Over 1 Billion People Projected to Live with Obesity by 2030, Warns New World Obesity Atlas 04/03/2022 Raisa Santos Obesity is most common for both men and women in the WHO Americas region. By 2030, 20% of women and 14% of men, or over 1 billion people, will be living with obesity globally, according to the new World Obesity Atlas 2022 published Friday. The new Atlas, launched on World Obesity Day, predicts that by that time, the number of people with obesity globally will have doubled since 2010. The Atlas presents new projections on obesity and severe obesity among men and women as of 2030, as well as revisiting projections for children. Two years into the pandemic, obesity was also found to be closely correlated with COVID-19 associated mortality, with death rates ten times higher in countries where over 50% of the population are overweight. “This has shown clearly that an unhealthy population, without concerted action in anticipation of the next pandemic, will result in even more lives lost needlessly,” said World Obesity Federation President John Wilding and CEO Johanna Ralston, in the Atlas’s Foreword. Katie Dain of the NCD Alliance called obesity a “slow-burn pandemic, one that has the health of a billion people sitting on a precipice. 📢OUT NOW! @worldobesity atlas shares obesity-NCD preparedness ranking & country prevalence. “#Obesity is a slow burn pandemic, one that has the health of a billion people sitting on a precipice,” says CEO @katiedain1 ➡️https://t.co/OorTeAYk6y #ActOnNCDs #WorldObesityDay pic.twitter.com/dpvDf0IiL3 — NCD Alliance (@ncdalliance) March 4, 2022 Missing WHO global targets Given current trends, chances of meeting the WHO global targets to halt the rise in obesity by 2025 also have likely passed, the report acknowledges. The WHO targets called for no increase in the prevalence of adult obesity between 2010 and 2025. Authors of the Atlas – the World Obesity Federation – said that they are “hopeful”, nonetheless, in the fact that public and policymakers’ understanding about obesity has increased, and there has been more recent momentum to take action. “As we reflect on the COVID-19 pandemic, it is essential that lessons are learnt…and that governments take the difficult but necessary steps – with obesity treatment and obesity prevention – to reduce the prevalence of obesity in this and future generations,” said both Wilding and Ralston, in the Foreword. Obesity in Africa to triple by 2030 Mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but too much of it can lead to obesity and related diseases later in life. While the highest rates of obesity are still found in the WHO Americas region for both men and women, the numbers in Africa are expected to triple by 2030. Countries in the Americas are projected to see a 1.5- fold increase in obesity between 2010 and 2030, while Africa is predicted to experience a rise from 34 million obese people in 2010 to 101 million in 2030, 75% of which would be women. That, while the African continent continues to struggle with undernutrition, leading to the wasting and stunting of many children. Worldwide, obesity is higher among women than men and the gender gap will continue to rise in all regions by 2030. Across all regions, obesity is expected to impact women more than men. Trends are also very geographically defined. Currently, one-half of all women with obesity live in just 11 countries: United States, China, India, Brazil, Mexico, Russia, Egypt, Indonesia, Iran, Turkey and Pakistan. At the same time, one half of all men with obesity live in 9 countries: US, China, India, Brazil, Mexico, Russia, Egypt, Germany and Turkey. Especially concerning are the countries that feature in both the top 20 rankings for prevalence and number of people living with obesity projections; namely US, Egypt, Turkey and Saudi Arabia. High BMI causes loss of 160 million years of healthy life Years of life lost due to high BMI has huge financial implications. Over 160 million lost years of healthy life were due to high body-mass index (BMI) in 2019 globally, accounting for more than 20% of all lost years of healthy life caused by preventable chronic ill-health, the atlas also finds. The greatest proportion of years lost, or disability adjusted life years (DALYs) and deaths that result from high BMI can be found in the Eastern Mediterranean region and in higher income countries. The Atlas warns that the years of healthy life lost due to high BMI and increasing obesity will hold back economic development and will lead to high levels of stress on the health services of many countries. “A failure by governments to act to reduce the high prevalence of obesity in populations have high financial implications on health systems, as more people require support to manage and treat obesity and comorbidities,” authors say. They project that countries such as Mexico and the US will suffer a total economic impact of $160 billion by 2060. For India, that impact is $479 billion; for Brazil, $181 billion. Obesity-NCD Preparedness Ranking shows variability in preparedness across regions The report also introduces a new “Obesity-NCD Preparedness Ranking” which takes into account countries’ current health system responses to NCDs and wider commitment to the implementation of prevention policies, giving an indication for how well, or poorly, countries are prepared to address the rise in obesity. Western African countries rank among the least prepared. The 15 most well-prepared countries globally are in the WHO European region. The findings highlight that many countries ranked lowest in preparedness to prevent and treat obesity are low- and middle-income countries, especially in Western Africa, as well as in WHO’s Western Pacific and Eastern Mediterranean (Middle East) regions. In contrast, the WHO European Region appears best-equipped to prevent and respond to obesity trends, with a population-weighted average preparedness score of 37 out of 183 – with Switzerland, ranking as Number 1 – as the most prepared. But even within the European region there was some variability – in countries such as Kyrgyzstan, Azerbaijan, and Uzbekistan. “It is clear that the preparedness ranks are not distributed uniformly around the globe, but vary markedly across national income levels, and across geographical regions,” notes the Atlas. Overall, African region countries scored poorly in the global preparedness rankings, with only Algeria, Seychelles, and Mauritius scoring better than the global average of 87. Western Africa appears to be the least prepared – with conflict-ridden Central African Republic, Nigeria, and Niger, ranking 179, 180, and 183 respectively. Another conflict zone, Somalia and Pakistan in WHO’s Eastern Mediterranean region also rank poorly in preparedness, with scores of 181 and 172 respectively. For the Western Pacific region, Pacific Islands countries such as Papau New Guinea, Vanuatu, adn Kiribati, were among the lowest-scoring. They also have some of the highest obesity prevalence levels globally. ‘Double burden’ of obesity and undernutrition A malnourished child is weighed at a clinic in Abu Shouk camp for Internally Displaced Persons, North Darfur. With the majority of people with obesity living in LMICs, where obesity rates are rising fastest and health systems capacity is lowest, countries also are ill-equipped to tackle the double burden of both malnutrition and undernutrition, as well as obesity. Health service budgets in these countries also are unlikely to be able to cover advanced forms of obesity treatment, such as bariatric surgery. This reinforces the need for a comprehensive approach to managing and treating obesity, says the Atlas. “Countries have a major challenge to halt the rise in obesity and reduce obesity across all age groups.” Global action plan should replace ‘disjointed global response’ Responding to the report, the NCD Alliance called upon the WHO to advance a new Global Action Plan on Obesity in time for review at the upcoming World Health Assembly, which takes place 22 – 28 May 2022 . The plan would bring together all existing actions, including the WHO’s recent draft recommendations on obesity, which were considered at January 2022 Executive Board meeting. But an action plan would also expand the ambition and scope of WHO’s work to accelerate action on obesity in priority countries. “A disjointed response, lack of ambition, and inaction is hurting the most vulnerable, and the impact couldn’t be more striking than it is today,” said Margot Neveux, a Senior Policy Manager at World Obesity Federation. “We need more from our leaders; we need governance that puts the health and well-being of its people first.” Image Credits: Malingering/Flickr, Jen Wen Luoh, World Obesity Federation, Flickr – UN Photo, World Obesity Federation . WHO Welcomes US Move to Share COVID-19 Technologies with C-TAP Patent Pool 04/03/2022 Raisa Santos US NIH will offer some of its COVID-19 technologies to WHO’s C-TAP patent pool. The United States National Institutes of Health (NIH) will offer certain government-funded coronavirus technologies to WHO’s COVID-19 Technology Access Pool (C-TAP), top US officials said on Thursday. The announcement by US Secretary of Health and Human Services Xavier Becerra at a virtual meeting Thursday with other ministers of health, could help bolster support for the WHO effort to build a repository of treatments, tests and vaccines available to any country on an open license – an effort that has failed to gain much buy-in from either governments, researchers or industry so far. WHO welcomed the move saying it would help the agency and countries to more quickly overcome the COVID pandemic. “This is a strong example of innovation and collaboration coming together to expand access,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, who also spoke at the virtual ‘COVID-19 Dialogue – Potential Opportunities for Innovation and Collaboration, convened by Becerra with over 20 health ministers and senior health officials from Europe, Asia, Africa, the Middle East and Latin America. “Voluntary sharing of technologies through non-exclusive agreements will not only help us put the pandemic behind us; it will also empower low- and middle-income countries to produce their own medical products and achieve equitable access,” Tedros added in a follow-up statement. US Secretary of Health and Human Services, Xavier Becerra The NIH technologies will also be sub-licensed to the United Nations backed Medicines Patent Pool (MPP) – in an effort to amplify the impact of certain American scientific breakthroughs to better fight the pandemic, said Becerra. Sharing technologies behind NIH-devised coronavirus diagnostics, treatments and vaccines will help other nations and developers to move innovations to the manufacturing phase more quickly, Becerra said. The HHS secretary also hinted that the move to share NIH technologies with C-TAP could set the stage for further policy changes around how NIH innovations are used and shared, noting that: “moving forward, HHS will work with manufacturers to promote global access to public health emergency products in future purchase agreements”. ‘Push the envelope where the law allows’ Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease (NIAID), also confirmed the plan to share the NIH know-how on a call with US media later Thursday. But he declined to offer details on exactly what technologies will be shared, saying the plan is “still being ironed out.” However, both Fauci and Becerra hinted that they would try to push for the inclusion of powerful innovations like the Moderna mRNA vaccine in the patent pool – if the NIH were to win a bitterly-contested patent dispute with the company over the ownership of a patent critical to the vaccine recipe. “We’re still in early stages,” Becerra quoted as saying. “This latest announcement is an effort to try to let low and middle-income countries know that we want them to have capacities as well.” But he added that HHS would “push the envelope where the law allows us.” The NIH and Moderna are locked in a battle around patent ownership for key technologies related to the Moderna vaccine. WHO – NIH move will help ‘put pandemic behind us’ “We will be honored to sign public health-driven transparent non-exclusive license agreements with NIH under the auspices of C-TAP when the negotiations have concluded, with the goal to provide access of these innovative technologies to people in need around the world and help put an end to the pandemic,” said MPP Executive Director Charles Gore in the joint WHO-MPP statement. In Nov. 2021, Spain announced that it would share the technology behind a coronavirus antibody test to the pool, known as C-TAP, the first significant donation. However, few other takers have surfaced, and WHO has since refocused more of its efforts on building a series of technology transfer hubs that aimed to train researchers and jump-start manufacturing of vaccines and other innovations – including one based in Cape Town and another, announced last week, in the Republic of Korea. Medecines access advocates also said they were heartened by the decision – although some took a wait-and-see attitude to see what technologies are really shared. “HHS’s announcement is a turn towards sharing not only doses, but knowledge, which is the difference between charity and justice. It is a trajectory which if pursued with seriousness of purpose can improve resilience to future pandemics and bring a measure of justice to a terribly unjust time,” said Peter Maybarduk, who oversees the global medicine program at Public Citizen, an advocacy organization. Entry point for US to share patents While the newly-announced agreement is with WHO’s C-Tap, the US announcement could also open the door for new policies on NIH funding of discovery research, some observers also suggested. If future funding arrangements provide an entry point for the US to explicitly preserve its right to share patents for global health objectives, that would have more long-term impacts on the ecosystem of R&D-sharing, beyond the current pandemic, said Knowledge Ecology International Director James Love: “In the past, the NIH has opposed such agreements or clauses in the NIH funding agreements, and we hope that attitudes are changing,” he said. Becerra’s announcement followed Wednesday’s release of a new White House plan for US COVID-19 preparedness, which also emphasises the importance of “vaccinating the world” to prevent future pandemics. Image Credits: wasajja_j/Twitter, Twitter . WHO Releases New Noise Standard for Public Venues to Tackle Hearing Loss 03/03/2022 Editorial team Speech and hearing testing in Karnataka, India. Over one billion people aged 12 – 35 are at risk of hearing loss. Ahead of World Hearing Day 2022, WHO has issued a new international standard for safe noise levels and hearing at public venues and events. It aims to combat the growing problem of hearing loss from exposure to excessively loud music and other recreational noise. Over 1 billion people aged 12 – 35 risk losing their hearing due to prolonged and excessive exposure to loud music and other recreational sounds, which has devastating consequences for their physical and mental health, education, and employment prospects. “Millions of teenagers and young people are at risk of hearing loss due to the unsafe use of personal audio devices and exposure to damaging sound levels at venues such as nightclubs, bars, concerts and sporting events,” said Dr Bente Mikkelsen, WHO Director for the Department for Noncommunicable Diseases. The Global standard for safe listening at venues and events highlights six recommendations under the theme, To hear for life, listen with care!. The six recommendations in the new WHO report to limit the risk of hearing loss are: (1) a maximum average sound level of 100 decibels (2) live monitoring and recording of sound levels using calibrated equipment by designated staff (3) optimizing venue acoustics and sound systems to ensure enjoyable sound quality and safe listening (4) making personal hearing protection available to audiences including instructions on use (5) access to quiet zones for people to rest their ears and decrease the risk of hearing damage; and (6) provision of training and information to staff. More about the safe standard Image Credits: Trinity Care Foundation/Flickr. Molnupiravir Joins WHO’s Recommended COVID-19 Treatment List 03/03/2022 Editorial team Molnupiravir Molnupiravir, an oral COVID-19 antiviral medication, has just been added as a conditional recommendation to the World Health Organization’s living guidelines on COVID-19 therapeutics. The pill, created by Merck, had already been approved by the Medicines Patent Pool (MPP) in January to be distributed and supplied in 105 low- and middle-income countries (LMICs). In comparison with Pfizer’s Paxlovid, Monulpiravir emerged with lower efficacy ratings and more potential adverse effects, in the FDA’s final review of clinical trial results. Even so, the Merck drug is still regarded as an important new tool in countries’ arsenals, as it can be administered to certain patients unable to tolerate Paxlovid. WHO recommends molnupiravir to non-severe COVID-19 patients with the highest risk of hospitalizations, including people who have not received a COVID-19 vaccination, older people, people with immunodeficiencies, and people living with chronic diseases. WHO has not yet made a recommendation See more about monulpiravir: WHO Image Credits: Merck . As UN ‘Deplores’ Russian Invasion, WHO Appeals for Humanitarian Corridor in Ukraine for Medical Supplies 02/03/2022 Kerry Cullinan The World Health Organization (WHO) on Wednesday appealed for a “humanitarian corridor” to enable it to deliver emergency medical supplies to sick and injured Ukrainians – particularly oxygen, insulin and equipment needed to treat battle wounds. The WHO appeal at a media briefing Wednesday came just hours before the UN General Assembly overwhelmingly approved a resolution that “deplores” Russia’s “aggression