Pfizer’s experimental pill works by inhibiting replication of SARS-CoV2 virus.

Pfizer Friday announced that its experimental COVID-19 oral antiviral drug PAXLOVID™ reduced risks of hospitalization and death by 89% among patients who received the drug within the first three days of their illness. The company said it had stopped its Phase 2/3 trial on the drug owing to the success rate seen in an interim analysis of 1,219 adults enrolled in the study – who also had chronic health conditions placing them at higher risk of severe COVID.  

Pfizer is the second pharma firm, after Merck Sharp & Dohme (Merck), to announce highly promising results for an oral drug treatment that reduces serious COVID-19 illness – although the Pfizer results were even more stunning.

PAXLOVID™ has the potential to eliminate up to nine out of ten hospitalizations, Albert Bourla, Chairman and Chief Executive Officer, Pfizer, said in a press release. 

It’s a gamechanger,” Pfizer CEO Albert Bourla told @megtirrell about its Covid-19 antiviral drug. “This is a fantastic demonstration of the power of science.”

If approved for emergency use by the United States Food and Drug Administration (US FDA), PAXLOVID™ would become the first oral COVID antiviral of its kind. The novel treatment includes a newly- designed SARS-CoV-2-3CL protease inhibitor used in combination with a common anti-HIV drug, ritonavir.

Bourla told CNBC that the filing for the drug is expected to be submitted before the U.S. Thanksgiving holiday on Nov. 25.

Pfizer’s results more impressive than Merck’s

The Pfizer announcement follows Merck’s announcement last month that it’s new oral pill, molnupiravir,  had reduced the risks of hospitalization and death by some 50% among people with mild or moderate COVID.

The Merck pill, which was approved by UK regulators last week, introduces errors into the genetic code of the SARS-CoV2 virus that it targets, slowing virus replication.

Pfizer’s reported  results were even more impressive, however.  Based on a primary analysis of interim data from 1,219 at-risk adults who were enrolled by September 29, 2021, only three people administered the drug within three days of sympton onset were hospitalized through day 28 of their illness, with no deaths. In the control group, 27 people were hospitalized, with seven subsequent deaths.

When the company decided to stop recruiting more patients, their enrollment had reached 70 percent of the planned 3,000 patients across North and South America, Europe, Africa, and Asia.

Pfizer drug is based upon a novel protease inhibitor, PF-07321332, that blocks the activity of the enzyme that the coronavirus needs to replicate. Co-administration of ritonavir means that protease inhibitor remains active in the body for longer periods of time to combat the virus. Treatment involves the administration of three PAXLOVID™ pills, twice a day, for five days. 

Pfizer says it will also ensure equitable access to new drug formulation

While Merck’s molnupiravir pill is set to be licensed for generic production in most low- and middle-income countries, Pfizer said that it will offer PAXLOVID™ worldwide, through a tiered pricing approach – while maintaining control of its IP. 

Last week, Merck and the Medicines Patent Pool signed an agreement that paves the way for MPP to sign contracts with generic drug manufacturers to produce and sell their treatment molnupiravir at discounted prices to more than 105 countries worldwide, once the drug receives approval by the World Health Organization.

Pfizer, in contrast, said that its tiered pricing would be “based on the income level of each country to promote equity of access across the globe.

“High and upper-middle income countries will pay more than lower income countries,” Pfizer said, adding that it had already entered into advance purchase agreements with “multiple countries and is in negotiations with several others” – without naming which.

“Pfizer has also begun and will continue to invest up to approximately $1 billion to support the manufacturing and distribution of this investigational treatment, including exploring potential contract manufacturing options to help ensure access across low- and middle-income countries, pending regulatory authorization.”

Image Credits: Wikimedia Commons, peterschreiber.media/Shutterstock .

Dr Tedros

Europe is now the epicentre of the COVID-19 pandemic and what it is experiencing now provides lessons for the rest of the world, according to World Health Organization (WHO) officials addressing a media briefing on Thursday.

In addition, the lack of a systematic, multilateral approach to address this pandemic has only underscored the need for a global agreement on how to address future pandemics, asserted WHO Secretary-General Dr Tedros Adhanom Ghebreyesus. 

Cases in Europe have increased by over 55% increase over the last four weeks despite an ample supply of vaccines and tools. Germany reported 33,949 new COVID-19 infections on Wednesday, its highest daily increase since the start of the pandemic last year.

“We only have to look at the roller-coaster epidemiologic curve [over the past two years] to know that when you’re coming down the mountain you usually about to go back up another one,” said Dr Mike Ryan, WHO Executive Director of Health Emergencies.

“The fact that Europe is climbing that mountain again should really make everyone in the rest of the world stand up. It’s a warning shot for the world to see what’s happening in Europe despite the availability of vaccines.”

Governments put the onus back on individuals

Ryan said that Europe’s cases had been fuelled by increased summer social mixing, more indoor activities as the weather cooled, a reduction in restrictions and – crucially – “the onus has been put back on individuals to continue into individual risk management with little support from the governments”.

“In European countries that have high vaccination levels in vulnerable groups, transmission has been transferred into younger age groups so you have intense transmission without a necessarily huge increase in hospitalisations and deaths,” said Ryan. 

But countries with relatively low vaccine uptake are “facing a very difficult situation” particularly if vaccine uptake has not been high in vulnerable groups, he added.

“Is there a possibility where we can reach a state where we have gained control over transmission in 2022? Absolutely. Is there the possibility that we can remove the death, the severe hospitalizations and death in 2022? Absolutely. We could have done that already. But we haven’t,” added Dr Maria Van Kerkhove, WHO lead on COVID-19.

