In Pakistan, a healthcare worker listens to a child’s lungs for signs of tuberculosis.

Deaths from tuberculosis increased for the first time in a decade in 2020 due to the COVID-19 pandemic, according to the World Health Organization’s (WHO) 2021 Global TB report. 

The diversion of health resources to address COVID-19 led to fewer TB diagnoses as well as a drop in treatment last year. This is likely to result in even higher TB-related deaths in 2021 and 2022, warned the report, which was released on Thursday.

Over a million fewer people were diagnosed in 2020 than the previous year with the south-east Asia and Western Pacific region accounting for 84 % of the global reductions. India and Indonesia were responsible for more than half of the drop in case notifications in this region between 2019 and 2020. 

The most sobering part of the report was its warning that negative impacts on TB mortality and TB incidence in 2020 will be even worse in the next two years, with 2021 forecast to have even higher TB deaths while 2022 is likely to see the biggest impact on TB incidence. The pandemic and lockdowns have knocked TB’s elimination progress to 2012 levels. 

Fewer case notifications, dip in treatment 

Most 2020 targets set for TB elimination have been missed by almost all WHO regions. The WHO Europe region, which achieved and surpassed most of its 2020 targets, faltered when it came to TB notification and registered a dip in notifications. 

The number of new TB case notifications globally was 5.8 million in 2020, whereas the figure for 2019 was 7.1 million.

The huge drop in reporting and detection of TB between 2019 and 2020 points to a disruption in the supply-and-demand of TB diagnostic and treatment services, the report said. Fewer people were able to get access to resources due to lockdowns and fears of COVID-19, and the healthcare system also took a hit due to the diversion of resources. 

The WHO estimates that 4.1 million people who currently suffer from this deadly disease have not been diagnosed or have not officially reported to national authorities. The figure was 2.9 million in 2019.

India and Indonesia had previously been the main contributors to the uptick in TB notifications between 2013 and 2019 when their combined annual total number of notifications increased by 1.2 million in that period. However, all that was nearly erased between 2019 and 2020 when notifications fell by 0.7 million. 

According to the Indian Health Ministry’s 2021 Annual Report on tuberculosis elimination, reports and notification of confirmed TB diagnoses tumbled 38 % in March-April 2020 owing to the lockdown. Private notifications were down 41 % for the same period. 

At the press conference to launch the report, Katherine Floyd, Coordinator of the TB Monitoring and Evaluation Group in the WHO Global TB Programme, said that India has the highest TB burden in the world. In 2020, some 2.6 million people developed TB while half a million people died – one-third of all global deaths. 

Treatment, deaths and intervention

Based on the country-specific models for 16 countries that accounted for most of the global drop in 2020, the negative impacts on TB mortality and incidence will get worse in 2021 and beyond. 

The organisation estimated that approximately 1.5 million people died in 2020 from the air-borne disease, the first year-on-year increase in global deaths due to TB since 2005. 

The models of prediction for these figures have not considered the economic and nutritional aftermath of the Covid-19 that makes individuals more susceptible to developing TB diseases among those already infected with M.tuberculosis. 

How do we get back on track? 

“Getting back to the levels that were achieved in pre-COVID times would depend on the key stakeholders, officials, funders and the understanding that these investments and continuation of TB services are needed as soon as possible,” said Dr Tereza Kasaeva, WHO’s Director of the Global TB Programme, in response to a question from Health Policy Watch.

She said that urgent actions and investments are key to address these gaps in TB’s progress and a full recovery of services is essential. 

Dr Osamu Kunii, Head of Strategy, Investment and Impact Division at the Global Fund to Fight AIDS, Tuberculosis, and Malaria, said that “we need a global effort to support replenishment of the global fund for next year.” 

He added that while the G7 and G20 members are having discussions on pandemic preparedness, we need to remind them that “fighting against TB is also very useful for future pandemic response.” 