against the Ukraine” – on a day when Russia ramped up its bombing and shelling of major Ukranian urban centres, including Kharkhiv, Kherson and Mariupol, leading to evermore mounting casualties, by the hour. Meanwhile, over 870,000 people have already fled Ukraine, WHO European officials disclosed – several hundred thousand people than estimates from just 24 hours ago, as numbers grow exponentially. Their arrival will create more knock-on impacts for stressed health systems in neighboring countries. As for humanitarian supplies destined for the beseiged country, “the first shipment will arrive in Poland tomorrow, including six metric tonnes of supplies for trauma care and emergency surgery,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing. But getting the supplies to thousands of critically injured and ill people is yet another matter, he said. “There is an urgent need to establish a corridor to ensure humanitarian workers and supplies have safe and continuous access to reach people in need to support our response,” added Dr Tedros. Grim list of equipment Ukrainian child with his dog -displaced by war to a refugee camp on the border with Moldova. Dr Mike Ryan, WHO Executive Director of Health Emergencies, recited a grim list of some of the equipment in the shipment: “sutures, skin graft equipment, equipment for doing major surgery and unfortunately equipment for doing amputations, for bone grafting, for bone wiring. “These are ordinary civilians being broken and the health system is going to have to put them back together again and they need this very specialised equipment,” said Ryan. WHO also has a large stock of supplies in the country, concentrated in the Ukrainian capital city of Kyiv, Ryan added. But those stores, right now are “blocked” by the constant bombardments and tightening Russian blockade around the city. He appealed for “humanitarian access, corridors, moments of peace – anything that can be done … where we can move supplies, move patients.” ‘You can’t wait for oxygen’ Dr Mike Ryan An estimated 2000 COVID-19 patients remain seriously ill in hospital and in need of high-flow oxygen, Ryan added. WHO had warned earlier this week that oxygen was in short supply for those people and others with chronic conditions. But there are now soaring needs for more oxygen to treat the war-wounded, children struck with pneumonia, as well as mothers and newborns birthed in desperate conditions. “Oxygen is lifesaving, full stop. And when you need it, you can’t wait until tomorrow,” Ryan said, warning that without a replenishment of supplies soon “people will die needlessly in the dark. They are dying needlessly to start with, but there is a secondary level of needlessness”. “When you see nurses mechanically ventilating infants in basements of hospitals, even the toughest of us struggle to watch those heroes… taking care of those kids. “It’s really important that we don’t just break this down into supplies and commodities that we have to deliver,” he stressed. “This is people’s bodies. People’s bones are broken, people’s lives are being lost.” WHO training in mass casualty management Ryan also disclosed that the WHO had been conducting training in “mass casualty management and major surgical training” in hospitals all over Ukraine over the past few months – in anticipation of a possible Russian invasion. However, when asked why the WHO never mentioned Russia in its statements, Ryan said that the WHO stood for peace and did not want to get involved in the politics of the conflict. “Our primary purpose is to sustain and preserve the health system in Ukraine that may serve the people of Ukraine and we will do everything in our power to make that happen,” said Ryan. Attacks on health facilities violate international law COVID-19 patient in severe state in Chernivtsi, southwestern Ukraine. As the SARS-CoV2 pandemic wanes, a health emergency – created solely by human forces. The senior leadership was more outspoken about attacks on health facilities and health workers are, which Dr Tedros described as a violation of international law. He said that the WHO had confirmed one such report, which killed four people, and was in the process of verifying reports on several other incidents. The Ukrainian army claimed yesterday that a hospital had also come under attack in Kharkiv after Russian forces landed in the city. “We have received several unconfirmed reports of attacks on hospitals and health infrastructure and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers,” said Dr Tedros. “The sanctity and neutrality of health care, including of health workers, patient supplies, transport and facilities, and the right to safe access to care, must be respected and protected.” Maintaining COVID-19 care during a war Dr Jarno Habicht, WHO Ukraine Dr Jarno Habicht, head of the WHO’s Ukraine Country Office, said that while there was a protocol in place to move goods from Poland to Ukraine, this was only possible where direct military offensives are not taking place. “So there is certain access, but as the situation evolves, that access is decreasing and the challenge is that where the major needs are for the surgery, trauma care, there we don’t have access,” said Habicht. He added that an Omicron-driven COVID-19 outbreak had peaked in Ukraine in mid-February and although this wave had been milder, many elderly people had been hospitalised. The mass movement of people throughout the country to try to avoid the war is now likely to exacerbate the spread of the virus once more, he warned. “Infectious diseases ruthlessly exploit the conditions created by war: the increase the transmission of these diseases from the crowding, the conditions. More people are vulnerable in the settings and there’s less care available for them. It’s as simple as that. What can we do about it? Number one, stop the war,” said Dr Bruce Aylward, a WHO special adviser. Over 870,000 refugees from among Ukraine’s 44 million people, have already entered surrounding countries, which also are battling COVID-19, Dr Heather Papowitz, the WHO’s incident manager for Europe, reported. This inflow also will strain their health systems, she predicted. "They are just very young, they don't understand." Olga fled Ukraine with her children when the first bombs fell. pic.twitter.com/GDsHiZ6rSw — UNHCR, the UN Refugee Agency (@Refugees) March 1, 2022 UNICEF and UNHCR also issue warnings WHO’s briefing came just hours before the UN General Assembly voted overwhelmingly to “deplore” the Russian invasion. The vote came in a resolution supported by 141 of the Assembly’s 193 members, at an emergency session called by the U.N. Security Council. Meanwhile, UNICEF also called for an immediate suspension of hostilities, and the UNHCR warned that the humanitarian crisis being seen now, on day seven, of the crisis, is only the beginning. “As we speak there are 520,000 refugees from Ukraine in neighboring countries. This figure has been rising exponentially, hour after hour, literally since Thursday.” said High Commission Filippo Grandi, in a Tweet Tuesday. And indeed, 24 hours later, WHO estimates were that more than 800,00 people had fled. Meanwhile, heavy fighting continued in the strategically-located Black Sea port city of Kherson, while Russia claimed that it had taken control of the city, following hours of continuous air strikes and bombardment that has destroyed thousands of homes, and forced hundreds of thousands of people to flee – if they could. Russia meanwhile continued shelling and bombing other key cities, including Kharkiv and Mariupol, in its efforts to subdue the country that has shown unusually stiff resistance, despite the overwhelming imbalance of weaponry in favour of Moscow. Mariupol was near a “humanitarian catastrophe,” after more than 15 hours of continuous bombardment, its mayor told BBC. He said water and power to parts of the city had been cut off, a densely populated residential district nearly flattened, and hundreds of people were dead – with no way to even retrieve the bodies. Speaking to Health Policy Watch, diplomatic sources in Europe warned of a pending Russian attack on Kyiv, around which a massived columns of tanks and armored personal carriers have been grouping over the past few days, despite stiff Ukranian resistance on the roads. The next stage of Russian attack could likely involve “precision guided missiles,” aimed at the key government buildings of the city center. “Don’t know how precise it will be, there will certainly be lots of casualties,” said one source. “We see hospitals are being bombarded, people have nowhere to go. They have bombed out whole cities and there are no green zones for non-combatants. People don’t have bomb shelters because Ukraine hasn’t fought anyone since World War II. It’s like Canadians fighting Americans, no one could have imagined it could go to this level of barbarity and cruelty,” said one former resident of Kyiv, who spoke with Health Policy Watch. –Elaine Ruth Fletcher contributed to this story Image Credits: Elena Mozhvilo/ Unsplash, UNICEF/UN0599222/Moldovan, Mstyslav Chernov/ Wikimedia Commons. As Ukrainians Flee, WHO Stresses Importance of Lifesaving NCD Care for Refugees and Migrants 01/03/2022 Kerry Cullinan WHO NCD Director Dr Bente Mikkelsen As streams of Ukrainians leave their country to escape from Russian attacks, the World Health Organization (WHO) is concerned that they, and other migrants and refugees, are not being included in programmes to treat critical non-communicable diseases (NCDs), like diabetes, that can be deadly if treatment is not maintained. WHO’s NCD Director Dr Bente Mikkelsen said that she had been approached on Tuesday to assist with diabetes treatment for ill Ukrainian refugees. Addressing the launch of a new WHO review on ensuring NCD care and treatment for migrants on Tuesday, Mikkelsen said that “international migrants, including refugees, may face extreme poverty and inadequate access to food and health care already in their own countries, and then during the migration process, and in the country of destination, they may be exposed by economic inequalities, social exclusion and discrimination.” “As we speak, unfortunately, we see a new big wave of migration happening due to the horrible situation in Ukraine. This morning, I was contacted by people really concerned about diabetes care in already sick patients, and how we could best support this,” she added. As we are responding to the dire situation of people forcibly displaced in Ukraine, WHO 2nd report of the Global Evidence Review on Health and Migration series – on #NCDs reminds us of the need to better address the need of refugees and migrants https://t.co/5oo2RtQL7b — Slim Slama (@docfromtheblock) March 1, 2022 Meanwhile, WHO Deputy Director-General Dr Zsuzsanna Jakab, said that the 2030 Agenda for Sustainable Development and Sustainable Development Goals emphasised the principles of “leaving no one behind, including refugees and migrants”. “Refugees and migrants have specific health needs and vulnerabilities, which in practice, may all too often fail to be recognised and addressed and which may have been exacerbated during the pandemic,” added Jakab. “It is imperative that has the health needs of these vulnerable groups is addressed by transmitting and receiving countries using human rights principles and with careful coordination across sectors,” said Jakab, adding that more research was needed to better understand the global trends, magnitude and implications of migration and health as well as how to address migrants’ NCD-related needs Almost three-quarters (74%) of global deaths are caused by cancer, diabetes, cardiovascular diseases and lung diseases, said Mikkelson and that the lack of investment in NCD care was “dire”, particularly since COVID-19. The review looks at “academic and grey literature published between 2010 and 2021” that identified major challenges for NCDs in refugees and migrants because of the multifaceted dynamics of the migration processes. Migrant-specific barriers in accessing NCD services include cultural and language differences, social exclusion, discrimination and legal status, according to the review. It calls for strengthened governance and policies, research and data monitoring, and health service delivery to ensure inclusive NCD prevention, treatment and care to meet internationally agreed goals and targets. New Studies Contend: Wuhan Market Animals, Not Laboratory, First Infected Humans with SARS-COV2 28/02/2022 Kerry Cullinan Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter. Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats. The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year. Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control. It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating in the Huanan market in the early days of 2020 alongside its sequel, Lineage B. That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market – whereas Lineage A was the first to spread among people in the city of 10 million. China study corroborates findings of University of Arizona researchers Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues. The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak. While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held. The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2. Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020. Around one-third were lineage A and two-thirds were lineage B. “We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B. The patterns in the phylogeny are the giveaway,” according to Worobey. The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include: a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold. And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed. "Together, these analyses provide dispositive evidence for the emergence of SARS-CoV-2 via the live wildlife trade and identify the Huanan market as the unambiguous epicenter of the COVID-19 pandemic." pic.twitter.com/rjgNPyOu3q — Michael Worobey (@MichaelWorobey) February 26, 2022 In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more… “It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus. It happened to be a stall that one of us, @edwardcholmes, had visited 5 years before the pandemic, and where he had taken this photo of a raccoon dog. pic.twitter.com/19ltUkCI1W — Michael Worobey (@MichaelWorobey) February 26, 2022 Market is epicentre The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported. According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.” Based on these maps, “Huanan market sits right in the highest density region,” he adds. We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the the epidemic. Its epicenter was at the market — Michael Worobey (@MichaelWorobey) February 26, 2022 “This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market. Chinese paper also points to the market In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported. The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported. Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study. But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”. Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC. This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base. And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak. -Elaine Ruth Fletcher contributed to this story. Image Credits: Arend Kuester/Flickr. Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Welcomes US Move to Share COVID-19 Technologies with C-TAP Patent Pool 04/03/2022 Raisa Santos US NIH will offer some of its COVID-19 technologies to WHO’s C-TAP patent pool. The United States National Institutes of Health (NIH) will offer certain government-funded coronavirus technologies to WHO’s COVID-19 Technology Access Pool (C-TAP), top US officials said on Thursday. The announcement by US Secretary of Health and Human Services Xavier Becerra at a virtual meeting Thursday with other ministers of health, could help bolster support for the WHO effort to build a repository of treatments, tests and vaccines available to any country on an open license – an effort that has failed to gain much buy-in from either governments, researchers or industry so far. WHO welcomed the move saying it would help the agency and countries to more quickly overcome the COVID pandemic. “This is a strong example of innovation and collaboration coming together to expand access,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, who also spoke at the virtual ‘COVID-19 Dialogue – Potential Opportunities for Innovation and Collaboration, convened by Becerra with over 20 health ministers and senior health officials from Europe, Asia, Africa, the Middle East and Latin America. “Voluntary sharing of technologies through non-exclusive agreements will not only help us put the pandemic behind us; it will also empower low- and middle-income countries to produce their own medical products and achieve equitable access,” Tedros added in a follow-up statement. US Secretary of Health and Human Services, Xavier Becerra The NIH technologies will also be sub-licensed to the United Nations backed Medicines Patent Pool (MPP) – in an effort to amplify the impact of certain American scientific breakthroughs to better fight the pandemic, said Becerra. Sharing technologies behind NIH-devised coronavirus diagnostics, treatments and vaccines will help other nations and developers to move innovations to the manufacturing phase more quickly, Becerra said. The HHS secretary also hinted that the move to share NIH technologies with C-TAP could set the stage for further policy changes around how NIH innovations are used and shared, noting that: “moving forward, HHS will work with manufacturers to promote global access to public health emergency products in future purchase agreements”. ‘Push the envelope where the law allows’ Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease (NIAID), also confirmed the plan to share the NIH know-how on a call with US media later Thursday. But he declined to offer details on exactly what technologies will be shared, saying the plan is “still being ironed out.” However, both Fauci and Becerra hinted that they would try to push for the inclusion of powerful innovations like the Moderna mRNA vaccine in the patent pool – if the NIH were to win a bitterly-contested patent dispute with the company over the ownership of a patent critical to the vaccine recipe. “We’re still in early stages,” Becerra quoted as saying. “This latest announcement is an effort to try to let low and middle-income countries know that we want them to have capacities as well.” But he added that HHS would “push the envelope where the law allows us.” The NIH and Moderna are locked in a battle around patent ownership for key technologies related to the Moderna vaccine. WHO – NIH move will help ‘put pandemic behind us’ “We will be honored to sign public health-driven transparent non-exclusive license agreements with NIH under the auspices of C-TAP when the negotiations have concluded, with the goal to provide access of these innovative technologies to people in need around the world and help put an end to the pandemic,” said MPP Executive Director Charles Gore in the joint WHO-MPP statement. In Nov. 2021, Spain announced that it would share the technology behind a coronavirus antibody test to the pool, known as C-TAP, the first significant donation. However, few other takers have surfaced, and WHO has since refocused more of its efforts on building a series of technology transfer hubs that aimed to train researchers and jump-start manufacturing of vaccines and other innovations – including one based in Cape Town and another, announced last week, in the Republic of Korea. Medecines access advocates also said they were heartened by the decision – although some took a wait-and-see attitude to see what technologies are really shared. “HHS’s announcement is a turn towards sharing not only doses, but knowledge, which is the difference between charity and justice. It is a trajectory which if pursued with seriousness of purpose can improve resilience to future pandemics and bring a measure of justice to a terribly unjust time,” said Peter Maybarduk, who oversees the global medicine program at Public Citizen, an advocacy organization. Entry point for US to share patents While the newly-announced agreement is with WHO’s C-Tap, the US announcement could also open the door for new policies on NIH funding of discovery research, some observers also suggested. If future funding arrangements provide an entry point for the US to explicitly preserve its right to share patents for global health objectives, that would have more long-term impacts on the ecosystem of R&D-sharing, beyond the current pandemic, said Knowledge Ecology International Director James Love: “In the past, the NIH has opposed such agreements or clauses in the NIH funding agreements, and we hope that attitudes are changing,” he said. Becerra’s announcement followed Wednesday’s release of a new White House plan for US COVID-19 preparedness, which also emphasises the importance of “vaccinating the world” to prevent future pandemics. Image Credits: wasajja_j/Twitter, Twitter . WHO Releases New Noise Standard for Public Venues to Tackle Hearing Loss 03/03/2022 Editorial team Speech and hearing testing in Karnataka, India. Over one billion people aged 12 – 35 are at risk of hearing loss. Ahead of World Hearing Day 2022, WHO has issued a new international standard for safe noise levels and hearing at public venues and events. It aims to combat the growing problem of hearing loss from exposure to excessively loud music and other recreational noise. Over 1 billion people aged 12 – 35 risk losing their hearing due to prolonged and excessive exposure to loud music and other recreational sounds, which has devastating consequences for their physical and mental health, education, and employment prospects. “Millions of teenagers and young people are at risk of hearing loss due to the unsafe use of personal audio devices and exposure to damaging sound levels at venues such as nightclubs, bars, concerts and sporting events,” said Dr Bente Mikkelsen, WHO Director for the Department for Noncommunicable Diseases. The Global standard for safe listening at venues and events highlights six recommendations under the theme, To hear for life, listen with care!. The six recommendations in the new WHO report to limit the risk of hearing loss are: (1) a maximum average sound level of 100 decibels (2) live monitoring and recording of sound levels using calibrated equipment by designated staff (3) optimizing venue acoustics and sound systems to ensure enjoyable sound quality and safe listening (4) making personal hearing protection available to audiences including instructions on use (5) access to quiet zones for people to rest their ears and decrease the risk of hearing damage; and (6) provision of training and information to staff. More about the safe standard Image Credits: Trinity Care Foundation/Flickr. Molnupiravir Joins WHO’s Recommended COVID-19 Treatment List 03/03/2022 Editorial team Molnupiravir Molnupiravir, an oral COVID-19 antiviral medication, has just been added as a conditional recommendation to the World Health Organization’s living guidelines on COVID-19 therapeutics. The pill, created by Merck, had already been approved by the Medicines Patent Pool (MPP) in January to be distributed and supplied in 105 low- and middle-income countries (LMICs). In comparison with Pfizer’s Paxlovid, Monulpiravir emerged with lower efficacy ratings and more potential adverse effects, in the FDA’s final review of clinical trial results. Even so, the Merck drug is still regarded as an important new tool in countries’ arsenals, as it can be administered to certain patients unable to tolerate Paxlovid. WHO recommends molnupiravir to non-severe COVID-19 patients with the highest risk of hospitalizations, including people who have not received a COVID-19 vaccination, older people, people with immunodeficiencies, and people living with chronic diseases. WHO has not yet made a recommendation See more about monulpiravir: WHO Image Credits: Merck . As UN ‘Deplores’ Russian Invasion, WHO Appeals for Humanitarian Corridor in Ukraine for Medical Supplies 02/03/2022 Kerry Cullinan The World Health Organization (WHO) on Wednesday appealed for a “humanitarian corridor” to enable it to deliver emergency medical supplies to sick and injured Ukrainians – particularly oxygen, insulin and equipment needed to treat battle wounds. The WHO appeal at a media briefing Wednesday came just hours before the UN General Assembly overwhelmingly approved a resolution that “deplores” Russia’s “aggression against the Ukraine” – on a day when Russia ramped up its bombing and shelling of major Ukranian urban centres, including Kharkhiv, Kherson and Mariupol, leading to evermore mounting casualties, by the hour. Meanwhile, over 870,000 people have already fled Ukraine, WHO European officials disclosed – several hundred thousand people than estimates from just 24 hours ago, as numbers grow exponentially. Their arrival will create more knock-on impacts for stressed health systems in neighboring countries. As for humanitarian supplies destined for the beseiged country, “the first shipment will arrive in Poland tomorrow, including six metric tonnes of supplies for trauma care and emergency surgery,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing. But getting the supplies to thousands of critically injured and ill people is yet another matter, he said. “There is an urgent need to establish a corridor to ensure humanitarian workers and supplies have safe and continuous access to reach people in need to support our response,” added Dr Tedros. Grim list of equipment Ukrainian child with his dog -displaced by war to a refugee camp on the border with Moldova. Dr Mike Ryan, WHO Executive Director of Health Emergencies, recited a grim list of some of the equipment in the shipment: “sutures, skin graft equipment, equipment for doing major surgery and unfortunately equipment for doing amputations, for bone grafting, for bone wiring. “These are ordinary civilians being broken and the health system is going to have to put them back together again and they need this very specialised equipment,” said Ryan. WHO also has a large stock of supplies in the country, concentrated in the Ukrainian capital city of Kyiv, Ryan added. But those stores, right now are “blocked” by the constant bombardments and tightening Russian blockade around the city. He appealed for “humanitarian access, corridors, moments of peace – anything that can be done … where we can move supplies, move patients.” ‘You can’t wait for oxygen’ Dr Mike Ryan An estimated 2000 COVID-19 patients remain seriously ill in hospital and in need of high-flow oxygen, Ryan added. WHO had warned earlier this week that oxygen was in short supply for those people and others with chronic conditions. But there are now soaring needs for more oxygen to treat the war-wounded, children struck with pneumonia, as well as mothers and newborns birthed in desperate conditions. “Oxygen is lifesaving, full stop. And when you need it, you can’t wait until tomorrow,” Ryan said, warning that without a replenishment of supplies soon “people will die needlessly in the dark. They are dying needlessly to start with, but there is a secondary level of needlessness”. “When you see nurses mechanically ventilating infants in basements of hospitals, even the toughest of us struggle to watch those heroes… taking care of those kids. “It’s really important that we don’t just break this down into supplies and commodities that we have to deliver,” he stressed. “This is people’s bodies. People’s bones are broken, people’s lives are being lost.” WHO training in mass casualty management Ryan also disclosed that the WHO had been conducting training in “mass casualty management and major surgical training” in hospitals all over Ukraine over the past few months – in anticipation of a possible Russian invasion. However, when asked why the WHO never mentioned Russia in its statements, Ryan said that the WHO stood for peace and did not want to get involved in the politics of the conflict. “Our primary purpose is to sustain and preserve the health system in Ukraine that may serve the people of Ukraine and we will do everything in our power to make that happen,” said Ryan. Attacks on health facilities violate international law COVID-19 patient in severe state in Chernivtsi, southwestern Ukraine. As the SARS-CoV2 pandemic wanes, a health emergency – created solely by human forces. The senior leadership was more outspoken about attacks on health facilities and health workers are, which Dr Tedros described as a violation of international law. He said that the WHO had confirmed one such report, which killed four people, and was in the process of verifying reports on several other incidents. The Ukrainian army claimed yesterday that a hospital had also come under attack in Kharkiv after Russian forces landed in the city. “We have received several unconfirmed reports of attacks on hospitals and health infrastructure and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers,” said Dr Tedros. “The sanctity and neutrality of health care, including of health workers, patient supplies, transport and facilities, and the right to safe access to care, must be respected and protected.” Maintaining COVID-19 care during a war Dr Jarno Habicht, WHO Ukraine Dr Jarno Habicht, head of the WHO’s Ukraine Country Office, said that while there was a protocol in place to move goods from Poland to Ukraine, this was only possible where direct military offensives are not taking place. “So there is certain access, but as the situation evolves, that access is decreasing and the challenge is that where the major needs are for the surgery, trauma care, there we don’t have access,” said Habicht. He added that an Omicron-driven COVID-19 outbreak had peaked in Ukraine in mid-February and although this wave had been milder, many elderly people had been hospitalised. The mass movement of people throughout the country to try to avoid the war is now likely to exacerbate the spread of the virus once more, he warned. “Infectious diseases ruthlessly exploit the conditions created by war: the increase the transmission of these diseases from the crowding, the conditions. More people are vulnerable in the settings and there’s less care available for them. It’s as simple as that. What can we do about it? Number one, stop the war,” said Dr Bruce Aylward, a WHO special adviser. Over 870,000 refugees from among Ukraine’s 44 million people, have already entered surrounding countries, which also are battling COVID-19, Dr Heather Papowitz, the WHO’s incident manager for Europe, reported. This inflow also will strain their health systems, she predicted. "They are just very young, they don't understand." Olga fled Ukraine with her children when the first bombs fell. pic.twitter.com/GDsHiZ6rSw — UNHCR, the UN Refugee Agency (@Refugees) March 1, 2022 UNICEF and UNHCR also issue warnings WHO’s briefing came just hours before the UN General Assembly voted overwhelmingly to “deplore” the Russian invasion. The vote came in a resolution supported by 141 of the Assembly’s 193 members, at an emergency session called by the U.N. Security Council. Meanwhile, UNICEF also called for an immediate suspension of hostilities, and the UNHCR warned that the humanitarian crisis being seen now, on day seven, of the crisis, is only the beginning. “As we speak there are 520,000 refugees from Ukraine in neighboring countries. This figure has been rising exponentially, hour after hour, literally since Thursday.” said High Commission Filippo Grandi, in a Tweet Tuesday. And indeed, 24 hours later, WHO estimates were that more than 800,00 people had fled. Meanwhile, heavy fighting continued in the strategically-located Black Sea port city of Kherson, while Russia claimed that it had taken control of the city, following hours of continuous air strikes and bombardment that has destroyed thousands of homes, and forced hundreds of thousands of people to flee – if they could. Russia meanwhile continued shelling and bombing other key cities, including Kharkiv and Mariupol, in its efforts to subdue the country that has shown unusually stiff resistance, despite the overwhelming imbalance of weaponry in favour of Moscow. Mariupol was near a “humanitarian catastrophe,” after more than 15 hours of continuous bombardment, its mayor told BBC. He said water and power to parts of the city had been cut off, a densely populated residential district nearly flattened, and hundreds of people were dead – with no way to even retrieve the bodies. Speaking to Health Policy Watch, diplomatic sources in Europe warned of a pending Russian attack on Kyiv, around which a massived columns of tanks and armored personal carriers have been grouping over the past few days, despite stiff Ukranian resistance on the roads. The next stage of Russian attack could likely involve “precision guided missiles,” aimed at the key government buildings of the city center. “Don’t know how precise it will be, there will certainly be lots of casualties,” said one source. “We see hospitals are being bombarded, people have nowhere to go. They have bombed out whole cities and there are no green zones for non-combatants. People don’t have bomb shelters because Ukraine hasn’t fought anyone since World War II. It’s like Canadians fighting Americans, no one could have imagined it could go to this level of barbarity and cruelty,” said one former resident of Kyiv, who spoke with Health Policy Watch. –Elaine Ruth Fletcher contributed to this story Image Credits: Elena Mozhvilo/ Unsplash, UNICEF/UN0599222/Moldovan, Mstyslav Chernov/ Wikimedia Commons. As Ukrainians Flee, WHO Stresses Importance of Lifesaving NCD Care for Refugees and Migrants 01/03/2022 Kerry Cullinan WHO NCD Director Dr Bente Mikkelsen As streams of Ukrainians leave their country to escape from Russian attacks, the World Health Organization (WHO) is concerned that they, and other migrants and refugees, are not being included in programmes to treat critical non-communicable diseases (NCDs), like diabetes, that can be deadly if treatment is not maintained. WHO’s NCD Director Dr Bente Mikkelsen said that she had been approached on Tuesday to assist with diabetes treatment for ill Ukrainian refugees. Addressing the launch of a new WHO review on ensuring NCD care and treatment for migrants on Tuesday, Mikkelsen said that “international migrants, including refugees, may face extreme poverty and inadequate access to food and health care already in their own countries, and then during the migration process, and in the country of destination, they may be exposed by economic inequalities, social exclusion and discrimination.” “As we speak, unfortunately, we see a new big wave of migration happening due to the horrible situation in Ukraine. This morning, I was contacted by people really concerned about diabetes care in already sick patients, and how we could best support this,” she added. As we are responding to the dire situation of people forcibly displaced in Ukraine, WHO 2nd report of the Global Evidence Review on Health and Migration series – on #NCDs reminds us of the need to better address the need of refugees and migrants https://t.co/5oo2RtQL7b — Slim Slama (@docfromtheblock) March 1, 2022 Meanwhile, WHO Deputy Director-General Dr Zsuzsanna Jakab, said that the 2030 Agenda for Sustainable Development and Sustainable Development Goals emphasised the principles of “leaving no one behind, including refugees and migrants”. “Refugees and migrants have specific health needs and vulnerabilities, which in practice, may all too often fail to be recognised and addressed and which may have been exacerbated during the pandemic,” added Jakab. “It is imperative that has the health needs of these vulnerable groups is addressed by transmitting and receiving countries using human rights principles and with careful coordination across sectors,” said Jakab, adding that more research was needed to better understand the global trends, magnitude and implications of migration and health as well as how to address migrants’ NCD-related needs Almost three-quarters (74%) of global deaths are caused by cancer, diabetes, cardiovascular diseases and lung diseases, said Mikkelson and that the lack of investment in NCD care was “dire”, particularly since COVID-19. The review looks at “academic and grey literature published between 2010 and 2021” that identified major challenges for NCDs in refugees and migrants because of the multifaceted dynamics of the migration processes. Migrant-specific barriers in accessing NCD services include cultural and language differences, social exclusion, discrimination and legal status, according to the review. It calls for strengthened governance and policies, research and data monitoring, and health service delivery to ensure inclusive NCD prevention, treatment and care to meet internationally agreed goals and targets. New Studies Contend: Wuhan Market Animals, Not Laboratory, First Infected Humans with SARS-COV2 28/02/2022 Kerry Cullinan Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter. Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats. The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year. Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control. It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating in the Huanan market in the early days of 2020 alongside its sequel, Lineage B. That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market – whereas Lineage A was the first to spread among people in the city of 10 million. China study corroborates findings of University of Arizona researchers Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues. The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak. While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held. The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2. Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020. Around one-third were lineage A and two-thirds were lineage B. “We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B. The patterns in the phylogeny are the giveaway,” according to Worobey. The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include: a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold. And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed. "Together, these analyses provide dispositive evidence for the emergence of SARS-CoV-2 via the live wildlife trade and identify the Huanan market as the unambiguous epicenter of the COVID-19 pandemic." pic.twitter.com/rjgNPyOu3q — Michael Worobey (@MichaelWorobey) February 26, 2022 In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more… “It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus. It happened to be a stall that one of us, @edwardcholmes, had visited 5 years before the pandemic, and where he had taken this photo of a raccoon dog. pic.twitter.com/19ltUkCI1W — Michael Worobey (@MichaelWorobey) February 26, 2022 Market is epicentre The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported. According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.” Based on these maps, “Huanan market sits right in the highest density region,” he adds. We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the the epidemic. Its epicenter was at the market — Michael Worobey (@MichaelWorobey) February 26, 2022 “This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market. Chinese paper also points to the market In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported. The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported. Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study. But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”. Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC. This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base. And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak. -Elaine Ruth Fletcher contributed to this story. Image Credits: Arend Kuester/Flickr. Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Releases New Noise Standard for Public Venues to Tackle Hearing Loss 03/03/2022 Editorial team Speech and hearing testing in Karnataka, India. Over one billion people aged 12 – 35 are at risk of hearing loss. Ahead of World Hearing Day 2022, WHO has issued a new international standard for safe noise levels and hearing at public venues and events. It aims to combat the growing problem of hearing loss from exposure to excessively loud music and other recreational noise. Over 1 billion people aged 12 – 35 risk losing their hearing due to prolonged and excessive exposure to loud music and other recreational sounds, which has devastating consequences for their physical and mental health, education, and employment prospects. “Millions of teenagers and young people are at risk of hearing loss due to the unsafe use of personal audio devices and exposure to damaging sound levels at venues such as nightclubs, bars, concerts and sporting events,” said Dr Bente Mikkelsen, WHO Director for the Department for Noncommunicable Diseases. The Global standard for safe listening at venues and events highlights six recommendations under the theme, To hear for life, listen with care!. The six recommendations in the new WHO report to limit the risk of hearing loss are: (1) a maximum average sound level of 100 decibels (2) live monitoring and recording of sound levels using calibrated equipment by designated staff (3) optimizing venue acoustics and sound systems to ensure enjoyable sound quality and safe listening (4) making personal hearing protection available to audiences including instructions on use (5) access to quiet zones for people to rest their ears and decrease the risk of hearing damage; and (6) provision of training and information to staff. More about the safe standard Image Credits: Trinity Care Foundation/Flickr. Molnupiravir Joins WHO’s Recommended COVID-19 Treatment List 03/03/2022 Editorial team Molnupiravir Molnupiravir, an oral COVID-19 antiviral medication, has just been added as a conditional recommendation to the World Health Organization’s living guidelines on COVID-19 therapeutics. The pill, created by Merck, had already been approved by the Medicines Patent Pool (MPP) in January to be distributed and supplied in 105 low- and middle-income countries (LMICs). In comparison with Pfizer’s Paxlovid, Monulpiravir emerged with lower efficacy ratings and more potential adverse effects, in the FDA’s final review of clinical trial results. Even so, the Merck drug is still regarded as an important new tool in countries’ arsenals, as it can be administered to certain patients unable to tolerate Paxlovid. WHO recommends molnupiravir to non-severe COVID-19 patients with the highest risk of hospitalizations, including people who have not received a COVID-19 vaccination, older people, people with immunodeficiencies, and people living with chronic diseases. WHO has not yet made a recommendation See more about monulpiravir: WHO Image Credits: Merck . As UN ‘Deplores’ Russian Invasion, WHO Appeals for Humanitarian Corridor in Ukraine for Medical Supplies 02/03/2022 Kerry Cullinan The World Health Organization (WHO) on Wednesday appealed for a “humanitarian corridor” to enable it to deliver emergency medical supplies to sick and injured Ukrainians – particularly oxygen, insulin and equipment needed to treat battle wounds. The WHO appeal at a media briefing Wednesday came just hours before the UN General Assembly overwhelmingly approved a resolution that “deplores” Russia’s “aggression against the Ukraine” – on a day when Russia ramped up its bombing and shelling of major Ukranian urban centres, including Kharkhiv, Kherson and Mariupol, leading to evermore mounting casualties, by the hour. Meanwhile, over 870,000 people have already fled Ukraine, WHO European officials disclosed – several hundred thousand people than estimates from just 24 hours ago, as numbers grow exponentially. Their arrival will create more knock-on impacts for stressed health systems in neighboring countries. As for humanitarian supplies destined for the beseiged country, “the first shipment will arrive in Poland tomorrow, including six metric tonnes of supplies for trauma care and emergency surgery,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing. But getting the supplies to thousands of critically injured and ill people is yet another matter, he said. “There is an urgent need to establish a corridor to ensure humanitarian workers and supplies have safe and continuous access to reach people in need to support our response,” added Dr Tedros. Grim list of equipment Ukrainian child with his dog -displaced by war to a refugee camp on the border with Moldova. Dr Mike Ryan, WHO Executive Director of Health Emergencies, recited a grim list of some of the equipment in the shipment: “sutures, skin graft equipment, equipment for doing major surgery and unfortunately equipment for doing amputations, for bone grafting, for bone wiring. “These are ordinary civilians being broken and the health system is going to have to put them back together again and they need this very specialised equipment,” said Ryan. WHO also has a large stock of supplies in the country, concentrated in the Ukrainian capital city of Kyiv, Ryan added. But those stores, right now are “blocked” by the constant bombardments and tightening Russian blockade around the city. He appealed for “humanitarian access, corridors, moments of peace – anything that can be done … where we can move supplies, move patients.” ‘You can’t wait for oxygen’ Dr Mike Ryan An estimated 2000 COVID-19 patients remain seriously ill in hospital and in need of high-flow oxygen, Ryan added. WHO had warned earlier this week that oxygen was in short supply for those people and others with chronic conditions. But there are now soaring needs for more oxygen to treat the war-wounded, children struck with pneumonia, as well as mothers and newborns birthed in desperate conditions. “Oxygen is lifesaving, full stop. And when you need it, you can’t wait until tomorrow,” Ryan said, warning that without a replenishment of supplies soon “people will die needlessly in the dark. They are dying needlessly to start with, but there is a secondary level of needlessness”. “When you see nurses mechanically ventilating infants in basements of hospitals, even the toughest of us struggle to watch those heroes… taking care of those kids. “It’s really important that we don’t just break this down into supplies and commodities that we have to deliver,” he stressed. “This is people’s bodies. People’s bones are broken, people’s lives are being lost.” WHO training in mass casualty management Ryan also disclosed that the WHO had been conducting training in “mass casualty management and major surgical training” in hospitals all over Ukraine over the past few months – in anticipation of a possible Russian invasion. However, when asked why the WHO never mentioned Russia in its statements, Ryan said that the WHO stood for peace and did not want to get involved in the politics of the conflict. “Our primary purpose is to sustain and preserve the health system in Ukraine that may serve the people of Ukraine and we will do everything in our power to make that happen,” said Ryan. Attacks on health facilities violate international law COVID-19 patient in severe state in Chernivtsi, southwestern Ukraine. As the SARS-CoV2 pandemic wanes, a health emergency – created solely by human forces. The senior leadership was more outspoken about attacks on health facilities and health workers are, which Dr Tedros described as a violation of international law. He said that the WHO had confirmed one such report, which killed four people, and was in the process of verifying reports on several other incidents. The Ukrainian army claimed yesterday that a hospital had also come under attack in Kharkiv after Russian forces landed in the city. “We have received several unconfirmed reports of attacks on hospitals and health infrastructure and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers,” said Dr Tedros. “The sanctity and neutrality of health care, including of health workers, patient supplies, transport and facilities, and the right to safe access to care, must be respected and protected.” Maintaining COVID-19 care during a war Dr Jarno Habicht, WHO Ukraine Dr Jarno Habicht, head of the WHO’s Ukraine Country Office, said that while there was a protocol in place to move goods from Poland to Ukraine, this was only possible where direct military offensives are not taking place. “So there is certain access, but as the situation evolves, that access is decreasing and the challenge is that where the major needs are for the surgery, trauma care, there we don’t have access,” said Habicht. He added that an Omicron-driven COVID-19 outbreak had peaked in Ukraine in mid-February and although this wave had been milder, many elderly people had been hospitalised. The mass movement of people throughout the country to try to avoid the war is now likely to exacerbate the spread of the virus once more, he warned. “Infectious diseases ruthlessly exploit the conditions created by war: the increase the transmission of these diseases from the crowding, the conditions. More people are vulnerable in the settings and there’s less care available for them. It’s as simple as that. What can we do about it? Number one, stop the war,” said Dr Bruce Aylward, a WHO special adviser. Over 870,000 refugees from among Ukraine’s 44 million people, have already entered surrounding countries, which also are battling COVID-19, Dr Heather Papowitz, the WHO’s incident manager for Europe, reported. This inflow also will strain their health systems, she predicted. "They are just very young, they don't understand." Olga fled Ukraine with her children when the first bombs fell. pic.twitter.com/GDsHiZ6rSw — UNHCR, the UN Refugee Agency (@Refugees) March 1, 2022 UNICEF and UNHCR also issue warnings WHO’s briefing came just hours before the UN General Assembly voted overwhelmingly to “deplore” the Russian invasion. The vote came in a resolution supported by 141 of the Assembly’s 193 members, at an emergency session called by the U.N. Security Council. Meanwhile, UNICEF also called for an immediate suspension of hostilities, and the UNHCR warned that the humanitarian crisis being seen now, on day seven, of the crisis, is only the beginning. “As we speak there are 520,000 refugees from Ukraine in neighboring countries. This figure has been rising exponentially, hour after hour, literally since Thursday.” said High Commission Filippo Grandi, in a Tweet Tuesday. And indeed, 24 hours later, WHO estimates were that more than 800,00 people had fled. Meanwhile, heavy fighting continued in the strategically-located Black Sea port city of Kherson, while Russia claimed that it had taken control of the city, following hours of continuous air strikes and bombardment that has destroyed thousands of homes, and forced hundreds of thousands of people to flee – if they could. Russia meanwhile continued shelling and bombing other key cities, including Kharkiv and Mariupol, in its efforts to subdue the country that has shown unusually stiff resistance, despite the overwhelming imbalance of weaponry in favour of Moscow. Mariupol was near a “humanitarian catastrophe,” after more than 15 hours of continuous bombardment, its mayor told BBC. He said water and power to parts of the city had been cut off, a densely populated residential district nearly flattened, and hundreds of people were dead – with no way to even retrieve the bodies. Speaking to Health Policy Watch, diplomatic sources in Europe warned of a pending Russian attack on Kyiv, around which a massived columns of tanks and armored personal carriers have been grouping over the past few days, despite stiff Ukranian resistance on the roads. The next stage of Russian attack could likely involve “precision guided missiles,” aimed at the key government buildings of the city center. “Don’t know how precise it will be, there will certainly be lots of casualties,” said one source. “We see hospitals are being bombarded, people have nowhere to go. They have bombed out whole cities and there are no green zones for non-combatants. People don’t have bomb shelters because Ukraine hasn’t fought anyone since World War II. It’s like Canadians fighting Americans, no one could have imagined it could go to this level of barbarity and cruelty,” said one former resident of Kyiv, who spoke with Health Policy Watch. –Elaine Ruth Fletcher contributed to this story Image Credits: Elena Mozhvilo/ Unsplash, UNICEF/UN0599222/Moldovan, Mstyslav Chernov/ Wikimedia Commons. As Ukrainians Flee, WHO Stresses Importance of Lifesaving NCD Care for Refugees and Migrants 01/03/2022 Kerry Cullinan WHO NCD Director Dr Bente Mikkelsen As streams of Ukrainians leave their country to escape from Russian attacks, the World Health Organization (WHO) is concerned that they, and other migrants and refugees, are not being included in programmes to treat critical non-communicable diseases (NCDs), like diabetes, that can be deadly if treatment is not maintained. WHO’s NCD Director Dr Bente Mikkelsen said that she had been approached on Tuesday to assist with diabetes treatment for ill Ukrainian refugees. Addressing the launch of a new WHO review on ensuring NCD care and treatment for migrants on Tuesday, Mikkelsen said that “international migrants, including refugees, may face extreme poverty and inadequate access to food and health care already in their own countries, and then during the migration process, and in the country of destination, they may be exposed by economic inequalities, social exclusion and discrimination.” “As we speak, unfortunately, we see a new big wave of migration happening due to the horrible situation in Ukraine. This morning, I was contacted by people really concerned about diabetes care in already sick patients, and how we could best support this,” she added. As we are responding to the dire situation of people forcibly displaced in Ukraine, WHO 2nd report of the Global Evidence Review on Health and Migration series – on #NCDs reminds us of the need to better address the need of refugees and migrants https://t.co/5oo2RtQL7b — Slim Slama (@docfromtheblock) March 1, 2022 Meanwhile, WHO Deputy Director-General Dr Zsuzsanna Jakab, said that the 2030 Agenda for Sustainable Development and Sustainable Development Goals emphasised the principles of “leaving no one behind, including refugees and migrants”. “Refugees and migrants have specific health needs and vulnerabilities, which in practice, may all too often fail to be recognised and addressed and which may have been exacerbated during the pandemic,” added Jakab. “It is imperative that has the health needs of these vulnerable groups is addressed by transmitting and receiving countries using human rights principles and with careful coordination across sectors,” said Jakab, adding that more research was needed to better understand the global trends, magnitude and implications of migration and health as well as how to address migrants’ NCD-related needs Almost three-quarters (74%) of global deaths are caused by cancer, diabetes, cardiovascular diseases and lung diseases, said Mikkelson and that the lack of investment in NCD care was “dire”, particularly since COVID-19. The review looks at “academic and grey literature published between 2010 and 2021” that identified major challenges for NCDs in refugees and migrants because of the multifaceted dynamics of the migration processes. Migrant-specific barriers in accessing NCD services include cultural and language differences, social exclusion, discrimination and legal status, according to the review. It calls for strengthened governance and policies, research and data monitoring, and health service delivery to ensure inclusive NCD prevention, treatment and care to meet internationally agreed goals and targets. New Studies Contend: Wuhan Market Animals, Not Laboratory, First Infected Humans with SARS-COV2 28/02/2022 Kerry Cullinan Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter. Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats. The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year. Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control. It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating in the Huanan market in the early days of 2020 alongside its sequel, Lineage B. That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market – whereas Lineage A was the first to spread among people in the city of 10 million. China study corroborates findings of University of Arizona researchers Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues. The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak. While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held. The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2. Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020. Around one-third were lineage A and two-thirds were lineage B. “We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B. The patterns in the phylogeny are the giveaway,” according to Worobey. The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include: a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold. And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed. "Together, these analyses provide dispositive evidence for the emergence of SARS-CoV-2 via the live wildlife trade and identify the Huanan market as the unambiguous epicenter of the COVID-19 pandemic." pic.twitter.com/rjgNPyOu3q — Michael Worobey (@MichaelWorobey) February 26, 2022 In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more… “It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus. It happened to be a stall that one of us, @edwardcholmes, had visited 5 years before the pandemic, and where he had taken this photo of a raccoon dog. pic.twitter.com/19ltUkCI1W — Michael Worobey (@MichaelWorobey) February 26, 2022 Market is epicentre The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported. According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.” Based on these maps, “Huanan market sits right in the highest density region,” he adds. We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the the epidemic. Its epicenter was at the market — Michael Worobey (@MichaelWorobey) February 26, 2022 “This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market. Chinese paper also points to the market In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported. The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported. Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study. But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”. Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC. This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base. And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak. -Elaine Ruth Fletcher contributed to this story. Image Credits: Arend Kuester/Flickr. Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Molnupiravir Joins WHO’s Recommended COVID-19 Treatment List 03/03/2022 Editorial team Molnupiravir Molnupiravir, an oral COVID-19 antiviral medication, has just been added as a conditional recommendation to the World Health Organization’s living guidelines on COVID-19 therapeutics. The pill, created by Merck, had already been approved by the Medicines Patent Pool (MPP) in January to be distributed and supplied in 105 low- and middle-income countries (LMICs). In comparison with Pfizer’s Paxlovid, Monulpiravir emerged with lower efficacy ratings and more potential adverse effects, in the FDA’s final review of clinical trial results. Even so, the Merck drug is still regarded as an important new tool in countries’ arsenals, as it can be administered to certain patients unable to tolerate Paxlovid. WHO recommends molnupiravir to non-severe COVID-19 patients with the highest risk of hospitalizations, including people who have not received a COVID-19 vaccination, older people, people with immunodeficiencies, and people living with chronic diseases. WHO has not yet made a recommendation See more about monulpiravir: WHO Image Credits: Merck . As UN ‘Deplores’ Russian Invasion, WHO Appeals for Humanitarian Corridor in Ukraine for Medical Supplies 02/03/2022 Kerry Cullinan The World Health Organization (WHO) on Wednesday appealed for a “humanitarian corridor” to enable it to deliver emergency medical supplies to sick and injured Ukrainians – particularly oxygen, insulin and equipment needed to treat battle wounds. The WHO appeal at a media briefing Wednesday came just hours before the UN General Assembly overwhelmingly approved a resolution that “deplores” Russia’s “aggression against the Ukraine” – on a day when Russia ramped up its bombing and shelling of major Ukranian urban centres, including Kharkhiv, Kherson and Mariupol, leading to evermore mounting casualties, by the hour. Meanwhile, over 870,000 people have already fled Ukraine, WHO European officials disclosed – several hundred thousand people than estimates from just 24 hours ago, as numbers grow exponentially. Their arrival will create more knock-on impacts for stressed health systems in neighboring countries. As for humanitarian supplies destined for the beseiged country, “the first shipment will arrive in Poland tomorrow, including six metric tonnes of supplies for trauma care and emergency surgery,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing. But getting the supplies to thousands of critically injured and ill people is yet another matter, he said. “There is an urgent need to establish a corridor to ensure humanitarian workers and supplies have safe and continuous access to reach people in need to support our response,” added Dr Tedros. Grim list of equipment Ukrainian child with his dog -displaced by war to a refugee camp on the border with Moldova. Dr Mike Ryan, WHO Executive Director of Health Emergencies, recited a grim list of some of the equipment in the shipment: “sutures, skin graft equipment, equipment for doing major surgery and unfortunately equipment for doing amputations, for bone grafting, for bone wiring. “These are ordinary civilians being broken and the health system is going to have to put them back together again and they need this very specialised equipment,” said Ryan. WHO also has a large stock of supplies in the country, concentrated in the Ukrainian capital city of Kyiv, Ryan added. But those stores, right now are “blocked” by the constant bombardments and tightening Russian blockade around the city. He appealed for “humanitarian access, corridors, moments of peace – anything that can be done … where we can move supplies, move patients.” ‘You can’t wait for oxygen’ Dr Mike Ryan An estimated 2000 COVID-19 patients remain seriously ill in hospital and in need of high-flow oxygen, Ryan added. WHO had warned earlier this week that oxygen was in short supply for those people and others with chronic conditions. But there are now soaring needs for more oxygen to treat the war-wounded, children struck with pneumonia, as well as mothers and newborns birthed in desperate conditions. “Oxygen is lifesaving, full stop. And when you need it, you can’t wait until tomorrow,” Ryan said, warning that without a replenishment of supplies soon “people will die needlessly in the dark. They are dying needlessly to start with, but there is a secondary level of needlessness”. “When you see nurses mechanically ventilating infants in basements of hospitals, even the toughest of us struggle to watch those heroes… taking care of those kids. “It’s really important that we don’t just break this down into supplies and commodities that we have to deliver,” he stressed. “This is people’s bodies. People’s bones are broken, people’s lives are being lost.” WHO training in mass casualty management Ryan also disclosed that the WHO had been conducting training in “mass casualty management and major surgical training” in hospitals all over Ukraine over the past few months – in anticipation of a possible Russian invasion. However, when asked why the WHO never mentioned Russia in its statements, Ryan said that the WHO stood for peace and did not want to get involved in the politics of the conflict. “Our primary purpose is to sustain and preserve the health system in Ukraine that may serve the people of Ukraine and we will do everything in our power to make that happen,” said Ryan. Attacks on health facilities violate international law COVID-19 patient in severe state in Chernivtsi, southwestern Ukraine. As the SARS-CoV2 pandemic wanes, a health emergency – created solely by human forces. The senior leadership was more outspoken about attacks on health facilities and health workers are, which Dr Tedros described as a violation of international law. He said that the WHO had confirmed one such report, which killed four people, and was in the process of verifying reports on several other incidents. The Ukrainian army claimed yesterday that a hospital had also come under attack in Kharkiv after Russian forces landed in the city. “We have received several unconfirmed reports of attacks on hospitals and health infrastructure and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers,” said Dr Tedros. “The sanctity and neutrality of health care, including of health workers, patient supplies, transport and facilities, and the right to safe access to care, must be respected and protected.” Maintaining COVID-19 care during a war Dr Jarno Habicht, WHO Ukraine Dr Jarno Habicht, head of the WHO’s Ukraine Country Office, said that while there was a protocol in place to move goods from Poland to Ukraine, this was only possible where direct military offensives are not taking place. “So there is certain access, but as the situation evolves, that access is decreasing and the challenge is that where the major needs are for the surgery, trauma care, there we don’t have access,” said Habicht. He added that an Omicron-driven COVID-19 outbreak had peaked in Ukraine in mid-February and although this wave had been milder, many elderly people had been hospitalised. The mass movement of people throughout the country to try to avoid the war is now likely to exacerbate the spread of the virus once more, he warned. “Infectious diseases ruthlessly exploit the conditions created by war: the increase the transmission of these diseases from the crowding, the conditions. More people are vulnerable in the settings and there’s less care available for them. It’s as simple as that. What can we do about it? Number one, stop the war,” said Dr Bruce Aylward, a WHO special adviser. Over 870,000 refugees from among Ukraine’s 44 million people, have already entered surrounding countries, which also are battling COVID-19, Dr Heather Papowitz, the WHO’s incident manager for Europe, reported. This inflow also will strain their health systems, she predicted. "They are just very young, they don't understand." Olga fled Ukraine with her children when the first bombs fell. pic.twitter.com/GDsHiZ6rSw — UNHCR, the UN Refugee Agency (@Refugees) March 1, 2022 UNICEF and UNHCR also issue warnings WHO’s briefing came just hours before the UN General Assembly voted overwhelmingly to “deplore” the Russian invasion. The vote came in a resolution supported by 141 of the Assembly’s 193 members, at an emergency session called by the U.N. Security Council. Meanwhile, UNICEF also called for an immediate suspension of hostilities, and the UNHCR warned that the humanitarian crisis being seen now, on day seven, of the crisis, is only the beginning. “As we speak there are 520,000 refugees from Ukraine in neighboring countries. This figure has been rising exponentially, hour after hour, literally since Thursday.” said High Commission Filippo Grandi, in a Tweet Tuesday. And indeed, 24 hours later, WHO estimates were that more than 800,00 people had fled. Meanwhile, heavy fighting continued in the strategically-located Black Sea port city of Kherson, while Russia claimed that it had taken control of the city, following hours of continuous air strikes and bombardment that has destroyed thousands of homes, and forced hundreds of thousands of people to flee – if they could. Russia meanwhile continued shelling and bombing other key cities, including Kharkiv and Mariupol, in its efforts to subdue the country that has shown unusually stiff resistance, despite the overwhelming imbalance of weaponry in favour of Moscow. Mariupol was near a “humanitarian catastrophe,” after more than 15 hours of continuous bombardment, its mayor told BBC. He said water and power to parts of the city had been cut off, a densely populated residential district nearly flattened, and hundreds of people were dead – with no way to even retrieve the bodies. Speaking to Health Policy Watch, diplomatic sources in Europe warned of a pending Russian attack on Kyiv, around which a massived columns of tanks and armored personal carriers have been grouping over the past few days, despite stiff Ukranian resistance on the roads. The next stage of Russian attack could likely involve “precision guided missiles,” aimed at the key government buildings of the city center. “Don’t know how precise it will be, there will certainly be lots of casualties,” said one source. “We see hospitals are being bombarded, people have nowhere to go. They have bombed out whole cities and there are no green zones for non-combatants. People don’t have bomb shelters because Ukraine hasn’t fought anyone since World War II. It’s like Canadians fighting Americans, no one could have imagined it could go to this level of barbarity and cruelty,” said one former resident of Kyiv, who spoke with Health Policy Watch. –Elaine Ruth Fletcher contributed to this story Image Credits: Elena Mozhvilo/ Unsplash, UNICEF/UN0599222/Moldovan, Mstyslav Chernov/ Wikimedia Commons. As Ukrainians Flee, WHO Stresses Importance of Lifesaving NCD Care for Refugees and Migrants 01/03/2022 Kerry Cullinan WHO NCD Director Dr Bente Mikkelsen As streams of Ukrainians leave their country to escape from Russian attacks, the World Health Organization (WHO) is concerned that they, and other migrants and refugees, are not being included in programmes to treat critical non-communicable diseases (NCDs), like diabetes, that can be deadly if treatment is not maintained. WHO’s NCD Director Dr Bente Mikkelsen said that she had been approached on Tuesday to assist with diabetes treatment for ill Ukrainian refugees. Addressing the launch of a new WHO review on ensuring NCD care and treatment for migrants on Tuesday, Mikkelsen said that “international migrants, including refugees, may face extreme poverty and inadequate access to food and health care already in their own countries, and then during the migration process, and in the country of destination, they may be exposed by economic inequalities, social exclusion and discrimination.” “As we speak, unfortunately, we see a new big wave of migration happening due to the horrible situation in Ukraine. This morning, I was contacted by people really concerned about diabetes care in already sick patients, and how we could best support this,” she added. As we are responding to the dire situation of people forcibly displaced in Ukraine, WHO 2nd report of the Global Evidence Review on Health and Migration series – on #NCDs reminds us of the need to better address the need of refugees and migrants https://t.co/5oo2RtQL7b — Slim Slama (@docfromtheblock) March 1, 2022 Meanwhile, WHO Deputy Director-General Dr Zsuzsanna Jakab, said that the 2030 Agenda for Sustainable Development and Sustainable Development Goals emphasised the principles of “leaving no one behind, including refugees and migrants”. “Refugees and migrants have specific health needs and vulnerabilities, which in practice, may all too often fail to be recognised and addressed and which may have been exacerbated during the pandemic,” added Jakab. “It is imperative that has the health needs of these vulnerable groups is addressed by transmitting and receiving countries using human rights principles and with careful coordination across sectors,” said Jakab, adding that more research was needed to better understand the global trends, magnitude and implications of migration and health as well as how to address migrants’ NCD-related needs Almost three-quarters (74%) of global deaths are caused by cancer, diabetes, cardiovascular diseases and lung diseases, said Mikkelson and that the lack of investment in NCD care was “dire”, particularly since COVID-19. The review looks at “academic and grey literature published between 2010 and 2021” that identified major challenges for NCDs in refugees and migrants because of the multifaceted dynamics of the migration processes. Migrant-specific barriers in accessing NCD services include cultural and language differences, social exclusion, discrimination and legal status, according to the review. It calls for strengthened governance and policies, research and data monitoring, and health service delivery to ensure inclusive NCD prevention, treatment and care to meet internationally agreed goals and targets. New Studies Contend: Wuhan Market Animals, Not Laboratory, First Infected Humans with SARS-COV2 28/02/2022 Kerry Cullinan Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter. Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats. The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year. Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control. It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating in the Huanan market in the early days of 2020 alongside its sequel, Lineage B. That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market – whereas Lineage A was the first to spread among people in the city of 10 million. China study corroborates findings of University of Arizona researchers Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues. The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak. While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held. The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2. Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020. Around one-third were lineage A and two-thirds were lineage B. “We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B. The patterns in the phylogeny are the giveaway,” according to Worobey. The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include: a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold. And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed. "Together, these analyses provide dispositive evidence for the emergence of SARS-CoV-2 via the live wildlife trade and identify the Huanan market as the unambiguous epicenter of the COVID-19 pandemic." pic.twitter.com/rjgNPyOu3q — Michael Worobey (@MichaelWorobey) February 26, 2022 In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more… “It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus. It happened to be a stall that one of us, @edwardcholmes, had visited 5 years before the pandemic, and where he had taken this photo of a raccoon dog. pic.twitter.com/19ltUkCI1W — Michael Worobey (@MichaelWorobey) February 26, 2022 Market is epicentre The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported. According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.” Based on these maps, “Huanan market sits right in the highest density region,” he adds. We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the the epidemic. Its epicenter was at the market — Michael Worobey (@MichaelWorobey) February 26, 2022 “This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market. Chinese paper also points to the market In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported. The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported. Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study. But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”. Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC. This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base. And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak. -Elaine Ruth Fletcher contributed to this story. Image Credits: Arend Kuester/Flickr. Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
As UN ‘Deplores’ Russian Invasion, WHO Appeals for Humanitarian Corridor in Ukraine for Medical Supplies 02/03/2022 Kerry Cullinan The World Health Organization (WHO) on Wednesday appealed for a “humanitarian corridor” to enable it to deliver emergency medical supplies to sick and injured Ukrainians – particularly oxygen, insulin and equipment needed to treat battle wounds. The WHO appeal at a media briefing Wednesday came just hours before the UN General Assembly overwhelmingly approved a resolution that “deplores” Russia’s “aggression against the Ukraine” – on a day when Russia ramped up its bombing and shelling of major Ukranian urban centres, including Kharkhiv, Kherson and Mariupol, leading to evermore mounting casualties, by the hour. Meanwhile, over 870,000 people have already fled Ukraine, WHO European officials disclosed – several hundred thousand people than estimates from just 24 hours ago, as numbers grow exponentially. Their arrival will create more knock-on impacts for stressed health systems in neighboring countries. As for humanitarian supplies destined for the beseiged country, “the first shipment will arrive in Poland tomorrow, including six metric tonnes of supplies for trauma care and emergency surgery,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing. But getting the supplies to thousands of critically injured and ill people is yet another matter, he said. “There is an urgent need to establish a corridor to ensure humanitarian workers and supplies have safe and continuous access to reach people in need to support our response,” added Dr Tedros. Grim list of equipment Ukrainian child with his dog -displaced by war to a refugee camp on the border with Moldova. Dr Mike Ryan, WHO Executive Director of Health Emergencies, recited a grim list of some of the equipment in the shipment: “sutures, skin graft equipment, equipment for doing major surgery and unfortunately equipment for doing amputations, for bone grafting, for bone wiring. “These are ordinary civilians being broken and the health system is going to have to put them back together again and they need this very specialised equipment,” said Ryan. WHO also has a large stock of supplies in the country, concentrated in the Ukrainian capital city of Kyiv, Ryan added. But those stores, right now are “blocked” by the constant bombardments and tightening Russian blockade around the city. He appealed for “humanitarian access, corridors, moments of peace – anything that can be done … where we can move supplies, move patients.” ‘You can’t wait for oxygen’ Dr Mike Ryan An estimated 2000 COVID-19 patients remain seriously ill in hospital and in need of high-flow oxygen, Ryan added. WHO had warned earlier this week that oxygen was in short supply for those people and others with chronic conditions. But there are now soaring needs for more oxygen to treat the war-wounded, children struck with pneumonia, as well as mothers and newborns birthed in desperate conditions. “Oxygen is lifesaving, full stop. And when you need it, you can’t wait until tomorrow,” Ryan said, warning that without a replenishment of supplies soon “people will die needlessly in the dark. They are dying needlessly to start with, but there is a secondary level of needlessness”. “When you see nurses mechanically ventilating infants in basements of hospitals, even the toughest of us struggle to watch those heroes… taking care of those kids. “It’s really important that we don’t just break this down into supplies and commodities that we have to deliver,” he stressed. “This is people’s bodies. People’s bones are broken, people’s lives are being lost.” WHO training in mass casualty management Ryan also disclosed that the WHO had been conducting training in “mass casualty management and major surgical training” in hospitals all over Ukraine over the past few months – in anticipation of a possible Russian invasion. However, when asked why the WHO never mentioned Russia in its statements, Ryan said that the WHO stood for peace and did not want to get involved in the politics of the conflict. “Our primary purpose is to sustain and preserve the health system in Ukraine that may serve the people of Ukraine and we will do everything in our power to make that happen,” said Ryan. Attacks on health facilities violate international law COVID-19 patient in severe state in Chernivtsi, southwestern Ukraine. As the SARS-CoV2 pandemic wanes, a health emergency – created solely by human forces. The senior leadership was more outspoken about attacks on health facilities and health workers are, which Dr Tedros described as a violation of international law. He said that the WHO had confirmed one such report, which killed four people, and was in the process of verifying reports on several other incidents. The Ukrainian army claimed yesterday that a hospital had also come under attack in Kharkiv after Russian forces landed in the city. “We have received several unconfirmed reports of attacks on hospitals and health infrastructure and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers,” said Dr Tedros. “The sanctity and neutrality of health care, including of health workers, patient supplies, transport and facilities, and the right to safe access to care, must be respected and protected.” Maintaining COVID-19 care during a war Dr Jarno Habicht, WHO Ukraine Dr Jarno Habicht, head of the WHO’s Ukraine Country Office, said that while there was a protocol in place to move goods from Poland to Ukraine, this was only possible where direct military offensives are not taking place. “So there is certain access, but as the situation evolves, that access is decreasing and the challenge is that where the major needs are for the surgery, trauma care, there we don’t have access,” said Habicht. He added that an Omicron-driven COVID-19 outbreak had peaked in Ukraine in mid-February and although this wave had been milder, many elderly people had been hospitalised. The mass movement of people throughout the country to try to avoid the war is now likely to exacerbate the spread of the virus once more, he warned. “Infectious diseases ruthlessly exploit the conditions created by war: the increase the transmission of these diseases from the crowding, the conditions. More people are vulnerable in the settings and there’s less care available for them. It’s as simple as that. What can we do about it? Number one, stop the war,” said Dr Bruce Aylward, a WHO special adviser. Over 870,000 refugees from among Ukraine’s 44 million people, have already entered surrounding countries, which also are battling COVID-19, Dr Heather Papowitz, the WHO’s incident manager for Europe, reported. This inflow also will strain their health systems, she predicted. "They are just very young, they don't understand." Olga fled Ukraine with her children when the first bombs fell. pic.twitter.com/GDsHiZ6rSw — UNHCR, the UN Refugee Agency (@Refugees) March 1, 2022 UNICEF and UNHCR also issue warnings WHO’s briefing came just hours before the UN General Assembly voted overwhelmingly to “deplore” the Russian invasion. The vote came in a resolution supported by 141 of the Assembly’s 193 members, at an emergency session called by the U.N. Security Council. Meanwhile, UNICEF also called for an immediate suspension of hostilities, and the UNHCR warned that the humanitarian crisis being seen now, on day seven, of the crisis, is only the beginning. “As we speak there are 520,000 refugees from Ukraine in neighboring countries. This figure has been rising exponentially, hour after hour, literally since Thursday.” said High Commission Filippo Grandi, in a Tweet Tuesday. And indeed, 24 hours later, WHO estimates were that more than 800,00 people had fled. Meanwhile, heavy fighting continued in the strategically-located Black Sea port city of Kherson, while Russia claimed that it had taken control of the city, following hours of continuous air strikes and bombardment that has destroyed thousands of homes, and forced hundreds of thousands of people to flee – if they could. Russia meanwhile continued shelling and bombing other key cities, including Kharkiv and Mariupol, in its efforts to subdue the country that has shown unusually stiff resistance, despite the overwhelming imbalance of weaponry in favour of Moscow. Mariupol was near a “humanitarian catastrophe,” after more than 15 hours of continuous bombardment, its mayor told BBC. He said water and power to parts of the city had been cut off, a densely populated residential district nearly flattened, and hundreds of people were dead – with no way to even retrieve the bodies. Speaking to Health Policy Watch, diplomatic sources in Europe warned of a pending Russian attack on Kyiv, around which a massived columns of tanks and armored personal carriers have been grouping over the past few days, despite stiff Ukranian resistance on the roads. The next stage of Russian attack could likely involve “precision guided missiles,” aimed at the key government buildings of the city center. “Don’t know how precise it will be, there will certainly be lots of casualties,” said one source. “We see hospitals are being bombarded, people have nowhere to go. They have bombed out whole cities and there are no green zones for non-combatants. People don’t have bomb shelters because Ukraine hasn’t fought anyone since World War II. It’s like Canadians fighting Americans, no one could have imagined it could go to this level of barbarity and cruelty,” said one former resident of Kyiv, who spoke with Health Policy Watch. –Elaine Ruth Fletcher contributed to this story Image Credits: Elena Mozhvilo/ Unsplash, UNICEF/UN0599222/Moldovan, Mstyslav Chernov/ Wikimedia Commons. As Ukrainians Flee, WHO Stresses Importance of Lifesaving NCD Care for Refugees and Migrants 01/03/2022 Kerry Cullinan WHO NCD Director Dr Bente Mikkelsen As streams of Ukrainians leave their country to escape from Russian attacks, the World Health Organization (WHO) is concerned that they, and other migrants and refugees, are not being included in programmes to treat critical non-communicable diseases (NCDs), like diabetes, that can be deadly if treatment is not maintained. WHO’s NCD Director Dr Bente Mikkelsen said that she had been approached on Tuesday to assist with diabetes treatment for ill Ukrainian refugees. Addressing the launch of a new WHO review on ensuring NCD care and treatment for migrants on Tuesday, Mikkelsen said that “international migrants, including refugees, may face extreme poverty and inadequate access to food and health care already in their own countries, and then during the migration process, and in the country of destination, they may be exposed by economic inequalities, social exclusion and discrimination.” “As we speak, unfortunately, we see a new big wave of migration happening due to the horrible situation in Ukraine. This morning, I was contacted by people really concerned about diabetes care in already sick patients, and how we could best support this,” she added. As we are responding to the dire situation of people forcibly displaced in Ukraine, WHO 2nd report of the Global Evidence Review on Health and Migration series – on #NCDs reminds us of the need to better address the need of refugees and migrants https://t.co/5oo2RtQL7b — Slim Slama (@docfromtheblock) March 1, 2022 Meanwhile, WHO Deputy Director-General Dr Zsuzsanna Jakab, said that the 2030 Agenda for Sustainable Development and Sustainable Development Goals emphasised the principles of “leaving no one behind, including refugees and migrants”. “Refugees and migrants have specific health needs and vulnerabilities, which in practice, may all too often fail to be recognised and addressed and which may have been exacerbated during the pandemic,” added Jakab. “It is imperative that has the health needs of these vulnerable groups is addressed by transmitting and receiving countries using human rights principles and with careful coordination across sectors,” said Jakab, adding that more research was needed to better understand the global trends, magnitude and implications of migration and health as well as how to address migrants’ NCD-related needs Almost three-quarters (74%) of global deaths are caused by cancer, diabetes, cardiovascular diseases and lung diseases, said Mikkelson and that the lack of investment in NCD care was “dire”, particularly since COVID-19. The review looks at “academic and grey literature published between 2010 and 2021” that identified major challenges for NCDs in refugees and migrants because of the multifaceted dynamics of the migration processes. Migrant-specific barriers in accessing NCD services include cultural and language differences, social exclusion, discrimination and legal status, according to the review. It calls for strengthened governance and policies, research and data monitoring, and health service delivery to ensure inclusive NCD prevention, treatment and care to meet internationally agreed goals and targets. New Studies Contend: Wuhan Market Animals, Not Laboratory, First Infected Humans with SARS-COV2 28/02/2022 Kerry Cullinan Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter. Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats. The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year. Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control. It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating in the Huanan market in the early days of 2020 alongside its sequel, Lineage B. That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market – whereas Lineage A was the first to spread among people in the city of 10 million. China study corroborates findings of University of Arizona researchers Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues. The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak. While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held. The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2. Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020. Around one-third were lineage A and two-thirds were lineage B. “We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B. The patterns in the phylogeny are the giveaway,” according to Worobey. The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include: a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold. And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed. "Together, these analyses provide dispositive evidence for the emergence of SARS-CoV-2 via the live wildlife trade and identify the Huanan market as the unambiguous epicenter of the COVID-19 pandemic." pic.twitter.com/rjgNPyOu3q — Michael Worobey (@MichaelWorobey) February 26, 2022 In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more… “It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus. It happened to be a stall that one of us, @edwardcholmes, had visited 5 years before the pandemic, and where he had taken this photo of a raccoon dog. pic.twitter.com/19ltUkCI1W — Michael Worobey (@MichaelWorobey) February 26, 2022 Market is epicentre The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported. According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.” Based on these maps, “Huanan market sits right in the highest density region,” he adds. We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the the epidemic. Its epicenter was at the market — Michael Worobey (@MichaelWorobey) February 26, 2022 “This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market. Chinese paper also points to the market In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported. The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported. Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study. But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”. Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC. This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base. And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak. -Elaine Ruth Fletcher contributed to this story. Image Credits: Arend Kuester/Flickr. Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