Future lies in a binding pandemic treaty

“We have no shortage of reports, reviews and recommendations, but we have a shortage of action,” added Tedros. 

“It’s clear what needs to happen: better governance for global health security, including a binding treaty on pandemic preparedness and response,” he said.

“Better financing to strengthen the capacities of all countries, especially the most vulnerable; better systems and tools to prepare for, prevent, detect and respond rapidly to outbreaks with epidemic or pandemic potential and strengthened, empowered and sustainably finance WHO at the centre of the global health architecture.”

Ryan added: “The way we’re dealing with our transnational health issues at the moment is we’re trying to deal with a global threat using individualised solutions.

“We need agreement at a global level on what is to be done to protect the health of the world’s population.”

 

Elhadj As Sy

Elhadji As Sy, the co-chair of the Global Preparedness Monitoring Board (GPMB), also made a strong appeal for an agreement on future pandemics.

The board, an initiative of the WHO and the World Bank, has made five recommendations for global leaders to address COVID-19 as well as future pandemics.

“First, agree at the November 2021 special session of the World Health Assembly (WHA) on the need to adopt an international agreement on pandemic preparedness and response and establish a process for taking forward negotiations,” said As Sy. 

A special session of the WHA is being convened on 31 November – 1 December to consider an international agreement to address future pandemics.

Additional proposals from the GPMB were for a global summit of heads of state and other stakeholders on pandemic preparedness and response; substantially increase the funds to WHO, and “establish a new financial intermediary fund for pandemic preparedness and response”.

As Sy also expressed disappointment at last weekend’s meeting of G20 leaders.

“Honestly, we had hoped for firm financial commitments to fully fund global efforts to curb the pandemic,” he said.

“We had hoped for an agreement to establish a financing mechanism that would provide predictable financing at the scale required to prevent further future pandemics. But what we got was a commitment to keep talking about it.” 

 

 

Prof Marion Koopmans (2nd right) chairs the Chinese and WHO-International team presentation of its findings on the SARS-CoV2 virus origins in Wuhan.

A US organisation that promotes transparency in health policy decisions, Right to Know, has asked the World Health Organization (WHO) to remove 10 of the 26 candidates it had recently named to a new Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) – due to alleged conflicts of interest – and replace them with a list of other candidates that it has proposed.

Coinciding with the letter’s publication, the WHO briefly re-opened nominations for SAGO for three days this week – without any initial elaboration – although a WHO spokesman later said that the Agency was looking for more “diversity” among the SAGO nominees.

In response to a query from Health Policy Watch, WHO spokesperson Tarik Jasarevic said that the agency is  “seeking greater diversity across the technical areas represented in SAGO”. He added that WHO was specifically encouraging additional applications from the fields of social science, anthropology, ethics, political science and biosafety or biosecurity – signalling that the reopening of applications may indeed be related to the criticism by Right to Know and others about the continuing lack of expertise in laboratory biosafety among members of the SAGO group.

In regard to the USRTK criticisms of specific candidates, Jasarevic told Health Policy Watch that WHO was “still reviewing comments received during the two-week period” – following the naming of the group on 13 October.  

The new WHO SAGO expert group is tasked with following upon on the controversial issue of the origins of SARS-CoV2 – to try to determine if the virus leapt to humans as a result of a direct infection by a bat, infection from another intermediate animal host, or as a result of a laboratory accident at the Wuhan Institute of Virology, which was researching bat-borne coronaviruses.  Most recent scientific studies suggest that the SARS-CoV2 is likely to have originated in bats – the question is how the virus was then transmitted to humans.

The open letter to WHO by the US-based Right to Know, (USRTK), a non-profit investigative research group, claims that the 10 SAGO appointees have conflicts of interest that are in violation of the WHO terms of reference for the group.

Objections stem from candidates’ remarks discrediting lab leak theory, and associations with EcoHealth Alliance

Right to Know’s objections to the 10 candidates stem largely from disparaging remarks that were reportedly made by some of the experts had made about the theory that the SARS-CoV2 virus may have escaped from a laboratory; Those views, says Right to Know, would prejudice the work of the SAGO group. 

The Right to Know letter also called out  direct or indirect associations between certain SAGO appointees and the EcoHealth Alliance – which maintained a series of contracts and scientific collaborations with the Wuhan Virology Institute that critics have said led it to protect WIV from allegations of a possible lab leak.

EcoHealth is headed by Peter Daszak, a vocal member of the first, now-disbanded WHO independent scientific group set up last year to look into the origins of SARS-COV2. 

Daszak was not appointed to SAGO amid controversy over the contractual and research ties between his organisation and the Wuhan Institute of Virology on the study of coronaviruses in bats and humans. 

However at least one of the new SAGO candidates, Dr Supaporn Wacharapluesadee is a  subcontractor on a large NIH grant to EcoHealth Alliance, claimed Right to Know, in their letter, stating, “her lab at Chulalongkorn University [Thailand] is slated to receive a $1.07 million subcontract.”  Another appointee, Dr Christian Drosen, had collaborated with EcoHealth and the Wuhan Institute of Virology, stating that r. Drosten’s funding and continued research collaborations rest on the zoonotic potential of bat coronaviruses. For these reasons, Dr. Drosten has a personal stake in SAGO’s outcome, because it is to his personal and professional advantage to declare a zoonotic origin for SARS-CoV-2.