Funding woes and missed targets 

The drop in people enrolled on drug-resistant TB treatment means that the target of treating 40 million people by 2022, which was adopted at the 2018 UN-High level meeting, is far out of reach.

“This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease,” cautioned the WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

Increases in both domestic and international funding for TB are urgently required, but provisional data suggest that allocations for 2021 will remain inadequate, according to WHO. 

“For more than a year now, we’ve been sounding the alarm over the growing number of people not being diagnosed and treated for TB,” said Dr Lucica Ditiu, Executive Director of the Stop TB Partnership.

“Unfortunately, today’s report confirms what we all feared—that more and more people are dying from TB. We now see more than 4,100 people dying from TB every single day. This is not a prediction; it is a reality. The COVID-19 pandemic combined with low political will and appallingly low levels of funding have reversed hard-fought gains in the fight against this age-old disease.”

Funding in the low-and middle-income countries that account for 98% of reported TB cases show an 8.7% decline last year 2020. The $5.3 billion spent in 2020 is less than half of the global target of $13 billion annually by 2022 and only 39% of the target amount estimated to be needed in 2020 in the Stop TB Partnership’s Global Plan to End TB, 2018–2022. 

The End TB Strategy targets for 2030 and 2035 cannot be met without intensified research and innovation, the report further said. 

There need to be more technological breakthroughs by 2025 so that the global incidence rate of TB could be accelerated to 17 % per year between 2025 and 2035. With the 2020 target for TB incidence missed, one will need to make bigger strides to meet the future targets. 

“If we had spent a fraction of the energy and money that governments and pharma have spent developing COVID-19 vaccines and then getting them to wealthy countries, we´d have stopped TB in its tracks long ago,” said Guy Marks, President of the International Union Against Tuberculosis and Lung Disease (The Union). 

“Instead, these devastating mortality numbers from the WHO Global TB Report indicate TB will return to being the biggest killer sooner than later. And that is a preventable tragedy.” 

The report lists priorities to meet the 2025 targets, including a TB vaccine or a new drug treatment for the nearly two billion people already infected, rapid diagnostics for use at the point of care, and simpler, shorter treatment for TB disease.

 

Image Credits: Stop TB Partnership.

South Sudan’s Minister of Health, Elizabeth Chuei, getting vaccinated against COVID-19.

Africa is estimated to have seven times more COVID-19 cases and three times as many deaths as officially reported, according to the World Health Organization (WHO) Africa region.

This means that the continent could have around 59 million cases and 634,500 deaths.

“We’re using a model to estimate the degree of under-estimation. Our analysis indicates that as few as one in seven cases is being detected, meaning that the true COVID-19 burden in Africa could be around 59 million people,” said Dr Matshidiso Moeti, WHO’s Africa executive director.

 “The proportion of underreporting on deaths is lower. Estimates such as around one in three deaths have been reported. Deaths appear to be low on the continent, in part because of the predominantly younger and more active population,” she told a media briefing on Thursday.

The case figure was extrapolated from country-based seroprevalence surveys while the mortality figure was reached on the basis of excess death statistics, said WHO’s team lead on operational partnerships, Dr Thierno Balde.

“With limited testing, we’re still flying blind in far too many communities in Africa,” conceded Moeti. 

The WHO recommends that member countries should perform 10 tests per 10,000 people each week yet around 20 countries – more than a third of African countries – do not reach this benchmark, said Moeti.

“Most tests are carried out on people with symptoms, but much of the transmission is driven by asymptomatic people. Estimates suggest that between 65% and 85% of COVID-19 cases are asymptomatic. The reported cases we see could therefore just give the tip of the iceberg,” she added.

Dr Matshidiso Moeti, WHO Africa Executive Director.

Community-based testing

The WHO has thus decided to invest $1.8 million to roll out COVID-19 rapid tests in hot spots, starting with pilots in eight countries including Senegal.

