya will help to increase access to surgery.

Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. 

The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. 

As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. 

The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. 

This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. 

ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary.

Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. 

But frankly, they were not enough and their goals were diverted by the immediate crisis. 

Nursing “offset credits” to countries that provide nurses 

The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus

Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. 

The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain..

For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland.  At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. 

Proportion of foreign-trained nurses – based on OECD data, as of January 2022.

We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. 

An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution.

Nurses at the policymaking table 

Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. 

Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found.

Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve.

But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now.

Health and peace are inseparable 

Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. 

Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve.

We should never forget that health, peace and prosperity are inseparable. 

And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. 

______________________________________________________

Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide.

 

Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022.

nutrition
Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020.

Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition.

Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. 

Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition.

Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021.

Two-thirds of these people lived in 10 countries, namely the Democratic Republic of  the Congo (21.8 million), Yemen  (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million)  and Haiti (4.1 million).

In his foreword for the report, António Guterres, Secretary-General of  the United Nations, decried the rising number of  people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. 

“Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. 

“Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade,  reduces access to vital resources like water and electricity,  and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.”  

The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable.

Addressing the issues

While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU.

The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa.

Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation.

At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. 

“It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit.

In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges.

Multipronged approaches

While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming.

The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. 

The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems.

“I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch.

But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.”

A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. 

“It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. 

Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas.

“There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added.

Interplay between the private sector and governments to promote good nutrition

The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. 

David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector.

“The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. 

“I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.”

Optimism despite uphill battles for nutrition

While African countries are responding to  multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. 

“I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch.

“We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added.

Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. 

Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy.

“We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. 

Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030.

“Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch.

Image Credits: Paul Adepoju.

30x30
Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue.

In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. 

Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target.

“We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. 

The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland.

HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. 

The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 

30×30 target is ‘necessary component’ to combat biodiversity and climate crisis 

In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”.

Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York.

Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. 

The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. 

Conservation efforts must protect Indigenous people

The Indigenous people of New Zealand – the Maori.

The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” 

“It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. 

Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” 

More must be done to build on progress as COP15 approaches 

Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. 

The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. 

But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. 

“Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ 

“Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. 

Other members of the GSC echoed these calls in separate statements.

“With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. 

“None of our futures are certain unless we are united in this effort.”

Image Credits: UNDP / Vlad Sokhin, einalem.