This, too, disqualifies him from being a SAGO member,” stated the letter, adding, “Anyone with personal, financial or academic ties to the EcoHealth Alliance (including grant funding, co-authorship or other research collaboration) or the Wuhan Institute of Virology, cannot be a SAGO member, because such ties could impair their judgment in an investigation of zoonotic and/or lab origins of SARS-CoV-2,” according to Right to Know. “Any such ties constitute an impermissible conflict of interest.”

The group also charged that other SAGO candidates, including Dr Christian Drosten, Katherin Summermatter and Marion Koopmans have made public remarks at conferences or in letters to scientific journals openly disparaging the lab escape theory – including one comparison with “meteorites and “snake origins” by Koopmans,  demonstrating their lack of objectivity.

Right to Know also wants a further six candidates removed simply because they served in the first WHO-convened global study of the origins of SARS-CoV-2. These are Vladimir Dedkov,  Elmoubasher Farag, Thea Fischer, Hung Nguyen-Viet, John Watson and Yungui Yang.

Letter proposes adding more biosafety experts & WHO critics to SAGO team

Right to Know  also proposed replacing the ten people that it says have conflicts of interest with more biosafety experts, and scientists who have criticized the WHO SARS-CoV2 origins investigation for its lack of attention to the lab escape narrative.  Among those names are Richard Ebright, a professor of chemical biology at Rutgers University, and one of the leading critics of the WHO process so far.

Ebright described as a “charade” the first WHO-led investigation into the origins of the virus, which concluded a lab escape was highly unlikely. In an interview in May with Health Policy Watch, he repeatedly stated that the lab escape theory needs to be pursued with equal vigour, alongside the theory that the virus emerged naturally.

“At this point in time, all scientific data related to the genome sequence of SARS-CoV-2 and the epidemiology of COVID-19 are equally consistent with a natural-accident origin or a laboratory-accident origin,” Ebright told Health Policy Watch – adding that the proximity of the Wuhan virology institute to the epicenter of the first coronavirus outbreak adds to concerns about a biosafety incident.

 

Global Group of Scientists Calls For Fresh Investigation Into Origins of SARS-CoV2 Virus

Fears that political bias will taint further investigations

Some scientists fear, however, that the lab escape theory has also gained additional traction as a result of political tensions between the United States and China – making it more difficult to untangle reality from a rife of conspiracy theories that began circulating during the administration of former US President Donald Trump. 

A recent report in August by US Congressional Republicans, for instance, also continued to push the lab leak theory.

At the same time,  recent genetic mapping studies found that other SARS-CoV2 virus variants were circulating elsewhere in China in late 2019, and those bore a greater similarity to the closest related bat coronaviruses than the virus sequences first identified and mapped in Wuhan.  That suggests that the source of infections could have been outside the city and through some kind of natural spread through the animal chain – rather than an escape from a Wuhan lab.

And at the same time, the fact that Wuhan’s food markets also were the focus point of many, if not all, of the first infections, still suggests some kind of food borne link to the outbreak – other researchers have pointed out.

Along with pursuing the research on the origins of SARS-CoV2, SAGO will also advise the WHO Secretariat on other technical and scientific considerations regarding emerging and re-emerging pathogens, and will be composed of experts acting in a personal capacity. 

The first SAGO meeting is supposed to take place later this month.

Image Credits: CGTN, @PeterDaszak.

 

 

The World Health Organization (WHO) has issued an emergency use listing (EUL) for India’s Covaxin, making it the eighth COVID-19 vaccine to be approved by the global body. 

“The emergency use listing expands the availability of vaccines, the most effective medical tools we have to end the pandemic,” said Dr Mariangela Simao, WHO Assistant-Director for Access to Medicines and Health Products on Wednesday.

“But we must keep up the pressure to meet the needs of all populations, giving priority to at-risk groups who are still waiting for their first dose, before we can start declaring victory,” she added.

Covaxin has been developed by the Indian pharmaceutical company, Bharat Biotech, and is formulated from an inactivated SARS-CoV-2 antigen.

It was found to be 78% effective against COVID-19 of any severity, 14 or more days after the second dose. 

The vaccine was assessed by the WHO’s Technical Advisory Group (TAG), which determined that the vaccine meets WHO standards for protection against COVID-19, and its benefits far outweigh the risks.

The WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), also reviewed the vaccine, and recommended it be used in two doses, with a dose interval of four weeks for people 18 and above.  However, data on vaccination of pregnant women remains insufficient, and studies in pregnant women are being planned in the future. 

Listing enables supply to COVAX 

Following EUL approval, the pharma company said in a tweet, “Bharat Biotech is motivated to mitigate the worldwide pandemic.” 

Days prior, the company celebrated its approval for use in Australia and for travel to Oman without quarantine, with Prime Minister of India Narendra Modi commenting on the “post-COVID partnership of India and Australia.”  

The Indian government has already approved the use of the vaccine for children from the age of two in October. 

Covaxin was approved by India back in January while its third phase clinical trials were still underway. Data in March showed the indigenous COVID vaccine showed an efficacy trend of 81% during an interim analysis of Phase 3 trials. 

Covaxin is already being used in 21 Indian states, according to Suchitra Ella, co-founder of Bharat. More than 105 million Covaxin doses have been administered so far in the country.  

The vaccine is suitable for low- and middle-income countries as it can be stored in a normal fridge at 2 to 8 degrees C. India’s regulatory body for pharmaceuticals and medical devices,  the Central Drugs Standard Control Organization recently been approved an extension of its shelf life for up to 12 months from the date of manufacture. 