“The community testing initiative is a radically new approach, which shifts from passive to active surveillance through working with communities, local authorities and hotspot districts,” said Moeti.

“We will use antigen detection, rapid diagnostic tests which are reliable, affordable, easy to use, and provides results in around 15 minutes.”

People living within a 100-metre radius of a case in various hotspots will be eligible for a free test and the WHO expects to reach over seven million people.

The WHO hopes that, by identifying potential spreaders early, countries will be able to break the chain of transmission and contain flare-ups – particularly as the continent expects a surge in infections during the festive season in December when there is a lot more movement of people.

“This community testing strategy is a key component in transitioning towards localised management of COVID-19 outbreaks,” Moeti stressed.

Deaths lower in Africa

Despite the mortality undercount, WHO Africa officials said that deaths appear to be low on the continent.

Moeti attributed this in part to the continent’s “predominantly younger and more active population”. 

Balde added that the continent also had a relatively low prevalence of the co-morbidities such as diabetes and hypertension that had made COVID-19 fatal for many people.

“There are also some hypotheses mentioning the existence of viruses and linked to the coronaviruses that some Africans have been exposed to over the years,” added Balde.

However, only a minority of African countries have accurate statistics on excess deaths.

Zero vaccinations

Only three countries in the world have not yet started to vaccinate their citizens against COVID-19 despite WHO engagement and support, including the Africa states of Burundi and Eritrea.

However, Balde said that Burundi was expected to start to roll out vaccinations within the next few weeks as the country had recently joined the African Vaccine Acquisition Trust (AVAT) and signed a contract with COVAX.

However, he said that WHO was still working in Eritrea and doing advocacy “on all levels”.

Only 4.9% of Africans have been vaccinated against COVID-19, said Moeti.

Image Credits: UNICEF.

Marion Koopmans (centre) was part of the WHO mission to Wuhan and has also been selected for its Scientific Advisory Group for the Origins of Novel Pathogens (SAGO).

The World Health Organization (WHO) has named 26 scientists to a new Scientific Advisory Group for the Origins of Novel Pathogens (SAGO), which will take forward the work of the international expert group that led an initial  mission to Wuhan in January 2021, as well as investigating future pandemics.

Six of the scientists are associated with the original investigative mission to Wuhan.  That includes five of the nine original international team members dispatched to Wuhan: Marion Koopmans, Vladimir Dedkov, John Watson, Thea Fischer, Hung Nguyen.  In addition, Dr Yungui Yang, Deputy Director of the Beijing Institute of Genomics, one of eight Chinese team members, and a group leader of the original mission, also will serve on the new SAGO team.

They are joined by more scientists from the world’s powerhouse nations, including Inger Damon from the US Centers for Disease Control and Prevention and a leading Swiss biosafety expert,  Dr Kathrin Summermatter. Five Africans are also part of the new group including Kenya’s Dr Rosemary Sang. 

Peter Daszak, the controversial president of the US-based Ecohealth, who had been a prominent member of the first WHO mission, was notably absent from the list.  Pre-pandemic, Ecohealth had supported a series of coronavirus research projects at the Wuhan Institute for Virology (WIV), including what critics say was  “high-risk” collection of such viruses – leading to charges that Daszak had an inherent conflict of interest with an mission supposedly tasked with determining how the virus first leapt to humans – and whether it was the result of a lab biosafety or food systems failure.  

That first WHO mission yielded a report that was widely criticized as papering over Chinese data omissions. It also failed to carefully consider the hypotheses that the virus might have escaped from the Wuhan Institute of Virology (WIV) that was researching bat coronaviruses – a theory that dozens of experts around the world say remains just as plausible as the theory that the virus escaped somewhere along the food chain – until more evidence is gathered.

Original Missions report temporarily disappeared from WHO website

A Health Policy Watch search Wednesday evening on the WHO website for the names and affiliations of the original mission team, and their papers, yielded a “this page cannot be found” message.