As Ukrainians Flee, WHO Stresses Importance of Lifesaving NCD Care for Refugees and Migrants 01/03/2022 Kerry Cullinan WHO NCD Director Dr Bente Mikkelsen As streams of Ukrainians leave their country to escape from Russian attacks, the World Health Organization (WHO) is concerned that they, and other migrants and refugees, are not being included in programmes to treat critical non-communicable diseases (NCDs), like diabetes, that can be deadly if treatment is not maintained. WHO’s NCD Director Dr Bente Mikkelsen said that she had been approached on Tuesday to assist with diabetes treatment for ill Ukrainian refugees. Addressing the launch of a new WHO review on ensuring NCD care and treatment for migrants on Tuesday, Mikkelsen said that “international migrants, including refugees, may face extreme poverty and inadequate access to food and health care already in their own countries, and then during the migration process, and in the country of destination, they may be exposed by economic inequalities, social exclusion and discrimination.” “As we speak, unfortunately, we see a new big wave of migration happening due to the horrible situation in Ukraine. This morning, I was contacted by people really concerned about diabetes care in already sick patients, and how we could best support this,” she added. As we are responding to the dire situation of people forcibly displaced in Ukraine, WHO 2nd report of the Global Evidence Review on Health and Migration series – on #NCDs reminds us of the need to better address the need of refugees and migrants https://t.co/5oo2RtQL7b — Slim Slama (@docfromtheblock) March 1, 2022 Meanwhile, WHO Deputy Director-General Dr Zsuzsanna Jakab, said that the 2030 Agenda for Sustainable Development and Sustainable Development Goals emphasised the principles of “leaving no one behind, including refugees and migrants”. “Refugees and migrants have specific health needs and vulnerabilities, which in practice, may all too often fail to be recognised and addressed and which may have been exacerbated during the pandemic,” added Jakab. “It is imperative that has the health needs of these vulnerable groups is addressed by transmitting and receiving countries using human rights principles and with careful coordination across sectors,” said Jakab, adding that more research was needed to better understand the global trends, magnitude and implications of migration and health as well as how to address migrants’ NCD-related needs Almost three-quarters (74%) of global deaths are caused by cancer, diabetes, cardiovascular diseases and lung diseases, said Mikkelson and that the lack of investment in NCD care was “dire”, particularly since COVID-19. The review looks at “academic and grey literature published between 2010 and 2021” that identified major challenges for NCDs in refugees and migrants because of the multifaceted dynamics of the migration processes. Migrant-specific barriers in accessing NCD services include cultural and language differences, social exclusion, discrimination and legal status, according to the review. It calls for strengthened governance and policies, research and data monitoring, and health service delivery to ensure inclusive NCD prevention, treatment and care to meet internationally agreed goals and targets. New Studies Contend: Wuhan Market Animals, Not Laboratory, First Infected Humans with SARS-COV2 28/02/2022 Kerry Cullinan Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter. Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats. The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year. Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control. It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating in the Huanan market in the early days of 2020 alongside its sequel, Lineage B. That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market – whereas Lineage A was the first to spread among people in the city of 10 million. China study corroborates findings of University of Arizona researchers Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues. The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak. While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held. The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2. Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020. Around one-third were lineage A and two-thirds were lineage B. “We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B. The patterns in the phylogeny are the giveaway,” according to Worobey. The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include: a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold. And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed. "Together, these analyses provide dispositive evidence for the emergence of SARS-CoV-2 via the live wildlife trade and identify the Huanan market as the unambiguous epicenter of the COVID-19 pandemic." pic.twitter.com/rjgNPyOu3q — Michael Worobey (@MichaelWorobey) February 26, 2022 In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more… “It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus. It happened to be a stall that one of us, @edwardcholmes, had visited 5 years before the pandemic, and where he had taken this photo of a raccoon dog. pic.twitter.com/19ltUkCI1W — Michael Worobey (@MichaelWorobey) February 26, 2022 Market is epicentre The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported. According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.” Based on these maps, “Huanan market sits right in the highest density region,” he adds. We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the the epidemic. Its epicenter was at the market — Michael Worobey (@MichaelWorobey) February 26, 2022 “This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market. Chinese paper also points to the market In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported. The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported. Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study. But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”. Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC. This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base. And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak. -Elaine Ruth Fletcher contributed to this story. Image Credits: Arend Kuester/Flickr. Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
New Studies Contend: Wuhan Market Animals, Not Laboratory, First Infected Humans with SARS-COV2 28/02/2022 Kerry Cullinan Wild animal carcasses in the Huanan market in Wuhan on display just after slaughter. Three pre-print papers published over the past few days have strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Huanan wildlife market in Wuhan – rather than from the Wuhan Institute of Virology, the laboratory studying coronaviruses in bats. The two theories have been hotly, and often bitterly, disputed by scientists around the world for over a year. Significantly, one of the pre-print papers was published by a large group of Chinese researchers based at the China Center for Disease Prevention and Control. It offers, after two years of silence, evidence that the first strain of the SARS-CoV2 virus to be identified circulating among people in Wuhan, dubbed SARS-CoV2 Lineage A, was also circulating in the Huanan market in the early days of 2020 alongside its sequel, Lineage B. That provides a critical missing link, insofar as other studies had previously only succeeded in identifying Lineage B in environmental samples taken from the Huanan market – whereas Lineage A was the first to spread among people in the city of 10 million. China study corroborates findings of University of Arizona researchers Equally significant, the findings of the China researchers also corroborate the conclusions of two studies led by Michael Worobey, Head of Ecology and Evolutionary Biology at the University of Arizona, and colleagues. The latest paper, published on 26 February, concludes that critical events of virus transmission from animals to humans happened in two different events at the market, possibly a week apart, and involving strains of the virus dubbed SARS-COV2 A and SARS-COV2 B – the main cases circulating in China during the early days of the outbreak. While all of the samples reviewed in both the Chinese study, as well as the one by Worobey, were taken from environmental surfaces – not the animals themselves – they are most evident in the areas of the market where wild animals were kept captive and slaughtered – including items like cages where the animals were held. The newly-published papers recently still fail to identify a single species as that elusive ‘Animal X’ – the so-called “intermediate host” that transmitted the virus originating harbored by bats to humans. But the studies still offer the most conclusive evidence, to date, that animals in the Huanan market indeed may have been the first to infect people in the city of 10 million people with SARS-CoV2. Where is ‘Animal X’? Summary of SARS-CoV2 Origins Report Worobey and colleagues examined over 700 complete genomes of SARS-CoV-2 that could be mapped from the environmental samples in the market, taken between December 2019 and up until mid-February 2020. Around one-third were lineage A and two-thirds were lineage B. “We find that there were very likely at least two origins of SARS-CoV-2 – one for lineage A and one for lineage B. The patterns in the phylogeny are the giveaway,” according to Worobey. The study adds that “multiple lines of evidence” from the environmental samples all point to wild animals – even if animal samples, per se, were not available for the study. Those include: a high concentration of SARS-CoV2 positive samples taken from surfaces in the southwestern corner of the market where wild mammals were sold and slaughtered, and the highest concentration of early SARS-CoV2 cases among vendors in the areas where live mammals were sold. And while no single animal was identified as the main cause of transmission, the study also singles out a particular cluster of positive virus samples in the area where racoon dogs were illegally sold, as well as a cage where the dogs were housed. "Together, these analyses provide dispositive evidence for the emergence of SARS-CoV-2 via the live wildlife trade and identify the Huanan market as the unambiguous epicenter of the COVID-19 pandemic." pic.twitter.com/rjgNPyOu3q — Michael Worobey (@MichaelWorobey) February 26, 2022 In a detailed series of tweets, Worobey zeroes in on the racoon dogs further saying: “One striking (to us at least) finding: one stall had 5 environmental positive samples for very animal-centric surfaces, including a “metal cage in a back room”. …one of the stalls we know was selling live mammals illegally in late 2019. But, there’s more… “It happened to be a stall that one of us, @edtwardcholmes, had visited 5 years before the pandemic, and where he had taken a photo of this racoon dog” – an animal susceptible to the SARS-CoV2 virus. It happened to be a stall that one of us, @edwardcholmes, had visited 5 years before the pandemic, and where he had taken this photo of a raccoon dog. pic.twitter.com/19ltUkCI1W — Michael Worobey (@MichaelWorobey) February 26, 2022 Market is epicentre The other paper makes a detailed examination of the spatial evidence on the proximity of the market to the first clusters of human cases in the Wuhan community. It refers to maps from the World Health Organization (WHO) report on the origins of SARS-CoV-2, which enabled researchers to plot the density of the first COVID-19 cases in Wuhan in December 2019 – even before the outbreak was publicly reported. According to Worobey, “We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the epidemic.” Based on these maps, “Huanan market sits right in the highest density region,” he adds. We found that cases in December were both nearer to, and more centered on, the Huanan market than could be expected given either the population density distribution of Wuhan, or the spatial distribution of COVID cases later in the the epidemic. Its epicenter was at the market — Michael Worobey (@MichaelWorobey) February 26, 2022 “This is a clear indication that community transmission started at the market,” added Worobey in his lengthy Twitter thread explaining the findings of the two studies. In addition, the mapping showed that both cases of people infected with both SARS-CoV-2 lineage A and lineage B had a strong association with the market. Chinese paper also points to the market In the case of the other pre-print published by the group of China CDC researchers led by George Gao, Gao and colleagues examined 1380 samples collected from both the environment and animals at the market in early 2020. Of these, 73 environmental samples tested positive for SARS-CoV-2 and three live viruses were successfully isolated, they reported. The viruses “shared nucleotide identity of 99.980% to 99.993% with the human isolate”, they reported. Here too, no SARS-CoV2 virus was detected in the animal swabs covering 18 species of animals on sale in the market – despite the fact that such samples were taken and study. But the paper still concludes that there is “convincing evidence of the prevalence of SARS-CoV-2 in the Huanan Seafood Market during the early stage of COVID-19 outbreak”. Although that conclusion does not go as far those of Worobey and his colleagues, it is significant insofar as the study’s authors are affiliated with China CDC. This also suggests that Chinese authorities may be finally coming to terms with the overwhelming evidence about the Chinese origins of the virus outbreak in humans, which some reports earlier had tried to attribute to factors such as the import of frozen foods, or an imported outbreak from a foreign military base. And in light of that, scientists are being allowed to release some long-sought evidence about the presence of the virus in the Wuhan market during the early days of the outbreak. -Elaine Ruth Fletcher contributed to this story. Image Credits: Arend Kuester/Flickr. Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Expanding Global Research Capabilities to Prepare for Future Pandemics 27/02/2022 Raisa Santos R&D for new vaccines, tests and treatments: Despite the ever-increasing complexity of the pure science, political and community buy-in and ecosystem approaches to prevention remain equally critical. From increasing disease surveillance and developing a pan-coronavirus vaccine to ‘eco-health’ and public trust, participants in the COVID-19 Global Research and Innovation Forum considered ways to globally prepare for future pandemics and end the current one. The third such forum, hosted by the World Health Organization, brought together over 100 research scientists, experts, policy makers, and donors worldwide to discuss and strategize about the future of COVID-19 research 24-25 February. Along with the more technical aspects of disease tracking, diagnostics and new vaccines, speakers emphasized the need for research to go beyond the narrow confines of laboratories and clinical trials so as to strengthen health systems to use the science well – and build public confidence in its value. Wellcome Trust Director Jeremy Farrar Ultimately it’s about preparedness, said Wellcome Trust Director Jeremy Farrar, in a Thursday keynote address, “what you have before a crisis hits will determine your ability to prevent it and respond early.” Public trust in scientific solutions also needed to be rebuilt, he added, making indirect reference to the public protests seen in the last pandemic over issues like masks and vaccines. “No amount of science will deliver vaccines, therapeutics, diagnostic tests, or anything else that we can intervene with, unless we have the trust of societies. And all of us, myself included, have taken that trust for granted for too long.” To do that, as well as ensuring equitable access to tools and solutions, Farrar and others urged policymakers to ‘reinvent’ health systems, science, and research ensuring that they are anchored within the communities that are to be served. Increased access to data surveillance through WHO Pandemic and Epidemic Hub Dr Chikwe Ihekweazu Getting down to the nitty-gritty, Chikwe Ihekwazu, the recently-named director of the new WHO Hub for Pandemic and Epidemic Intelligence, explained how increased global surveillance data, inclusive animal and environmental health, is critical to quickly identifying and tracking outbreaks. The new hub, a collaboration with the German government, is based in Berlin. However, data alone is not enough. “Often we have the data but we are unable to use it, because we don’t have access to the analytics, both in terms of the tools, the human resources, and all the governance in place,” said Ihekwazu. “Our problem, our challenge, is not to ensure that [politicians] make the right decisions, we need to provide them [with] the best possible opportunity of making the right decisions for humanity.” What is needed for pandemic and epidemic intelligence. The role of the WHO Hub, inaugurated last September, is to fill critical surveillance gaps, supporting national public health experts and policy-makers in acquring and developing the very tools needed to forecast, detect, and assess epidemic and pandemic risks through a ‘system of collaborative intelligence’. ‘Collaborative’ is the key word, noted Ihekwazu. “This is not something we will do for the world. This is something we will do with the world.” Pan coronavirus vaccine is next step The technology to develop a pan-coronavirus vaccine is already in place. Along with the continuous evolution of SARS-CoV2, there is a high likelihood that other coronavirus strains could emerge from the wild, and so the holy grail of vaccine R&D now should be the development of a pan-coronavirus vaccine, many researchers also agreed. They spoke just a day after the CEPI announced a major grant to India to develop such a jab. Moderna and US-based Duke University also are working on pan-coronavirus technologies that would offer broader protection against both existing and future SARS-CoV2 variants, as well as all beta coronaviruses. “It’s not a sustainable strategy to continue to have to boost people as variants continue to rise, and at some point, this boosting may not adequately address future variants,” said Phil Krause, chairperson of the WHO COVID vaccines research expert group. “We wouldn’t have gotten to where we are today if there hadn’t been some work on previous pandemics or epidemics including MERS. [We need to keep] both speed and rigour in developing and evaluating vaccines.” Pandemic saw boom in vaccine R&D As a silver lining in the cloud, the pandemic has accelerated know-how that makes development of a pan-coronavirus vaccine, as well as other types of new vaccines, more feasible, said Stanley Plotkin, of the US-based Johns Hopkins University. “Despite the death and destruction and disease that this SARS-CoV-2 has caused us, these last two years have been the best years in vaccinology since the polio days, because we now have multiple strategies for developing vaccines. “The advantage of this extends beyond coronavirus,” Plotkin added, noting that new and improved vaccine technologies can be applied to a range of deadly diseases with epidemic potential, including Zika virus, Nipah virus, and Ebola. Embedding the ‘one-health’ approach into prevention strategies Drivers of disease emergence over last 60 years Beyond vaccines, broader “ecosystem” and one-health approaches are needed to address pandemic risks. That’s not only because prevention is better than cure – but because coronaviruses, as such, are not the only risk. The risk can be from a range of infectious respiratory, vector-borne or water-borne viruses that come into increased contact with people, as a result of urbanization, wilderness degradation and industrialised food production, and then adapt to infect humans. So looking at the drivers of disease emergence, are equally important, said William Karesh of the Canadian-based EcoHealth Alliance, as “many of which lead to pandemics and some of which do not.” Those include land use changes that bring wildlife and humans in closer contact, as well as certain patterns of intensive agriculture and meat production, which stimulate disease transmission between animals and between animals to humans. Karesh proposes a ‘society-wide approach’, echoing Farrar about the importance of engaging with communities to influence health, economic, and social wellbeing outcomes. This doesn’t mean that investments should shift away from the health sector, but investments in pandemic preparedness and prevention should be ‘diversified’ with other stakeholders. “We need to expand the pie by engaging other sectors of society.” Better planning of pig farms to prevent Nipah virus in Malaysia He and others described, for instance, how the better planning of pig farms had been used to help prevent the transmission of Nipah virus in Malaysia from bats to pigs and finally humans. Nipah virus was first identified in pigs and pig farmers in the country in 1998; however, the virus itself originates from fruit bats. The practice of planting fruit trees, which harbour bats, on land that is also used for livestock production is the most likely pathway of transmission to humans. With this in mind, farmers have been encouraged to separate their pig styes from areas where they are raising orchard trees. These “practical solutions that are at our disposal already” said Catherine Machalaba, also of the EcoHealth Alliance, saying: “[We need to build that] into how we plan our new developments and make prevention embedded into our other sectors.” Image Credits: Afrigen , (Photo: Adobe Stock), WHO , WHO, Eco Health Alliance , EcoHealth Alliance . 13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
13 African Nations Have Expressed Interest in Hosting the New African Medicines Agency 26/02/2022 Paul Adepoju Margareth Ndomondo-Sigonda Some thirteen African nations have expressed interest in hosting the new African Medicines Agency, with an AU decision on where to establish the AMA’s headquarters set for July 2022, senior African Union officials say. A decision on a headquarters would also pave the way for the recruitment of a director general for the new AMA agency. And if the DG selection is completed by the third or fourth quarter of 2022, as expected: “from there the AMA will be ready for takeoff.” That was the forecast of Margareth Ndomondo-Sigonda, Head of the Health Unit at the African Union Development Agency–New Partnership for Africa’s Development (AUDA-NEPAD). She was speaking at a special briefing Thursday on the AMA, sponsored by the US-based Center for Global Development. COVID pandemic has accelerated AMA’s establishment Jean Baptiste Nikiema – WHO Africa Regional Office The COVID-19 pandemic has played a crucial role in accelerating the emergence of the AMA, said Jean Baptiste Nikiema, Regional Advisor for Essential Medicines, World Health Organization Africa Regional Office, also speaking at the briefing. Nikiema noted that the current regulatory system, which meant all 55 African Union countries had to individually assess the complex biomolecules, therapeutics and vaccines associated with the COVID pandemic at a rapid pace – had underscored the need to have a continental regulatory authority. “The need arose for an authority to put the sectors together and assess and save time,” he said. “AMA will be the solution in the future [because] we know that this pandemic will not be the last one,” he said. WHO is supporting African countries in the areas of organization, review and to build capacity, he said. Widespread support across continent Nikiema described 2022 and 2023 as very critical years in terms of getting the AMA onto the right path; the momentum created over the past months should be maintained considering the agency is enjoying widespread support across the continent. “When we are speaking to member states, there are no bottlenecks to the treaty’s ratification. The issue is mainly related to country processes,” he said. He therefore enjoined the stakeholders to go beyond the continent-wide approach and start driving the cause nationally too so that the agency can best perform its saddled tasks. “Let’s look at the country level also and maybe have a set of mechanisms to push for the ratification of the treaty because we need AMA for the next pandemic, including this one which is not yet finished,” he said. Dealing with holdouts AMA countdown map – multimedia Infogram As of early February, 30 countries had committed to the AMA by either signing or ratifying the AMA treaty, as reported by Health Policy Watch. However, the continent’s economic powerhouses are still holding out, including Nigeria, South Africa, Ethiopia and Kenya. Responding to the concerns about foot-dragging among these countries, Ndomondo-Sigonda, called for patience and more advocacy, adding that their sovereignty also must be recognized and respected. “These are sovereign states that have the prerogative of determining what is the priority for their respective countries and therefore, we need to not only be patient but I think we need also to do our part in terms of advocacy so that they can understand the value that AMA brings on board when it is operational,” she said. She added that the strength of the AMA also hinges on the strength of national regulatory authorities as such, she said this should be brought to the attention of the strategic countries that their respective national regulatory authorities would also be strengthened in the process. “We know that it’s not just that they will be supporting other countries, but they will also benefit from the outcome of the undertaking. Our advocacy, I think, is very key when it comes to engaging those countries that are considered very strategic,” she added. Calls for patience in operationalizing up the agency David Mukanga, The Bill and Melinda Gates Foundation Even though the AMA would certainly be relevant to the present pandemic, there are also calls for patience with the process – and a long-view perspective. David Mukanga, Senior Program Officer of Regulatory Affairs at the Bill and Melinda Gates Foundation, observed that the Africa CDC was set up about six years ago – and now it is having visible impacts across the continent. “We will need to count on the leadership of the African Union and whoever the AMA DG will be, and the governing board — to really set the tone and the pace, so that people remain excited to continue to support, not just the partners, but more importantly the member states,” Mukanga said. What’s next? Ndomondo-Sigonda said the next step in the AMA’s establishment is the assessment of the proposals by the 13 countries that have offered to host the agency – a process that will take place between March and April 2022. “We’re busy preparing for that. So once that is done, approved and the report is ready, then the plan is to convene the first meeting of the Conference of the State parties which is the highest policy making organ of the AMA,” she said. That AU conference is planned for May 2022. At the AU Assembly to be held in July 2022, the final decision on which country will host AMA headquarters will be made. This, in turn, would pave the way to recruitment of a Director-General of the agency. “So, we are hoping that if all goes well, then in Q3 or Q4 of this year, we’ll have the Director-General in office and, AMA will essentially be running from there and will be ready for takeoff.” See more of our AMA countdown coverage here: African Medicines Agency Countdown In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
In a Pandemic, Put the Last Mile First 26/02/2022 Elke Konings & Lisa Stone Midwife vaccinates an older man during a COVID-19 vaccine campaign in Madagascar. The past 10 days have seen a flurry of new US initiatives to meet the World Health Organizations target of vaccinating 70% of the global population – including a new Global Action Plan; involvement of PEPFAR networks to strengthen health system response; and most recently, a special US thrust in Nigeria, the continent’s most populous nation. Underlining these efforts, as noted by US Secretary of State Antony Blinken in his announcement of the GAP plan, is the urgency of solving so-called ‘last mile’ challenges, like access to cold storage for transporting vaccines to places of implementation. Along with generating demand for vaccines, strengthening community health systems is a vital part of bringing the pandemic to an end. At the same time, we are seeing developed countries finally moving on from the pandemic. Europe is lifting COVID restrictions. Most US states are abandoning mask mandates, and even countries such as Australia are finally reopening to tourists – steps Africa took some months ago. Prioritizing the last mile – investing in the future Health volunteers pick up supplies during a seasonal malaria chemoprevention campaign in Nigeria. But there is a danger, as societies move on – leaving global health agencies to carry out the unfinished business of vaccinating the world – that we will quickly forget the lessons of the last two years. If we only focus on the moment, we will not invest in what needs to be done for the future, to meet the next outbreak, when it happens. In addition, it is essential that we do not forget the importance of investing in local capacity, primary health care and disaster management. The next disease outbreak, just like this one, will begin at the household and community level and reverberate outward as infections spread – we need, therefore, to put the “last mile” first and prioritize local solutions. Vaccines take time to develop and even longer to roll out. Local jurisdictions must be able to respond without waiting for assistance from often overtaxed national health care systems. As we’ve seen throughout the pandemic, a country’s success or failure will correlate with the aggregation of local efforts. From the lessons of the last two years, we recommend action on three fronts: 1. Act local Witoto indigenous nurse technician, Vanda Ortega, sets an example as the first person in her community to receive a COVID-19 vaccine in Manaus, Amazonas, Brazil, on January 18, 2021. National preparedness and response plans, including mitigation policies and vaccination and testing campaigns, must include training of local responders on the ground. These plans should include a pandemic planning scenario and be informed by a multisector, whole government approach with local flexibility. Local jurisdictions also need a legal framework established by the central government that gives them authority for early action. Without this, time is lost, and the window for containment closes. If they have the authority to act, and act quickly, local leaders are better able to manage the response, provide public messaging and risk communication, engage communities, and make key policy decisions. 2. Don’t forget about the importance of primary care and resilience of the public health infrastructure A volunteer carries out COVID19 prevention and risk communication activities under a USAID-supported ‘ACCESS’ programme to strengthen community health services in Madagascar. Who can forget the images of overwhelmed hospitals from New York to South Africa, with makeshift morgues and patients on gurneys clogging crowded hospital halls? Years into the pandemic, we’re now learning of collateral damage: significant excess deaths as cancer, TB, and other diseases go undiagnosed and untreated by overwhelmed hospitals or because people avoid health care institutions. These examples reflect the challenges in pivoting to triage care in a health emergency. Two capabilities are therefore needed when health system resources are overwhelmed: a framework to identify nonessential services that can be temporarily halted and the resources diverted to essential care, including non-pandemic essential care, and a holistic approach to identify additional capacity in the community so resources can be triaged to save the most lives. 3. Give public health a seat at the table with disaster management agencies Sudan: Physical distancing and clustered aid distribution times at this refugee camp during the COVID pandemic – among the critical public health measures taken in humanitarian settings. Pandemic preparedness and response must be fully integrated into existing disaster management agencies at the national and subnational levels. Multisector plans that provide for incident management and cross-sectoral collaboration and include continuity of essential operations should be developed and routinely exercised at the national and local levels. For example, the ability to transport medical supplies or set up security at mass vaccination sites cannot be handled by public health officials alone. The funding mechanisms, surge personnel, and expertise from the other sectors need to be accessed and coordinated through a single management entity. What’s needed are routine, annual exercises that reflect actual national and local plans and include the people who will be tasked with responding. Simulations geared to the highest levels are important, but insufficient. The nonprofit global health organization we work for, Management Sciences for Health, offers a toolkit for local leaders, in low resource settings to help with these efforts. Let’s build on the protocols and strategies developed throughout this pandemic and not forget the lessons learned as the current crisis eases. There will be another one, and we must be better prepared than we are now. Elke Konings Lisa Stone Elke Konings, PhD, MSc, is a senior director for pandemic preparedness, response and recovery at Management Sciences for Health, a nonprofit global health organization. Lisa Stone, MD, MPH, is a pandemic preparedness and response consultant. Image Credits: Samy Rakotoniaina/MSH, Munira Ismail_MSH, Flickr: IMF/Raphael Alves, MSH, UNHCR/Elizabeth Marie Stuart. Posts navigation Older postsNewer posts