WHO EUL also means that Covaxin can be distributed by COVAX. In addition, it means that Indians who have been vaccinated with Covaxin are likely to be able to travel internationally as most countries have agreed to recognise WHO-approved vaccines.

Indonesia has granted emergency use authorization (EUA) for the COVID-19 vaccine developed by Novavax, which will be made by the Serum Institute of India (SII) and sold under the brand name Covovax.

“This marks the first regulatory authorization worldwide of a protein-based COVID-19 vaccine based on Phase 3 clinical data demonstrating efficacy and a favourable safety profile,” said Novovax CEO Stanley Erck, adding that it was the first of many authorizations that the company expects in the coming weeks and months.

Novavax and SII have also filed for authorization of the vaccine vaccine in India and the Philippines. It has also applied for Emergency Use Listing (EUL) with the World Health Organization (WHO) and will supply the global body with additional supplemental filing “shortly”, it added.

Novavax recently also completed rolling submissions for authorization with regulatory agencies in the UK, European Union, Canada and Australia. Novavax expects to submit a full application to the US Food and Drug Administration by the end of the year.

“The first authorization of Novavax’ COVID-19 vaccine exemplifies our commitment to equitable global access and will fill a vital need for Indonesia, which despite being the fourth most populous nation on earth, continues to work to procure sufficient vaccine for its population,” said Erck.

The vaccine is stored at 2° to 8° Celsius (normal refrigeration).

“Access to a supply of a safe and highly effective vaccine, coupled with the ease of its distribution, should be a critical enabler to help Indonesia control the current coronavirus outbreak,” said SII CEO Adar Poonawalla. “We continue to work with urgency to ensure the first protein-based COVID-19 vaccine option in Indonesia is available for all awaiting its arrival.”

In two Phase 3 trials, the PREVENT-19 trial in the US and Mexico, demonstrated 100% protection against moderate and severe disease and 90.4% efficacy overall, according to the company – although it has not been tested on the Delta variant.

It is a protein-based vaccine candidate engineered from the genetic sequence of the first strain of SARS-CoV-2 using “recombinant nanoparticle technology to generate antigen derived from the coronavirus spike (S) protein”, and paired with Novavax’ patented “saponin-based Matrix-M adjuvant to enhance the immune response and stimulate high levels of neutralizing antibodies”, said the company. 

The US government gave Novovax a contract worth $1.6 billion to develop its vaccine and to provide 100 million doses to the government.

Novavax also has committed to supply 1.1 billion doses of its vaccine to COVAX. However, it has been hampered by manufacturing problems.

 

Every year, tobacco consumption claims 8 million lives and costs the economy $1.4 trillion.

The tobacco industry used the COVID-19 pandemic to ingratiate itself with governments around the world and win concessions for their harmful products, according to a review of 80 countries analyzed in the Global Tobacco Industry Interference Index 2021, which was released on Tuesday.

It wasn’t simply economically vulnerable countries that were susceptible to industry influence. The Swiss government allowed one of the highest levels of influence, second only to the Dominican Republic.

The Index notes that the president of the Swiss Tobacco Trade Association, Gregor Rutz, is a member of the Swiss National Council, the lower house of the Federal Assembly of Switzerland, thus “ensuring direct access to policymaking”.

Switzerland also doesn’t have an age limit of 18 years on the purchase of tobacco products, which have not had a tax increase since 2013. Swiss tobacco farmers also receive subsidies, and the country is home to a wide range of powerful tobacco companies.

No Framework, more interference

Mary Assunta, of the Global Center for Good Governance in Tobacco Control,

Countries that have not signed the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC), face high levels of industry “meddling” which, aside from Switzerland and the Dominican Republic, include Argentina, Indonesia and the US.

“The tobacco industry’s behaviour during COVID-19 wasn’t just business as usual – this research suggests it’s been far worse in terms of scale and impact,” said Mary Assunta, of the Global Center for Good Governance in Tobacco Control, and lead author of the Index.

“The tobacco industry exploited the COVID-19 pandemic with a multi-pronged tactic to entice, persuade and coerce governments towards weaker public health policies. Many governments, made vulnerable by the pandemic, freely accepted and endorsed charity from the industry, when such donations often come with strings attached, and compromised on policies,” according to Stopping Tobacco Organizations and Products (STOP), an alliance of organisations that produces the index.

“Instead of removing benefits to the industry, many governments made decisions that benefited the industry, particularly in lowering or not imposing taxes and delaying legislation or its implementation.”

More deterioration than progress

Eighteen governments improved how they shield themselves from industry influence from the previous year, while 31 governments deteriorated in their efforts. Globally, Brunei, New Zealand and the UK were best able to resist industry attempts to influence policy.  

In addition, Botswana published a tobacco control law that limits interaction between the government and industry, including the prohibition of partnerships with or incentives for the industry. 

India’s health ministry adopted a code of conduct restricting collaboration between officials with tobacco industries, and  Cambodia’s Ministry of Education banned all forms of partnerships between educational facilities and the tobacco industry. 

Industry activity linked to delays in tobacco control

Industry activity was linked to delays in the implementation of tobacco control laws in countries including Bolivia, Ethiopia, Georgia, Guatemala, South Africa, Tanzania, Turkey and Zambia, the Index notes.

Ukraine was subjected to  “legislative spam”, where a tobacco control bill was delayed by the submission of several alternative bills, some sponsored by members of parliament connected to the tobacco industry, reports the Index.