After being alerted to the error, the correct link url was restored by WHO, which said that the omission had been due to an IT oversight, whereby “English versions of those pages were not republished during a web migration process.”

 

Fact of nature

The 26 scientists, selected from more than 700 applicants, according to the WHO, represent a wider range of disciplines than the previous group of only 17 members.  The new group includes experts in epidemiology, animal health, ecology, clinical medicine, virology, genomics, molecular epidemiology, molecular biology, biology, food safety, biosafety, biosecurity, and public health. 

“The emergence of new viruses with the potential to spark epidemics and pandemics is a fact of nature, and while SARS-CoV-2 is the latest such virus, it will not be the last,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, told a media briefing on Wednesday.

“Understanding where new pathogens come from is essential for preventing future outbreaks with epidemic and pandemic potential and requires a broad range of expertise. We are very pleased with the calibre of experts selected for SAGO from around the world, and look forward to working with them to make the world safer.” 

SAGO also will advise WHO on the development of a global framework into the origins of emerging and re-emerging pathogens, and on studies and field investigations into these pathogens.

As far as SARS-CoV-2 is concerned, SAGO will guide WHO on the next series of studies into the origins of of the virus, including “rapid advice on WHO’s operational plans to implement the next series of global studies into its origins”, according to the WHO.

Speaking at Wednesday’s briefing WHO’s Maria Van Kerkhove said that she expected the new SAGO group will also recommend more field missions to China – to comb first hand through markets, data bases and patient populations. 

Whether  or not China will agree is another matter. While Kerhkove said that China has expressed openess to more studies, Chinese officials have repeatedly asserted in recent months that the work of WHO is completed in China and that scientists should instead begin investigated possible sources of the outbreak in elsewhere in South East Asia or Europe. Tensions over the next stage of investigations were further exacerbated after the US administration of President Joe Biden administration tasked its own scientists to explore the theory abut a lab-based virus break – giving what had once been debunked as a conspiracy theory, much greater validity in the public eye. 

Famine in Tigray

Tigray refugees

Dr Tedros painted a bleak picture of northern Ethiopia, warning of “acute malnutrition rates at levels comparable to those we saw at the onset of the 2011 Somalia famine”.

This follows a year-long blockade of Tigray by Ethiopian government forces locked in an ethnic war, which has left up to seven million people facing hunger.

“An estimated 400,000 people are living in famine-like conditions based on the latest UN analysis,” Tedros, who is from Tigray, told the media briefing.

“Since the end of June, we have only had access to Tigray via one road through the neighbouring Afar region where movements are being severely restricted by official and unofficial checkpoints and roadblocks,” he said.

“The UN estimates that we need to bring in roughly 100 trucks of aid a day to meet basic needs in Tigray but since July, the UN has only been able to move 10% of this on the ground,” said Tedros.

Healthcare has almost collapsed as no medical supplies have been allowed into the region since July. 

Earlier in the month, the Ethiopian government expelled seven senior United Nations staff involved in humanitarian aid.

Image Credits: CGTN, Christine Nesbitt/ UNICEF.

The Indian government’s Subject Expert Committee (SEC) has recommended the use of the country’s home-grown COVID-19 vaccine, Covaxin, for children from the age of two.

This is the first vaccine in the world to be approved for such young children. Pfizer’s vaccine was recently approved for children from the age of 12 in the US.

India’s health ministry still has to approve the vaccine, which is the first to be  developed in India, by Bharat Biotech in collaboration with the Indian Council of Medical Research.

Covaxin has not yet been granted emergency use listing (EUL) by the World Health Organization (WHO), but a statement issued by the WHO on Monday about last week’s meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization stated that SAGE had reviewed Covaxin’s application.

 “A policy recommendation will be issued when the vaccine is Emergency Use listed by WHO,” said the report, seeming to indicate that such a listing is likely.

 

India’s decision comes after Bharat Biotech presented results from a trial involving 525 children to SEC in early October. According to the company, the vaccine provided 77.8% protection against COVID-19.