 At least 11 countries that received donations compromised on taxing the industry’s products, including Argentina, Czech Republic, Indonesia, Malaysia, Myanmar, Pakistan, Paraguay, Poland, Tanzania, Turkey and Zambia.  

In Georgia, the three multinational tobacco companies active there (British American Tobacco, Japan Tobacco International and Philip Morris International) met with the Prime Minister in relation to the pandemic. 

Pandemic profiteering

“In the middle of a pandemic, health should be the primary consideration in all policy decisions, but it was often sidelined in favour of the industry’s commercial interests,” said Assunta.

“Where policy isn’t well protected, more lives will be lost to tobacco and post-COVID economic recovery may be impacted, with higher health costs and potentially less tax revenue to fund recovery.”  

The industry also successfully lobbied governments to sell new products in countries including Egypt, Kenya, Lebanon and Spain.  

“Since the start of the pandemic, independent studies have found that smokers are more likely to develop severe COVID-19 as compared to non-smokers. Tobacco use is a known risk factor for a range of chronic conditions that also place people at greater risk from COVID-19,” notes the Index.

“While the pandemic wreaked havoc around the world and the global economy suffered, two of the world’s biggest tobacco companies reported earnings before tax of more than $10 billion each,” added Assunta. 

“Governments must hold this industry accountable and it must not be permitted to meddle in policy. It is time for all countries to ban tobacco-related corporate social responsibility activities.”

 

Image Credits: Chris Vaughan, WHO FCTC.

More than 5 million people have officially died from COVID-19 less than two years into the global pandemic. COVID-19 is now the third leading cause of death, after heart disease and stroke. 

There have been 5,003,021 COVID-19 related deaths as of 1 November, according to the Johns Hopkins COVID-19 Dashboard. 

covid-19
COVID-19 Dashboard as of 1 November 12:22 PM EST

In the United States, 746,021 people have died due to COVID-19, making it the country with the highest number of recorded deaths. Brazil has lost the second highest number of people, with over 605,000 deaths by 1 November.

“This is a defining moment in our lifetime,” Dr Albert Ko, an infectious disease specialist at the Yale School of Public Health, told AP News. “What do we have to do to protect ourselves so we don’t get to another 5 million?”

The death toll rivals the number of people killed in battles among nations since 1950, according to estimates from the Peace Research Institute Oslo.

Shifting COVID-19 hotspots: Europe experiencing ‘fourth wave’ 

International passengers at UK border controls – quarantine rules now based on where they were vaccinated, and not what vaccine they received.

Hot spots have shifted over the 22 months since the pandemic began, and parts of Europe are now reporting a “fourth wave”,  the only World Health Organization (WHO) region to report an increase in cases for the fourth week in a row. 

Cases in Belgium, Czechia, Hungary and Poland have  increased by 50% in October, according to the WHO.

Russia and Ukraine also have increased numbers of new cases, with a 15% and a 43% increase, respectively. 

And amid soaring COVID-19 cases in the UK, the government is now prioritising giving third vaccine booster shots to people, banking on the country’s high COVID-19 vaccination rate to prevent severe illness and death. 

“What’s uniquely different about this pandemic is it hit hardest the high-resource countries,” said Dr Wafaa El-Sadr, director of ICAP, a global health center at Columbia University. “That’s the irony of COVID-19.”

Wealthier nations with longer life expectancies have larger proportions of older people, cancer survivors and nursing home residents, all of whom are especially vulnerable to COVID-19, El-Sadr noted.

Decrease in cases in Africa, Western Pacific 

In contrast, the largest decrease in new weekly cases was reported in Africa (21%), followed by the Western Pacific Region (17%). 

India, which had experienced its second wave in early May, now has reported a lower daily death rate than wealthier countries such as Russia, the US, or the UK, though uncertainty remains around its figures. 

The country’s rural areas were devastated by this surge of cases in May, where health infrastructure was rickety and lacked trained healthcare workers, government support, and access. 

Africa remains the world’s least vaccinated region 

Health workers at Juba Teaching Hospital are waiting in line to have their first shot of COVID-19 vaccine.

However, while Africa reports decreased cases, the region remains the world’s least vaccinated region, with only 6% of Africans – 77 million people – fully vaccinated, while over 70% of high-income countries have already vaccinated more than 40% of their people. 

Only five African countries are likely to reach a WHO global goal of vaccinating 40% of their populations by the end of the year. “This devastating milestone reminds us that we are failing much of the world,” UN Secretary-General António Guterres said in a written statement. “This is a global shame.”

Image Credits: Vital Strategies, JHU, @HeathrowAirport/AndrewFell .

G20 leaders pose in front of the Trevi Fountain in Rome, October 2021

There will be no airlifting of COVID-19 vaccines to poor countries struggling to get their immunisation figures into double digits. There are also no concrete plans for wealthy countries to make good on their earlier dose promises to COVAX by giving actual delivery dates. 

And, there is no date for wealthy countries to phase out coal-based power.

Instead, the weekend G20 meeting of the world’s richest nations offered a bland declaration that failed to offer solutions to COVID-19 vaccine equity or the climate change crisis.

Even United Nations Secretary-General Antonio Guterres admitted that he left Rome “with my hopes unfulfilled”.

Ahead of the meeting, the World Health Organization’s (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus wrote an open letter to G20 leaders appealing for their support for the WHO targets to vaccinate 40% of the world by year-end and 70% by mid-2022, saying that  “decisions made this weekend may make or break those targets”.

Earlier, the WHO’s newly appointed Ambassador for Global Health Financing, Gordon Brown, called for a “globally coordinated, month by month operational plan and timetable” to transfer unused vaccines being held by the richest countries of the world to the world’s poorest countries.

“If at the G20 summit in Italy, the world’s richest countries cannot mobilise an extraordinary, expedited airlift of doses to the unvaccinated and unprotected of the world, and do so starting immediately, an epidemiological economic and ethical dereliction of duty will shame us all,” said Brown, the former UK Prime Minister.

In fact, the most decisive action at the Rome meeting came on its margins – when US President Joe Biden issued an executive order enabling the release of “strategic and critical materials from the National Defense Stockpile” to ease global supply-chain shortages related to vaccines.

Vague and non-specific declaration

The Rome Declaration, adopted on Sunday after months of negotiation, is bland and non-specific, particularly as far as concrete commitments of money or vaccine doses are concerned. 

Tedros’s letter, co-signed by the Duke and Duchess of Sussex, asked for four key actions.

First, in order to close the global shortage of 550 million doses to vaccinate 40% of people in every country by the end of 2021,  Tedros asked for the “speeding up existing commitments of dose donations to COVAX, pledging new ones, executing dose swaps with COVAX, and eliminating export restrictions on vaccines”.

The G20’s answer was vague, lacking commitments to any real targets: 

“We will take steps to help boost the supply of vaccines and essential medical products and inputs in developing countries and remove relevant supply and financing constraints” and “we commit to substantially increase the provision of and access to vaccines, as well as to therapeutics and diagnostics”. 

G20 health ministers were also asked to monitor progress and ”explore ways to accelerate global vaccination as necessary”.

No action on COVAX shortfall

Tedros’s second ‘ask’ was for the G-20  leaders to fully fund the Access to COVID-19 Tools (ACT) Accelerator, which currently has a $15.9 billion shortfall in monies needed to fund bigger  rollout of tests, treatment and vaccines.

The G20 simply reiterated its “support to all pillars of the ACT-Accelerator, including COVAX” – without promising a clear amount of new money.

Thirdly, the WHO chief asked the G20 leaders to “hold pharmaceutical companies to higher transparency standards, including publicly shared monthly production projections and delivery schedules to help countries better plan to receive and share doses”.

In response, the G20 simply committed to “enhance our efforts to ensure the transparent, rapid and predictable delivery and uptake of vaccines where they are needed” and called on “the private sector and on multilateral financial institutions to contribute to this endeavour”. 

Finally, Tedros asked for support for the TRIPS waiver in order to “share vaccine technology and dismantle vaccine production barriers”.

The G20’s response on this was predictable: silence on the waiver initiative – although there was a commitment to supporting “increased vaccine distribution, administration and local manufacturing capacity” in LMICs, possibly via  the newly established WHO-supported mRNA hubs in South Africa, Brazil and Argentina, and non-specified “joint production and processing arrangements”.

Ellen Johnson Sirleaf, former president of Liberia, and Helen Clark, former prime minister of New Zealand, said that “it would be an understatement to say that the decision of G20 Leaders meeting in Rome to respond to 22 months of the COVID-19 crisis by setting up a Health and Finance Minister Task Force, with no money behind it, is deeply disappointing”. 

The pair, former co-chairs of the Independent Panel for Pandemic Preparedness and Response, said that the G20 had both ignored its own financing panel which showed why up to $15 billion a year is needed in pandemic preparedness, and failed to support “specific and urgent action to redistribute vaccine doses around the world”. 

Nothing new to stop planet burnout

The G20’s failure to offer new or substantial measures to address planetary burnout – pointed to a lack-lustre outcome for the COP26 climate conference that opened on Monday. 

Rhetorically, G20 leaders committed to limiting global warming to 1.5 degrees C by 2050. 

But real follow-up on that commitment was marred by the absence of the key leading global polluter, China, which has only promised to reach carbon neutrality by 2060. Similarly Russia has stated that it is in no rush to achieve that goal. 

Climate scientists have said that without faster action on cutting climate emissions now – it will be impossible for the world to keep to 1.5°C – and indeed, temperatures are currently on a course to reach 2.7°C  by the end of the century, even if all current commitments are met. 

While the G20 statement included a promise to end international financing of coal-based power generation outside their own countries, the G20 members also did not commit to a date for phasing out coal-based power in their own territories.

Instead, the G20 statement said only said: “Keeping 1.5°C within reach will require meaningful and effective actions and commitment by all countries, taking into account different approaches, through the development of clear national pathways that align long-term ambition with short- and medium-term goals, and with international cooperation and support, including finance and technology, sustainable and responsible consumption and production as critical enablers, in the context of sustainable development.”

They further committed to cooperate on “zero or low carbon emission and renewable technologies” to enable a transition towards “low-emission power systems” – not zero emissions, and only for those countries that wanted to make this transition.

Lack of climate funds

Lack of funds to assist developing countries to mitigate climate change has been a serious obstacle to progress. Previously, developed countries had committed to making $100 billion available every year to do this from 2020 to 2025. But the meeting noted that this goal was only expected to be met in 2023.

“If the G20 was a dress rehearsal for COP26, then world leaders fluffed their lines,” said Greenpeace executive director Jennifer Morgan. “Their communique was weak, lacking both ambition and vision, and simply failed to meet the moment. Now they move onto Glasgow where there is still a chance to seize a historic opportunity, but the likes of Australia and Saudi Arabia need to be marginalised, while rich countries need to finally grasp that the key to unlock COP26 is trust.”

The G20 is made up of countries that produce 80% of the world’s global carbon emissions, comprising of the European Union plus Argentina, Australia, Brazil, Britain, Canada, China, France, Germany, India, Indonesia, Italy, Japan, Mexico, Russia, Saudi Arabia, South Africa, South Korea, Turkey and the US. 

 

Image Credits: G20.

Disha Shetty, an Indian climate and health journalist, will be reporting for Health Policy Watch from the Glasgow Climate Conference (COP 26).  She provides a birds-eye view on the conference here:

Climate and health activists fear that the bold action needed at the crucial United Nations climate conference, COP26, which began on Sunday, is unlikely to materialise because rich countries are delaying commitments to cut carbon emissions quickly.

Although the world is already witnessing rising extreme weather events, if high-income countries such as the United States fail to make bold moves on key issues like shifting from fossil fuels to cleaner energy, middle-and low-income countries cannot be expected to take dramatic actions themselves, observers in Asia and elsewhere fear.  

For this year’s COP26 to be successful, there are several issues that have to be addressed – and these are inextricably intertwined with commitments that low- and middle-income countries need to receive:

  • All countries will have to increase their voluntary nationally determined contributions (NDCs) under the Paris Agreement to rein in global temperature rise to no more than 1.5℃. 
  • Developed countries also have to commit to finances to fund adaptation in developing countries reeling under the impacts of climate change, and the Paris rulebook on implementation of the Paris Agreement will have to be finalised. 
  • There is also a growing call from developing countries for developed countries to acknowledge and compensate for the loss and damage that they are enduring due to the historically high carbon emissions of a handful of countries. 

In the run-up to COP26, the delivery of the highly anticipated $100 billion climate finance has once again been delayed. The COP26 presidency said on Monday that “it will not be known until 2022 whether the $100 billion goal has been met in 2020,” adding that the pledges expected from the developed countries were not yet ready to be included. 

Many poor countries for long have described climate talks by the rich ones as bullying or a con as the finance that eventually materialises is given as loans and debts. This is particularly worrisome for LMICs that will depend on such finance to meet their NDC commitments – and it will inevitably curb their ambition to set stakes even higher.

“This finance is not charity. This finance is to make sure that the polluters pay the cost, so that it may ensure that the emerging countries can actually do things differently,” said Sunita Narain of the Centre for Science and Environment.

World on the path to 2.7℃ temperature rise

The current updated NDCs too fall short and will mean global temperatures will rise by 2.7℃ by the turn of this century, as HPW reported on October 25. 

In light of the lack of progress, COP26 President Alok Sharma has already begun to talk about future COPs, saying at a Tuesday press conference that if the commitments this year aren’t enough to keep temperature well below 2℃, then in the next few years, “we may need to come back and reappraise the commitments that have been made”.

Around 148 countries have submitted new or updated NDCs according to Climate Tracker. Of these, 85 countries have promised to reduce their carbon emissions, including developing countries like South Africa, Kenya, Pakistan and Argentina.

Pakistan has promised to reduce its carbon emissions by 50% by 2030, a move that was welcomed by COP26. Countries in the middle east like Jordan and Kuwait, Uganda in Africa, and Japan in Asia have also improved their NDCs. China also updated its NDC on 28 October but its targets are being seen as falling short of what is needed at this point.

At last count, there were still 28 countries, including major annual carbon emitter India and other smaller countries like Ecuador, as well as conflict-ridden Afghanistan and Congo, that are yet to submit their updated NDCs. The hope is that ambitious targets would help keep the global temperature rise around 2℃ and keep the 1.5℃ in sight in the coming years.

Many countries’ longer-term commitments are more robust. Major global oil producer Saudi Arabia has announced the plan to turn net-zero by 2060 as has China, while Australia aims to become carbon neutral by 2050.  

But the problem is that the timeline of many countries postpone emission reductions until a time that is too late to avoid the world lurching well above 2.7℃ by 2100 and is being seen as mere shifting of goalposts to avoid drastic action now. 

India, currently the world’s fourth-highest annual carbon emitter after China, US and the European Union, has made it clear that it wants compensation for the damage caused by rich nations since pre-industrial times, focussing on the need for equity and historical context. 

Although India hasn’t yet submitted an NDC, it is likely to submit it before 31 October and is expected to announce a 450GW renewable energy target, up from its current installed capacity of 100GW. Sharma has already gone on record to say he hopes to see this reflected in India’s updated NDC and that it would be a welcome step. 

Rich countries are struggling to end coal dependance

With the COVID-19 vaccine roll-out leaving out many poor nations, the trust between developed and developing countries is at an all-time low. A major bone of contention in the talks is that rich countries like the US are asking poor ones to reduce their dependence on coal are themselves not sure how they will move away from fossil fuels.

US President Joe Biden has been struggling to get domestic support for his ambitious climate agenda at home, with just one senator from West Virginia committed to striking out a key clause of energy legislation that would penalize those that do not switch to renewable energy. 

UN Secretary-General António Guterres told a recent COP26 media briefing that he was “extremely worried but still hopeful”. 

Guterres will address leaders of the G20 countries – a group of the world’s largest economies – during their meeting on Saturday and is expected to ask them to be more ambitious in their targets. Guterres stressed the need for developed countries to phase out coal by 2030 and developing countries by 2040. 

This does not seem practical to experts who point out that even a rich country like Germany with resources at its disposal is looking at a coal phase-out by 2035. 

Meanwhile Sharma counted commitments from countries to end financing of new coal plants as a step forward.

Danger of moving to renewables too quickly

While climate talks paint renewables as a magic cure, countries that rely on renewables are beginning to see the social fallouts of moving too quickly. Electricity from renewable sources like wind and solar fluctuate seasonally and are thus perceived as unreliable as well as expensive by policymakers.

There is also pushback from leaders from Africa on the social costs of renewables. Developing countries transitioning to renewables quickly have little or no understanding of the social impacts of big new hydroelectric, wind power or solar farms on land rights, waterways and fisheries, upon which indigenous communities often depend the most. 

Climate change is already causing an energy crisis in key BRICS countries, disrupting supply chains, hitting both renewable and non-renewable sources. 

India was recently staring at a coal shortage caused in part due to excess rainfall hindering coal movement. Worsening drought in Brazil has hit water levels in hydropower generating dams and in turn the electricity supply. 

Experts say this indicates that future energy needs need to be met from diverse sources as no one source can provide energy security – a nuance that COP26 negotiations pushing for renewables have to be mindful of.

Poorer regions disproportionately affected

While poor nations are now being asked to contribute proportionately just as much as the rich to reach carbon neutrality, they also stand to lose the most from the world’s failure to clamp down on emissions so far. 

The global temperature is already 1.2℃ higher than the pre-industrial times and in 2020 this translated to around 51.6 million people being directly impacted by climate change-related extreme weather events, according to the latest report of Lancet Countdown on health and climate change.

A warmer climate would mean more infectious diseases and 79% losses in labour capacity due to heat waves for those involved in the agricultural sector in low-income countries. The COVID recovery has led to a surge in fossil fuel use instead of decline, making this an additional challenge, as HPW reported on October 21.
This impact on public health and communities that is being felt disproportionately more in the developing world has led to a rise in calls for compensation towards loss and damage due to climate change. 

Climate finance and a push for loss and damage

Ahead of COP26 a lot of the conversation has been around the need for rich countries to deliver $100 billion in climate finance. This figure already reflects a broken promise as the original commitment was to raise $100 billion annually. It has been over a decade since the commitment was first made in Copenhagen in 2009 and then reiterated in Paris in 2015. 

“Twelve years ago, in Copenhagen, developed nations made a promise to channel $100B per year to countries that are developing and vulnerable to climate change impacts,” said Chirag Gajjar who heads subnational climate action in climate programme at WRI India. “In Glasgow, rich nations must provide an implementation plan to deliver on this promise, translating to $500B between 2020 to 2024,” he said.

In an open letter to COP26, Climate Action Network International, a network of over 1,500 civil society organizations wrote, “The projected economic cost of loss and damage by 2030 is estimated to be between $290-580 billion in developing countries alone.”

China, currently the world’s largest annual carbon emitter, is aiming for net-zero by 2060 and the US, which is the world’s largest historical carbon emitter, is aiming to turn net-zero by 2050. 

But if the worst-case scenario of climate change is to be avoided then countries will have to commit to near-term changes instead of long-term ones on a timeline of decades.


Narain said that, according to the IPCC reports, all countries of the world have to turn net-zero by 2050 to limit global temperature rise to 1.5℃. This requires developed countries to turn net-zero earlier so the developing countries have time to transition. 

“If the US is 2050 and China is 2060 then India has to be 2070,” said Narain, who called net-zero “a scam”.

“Let’s get a perspective on this that we all understand the reality and don’t let some new fancy words divert us from the mission of saying: cut now, transform now!”

Disha Shetty is an independent science journalist based in India. She will be reporting from COP26 as a part of the 2021 Climate Change Media Partnership, a journalism fellowship organized by Internews’ Earth Journalism Network and the Stanley Center for Peace and Security. Follow her on Twitter @dishashetty20

–Updated 1 November 2021

Dr Tedros Adhanom Ghebreyesus.

The incumbent Director-General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, is the sole nominee for his position, which will be decided upon at the 75th World Health Assembly in May 2022. 

With the backing of 28 member states, Tedros is likely to be re-appointed unopposed as the deadline to submit nominations was 23 September. 

Tedros, who was the first African to become the chief of the WHO., was nominated by Germany after his home country,  Ethiopia, rejected nominating him for a second term, according to Reuters report. 

A former health and foreign minister of Ethiopia, Tedros has been accused by the Ethiopian Army Chief of supporting rebels in the conflict zone of Tigray in northern Ethiopia. Tedros is from Tigray. This tension is likely to have been the reason why only three African countries backed his re-appointment.  

Since his election in 2017, Tedros has risen to more prominence in 2020 for his response and communication on the Covid-19 Pandemic. As a Director General, he is the chief technical and administrative officer. If re-elected, it will be his last term as the WHO chief since an incumbent Director-General can be re-appointed only once. Each term is for five years and the next term will begin in August 2022. 

Even though Germany called for support for Tedros’s nomination last month, the US, China, and the UK have not endorsed him, as per documents on the WHO website. 

Relations between the US and Tedros soured during former US President Donald Trump’s term, while China’s cold shoulder to Tedros may be traced to July 2020 when he asked China to provide more raw data on the origins of the COVID-19 pandemic and had asked them to be more “transparent and open and to cooperate”. 

“After witnessing up close the world’s response to the pandemic, I have a unique understanding of the dynamics that have brought us to where we are, and a deep commitment to making the global system fit for purpose, with WHO at its centre,” Tedros said in his written statement to the WHO in response to his nomination for re-appointment.