Permission to test the vaccine on children was given by India’s drugs controller general, Dr VG Somani, following trials on adults.

However, final results have yet to be published in a peer-reviewed journal and the Indian government approved Covaxin before its phase 3 trial was completed. However, phase 1 results published in the Lancet established that the vaccine is safe. 

According to the BMJ, Covaxin “is similar to CoronaVac (the Chinese vaccine developed by Sinovac) in that it uses a complete infective SARS-CoV-2 viral particle consisting of RNA surrounded by a protein shell, but modified so that it cannot replicate”.

Covaxin can be stored in a normal fridge at 2-8°C, and people need to get two doses around 20 days apart.

Each dose of Covaxin costs 295 rupees (around $4) versus $25-$38 for the Moderna vaccine and $36,30 for the Pfizer/BioNTech, according to the BMJ. This makes the Indian vaccine the cheapest purchased by any country in the world.

Covaxin is already being used in 21 states according to Suchitra Ella, co-founder of Bharat.

Meanwhile, the US Food and Drug Administration (FDA) is meeting later this month to discuss a request from Pfizer to review data for COVID-19 vaccination for children aged 5 to 11 years and consider emergency authorisation of the vaccine for this age group. ​​

mental health
Mental health services for children and adolescents have been disrupted due to COVID-19

The most systematic study to date of the COVID-19 pandemic’s effects on mental health suggests that it has caused an additional 53 million cases of major depressive disorder, 76 million cases of anxiety across 204 countries in 2020 alone, according to a new Lancet study. 

The study, published just ahead of World Mental Health Day, which was observed Sunday, found that countries most affected by COVID-19 had the largest increases in the 2 disorders studied, and women and younger people were the most affected. 

The Lancet study was one of several published last week that shed new light on mental health issues around the commemoration of World Mental Health Day, on Sunday. 

It included UNICEF’s State of the World’s Children report, showing that one in seven adolescents aged 10-19  lives with an undiagnosed mental disorder. 

A new WHO Atlas on Mental Health, meanwhile, pointed to the low levels of investments by countries in mental health prevention and treatment  – averaging only 2.1% of national health expenditures, worldwide, and amounting to only US$1 on average, per capita, in least developed countries.

Breaking the silence 

More than 13%, or 1 out of 7 adolescents globally has a mental disorder.

The UNICEF report, the first ever to focus on mental health, called for “breaking the silence around mental health.” 

“[Mental health] is an iceberg we have been ignoring for far too long, and unless we act, it will continue to have disastrous results for children and societies long after the pandemic is over,” UNICEF Executive Director Henrietta H. Fore said, in the report’s Foreword. 

The report underlines the need for a more comprehensive approach to promoting and protecting good mental health for children, including more regular and systematic assessment of mental health indicators as well as the performance of existing mental health services.   

Investment in children’s mental health negligible 

Investment in protection and care for children’s mental health remains negligible, despite widespread demand for action, the UNICEF report stated.

In terms of the broader public, just 52% of countries delivered the targeted mental health promotion and prevention programs—far short of the 80% goal for 2020, according to the new WHO Atlas.

This lack of investments means that health workforces, including community-based workers, are not equipped to properly address mental health across multiple sectors. 

Additional analysis from the UNICEF report indicates that the annual loss in human capital arising from mental health conditions in children aged 0-19 is US $387.2 billion.

The Lancet, UNICEF call for increased mental health investment

The Lancet, in an editorial, echoed UNICEF’s calls for increased government and worldwide investment.

“We urge governments and international organisations to increase their commitment, investments, and actions to prioritise child and adolescent mental health,” the statement read. 

“In addition to expanding the capacity of mental health and psychosocial services to respond to the rise in demand, more investment is needed to promote mental health, especially through parenting programmes and schools.”

Investing in school-based interventions that address anxiety, depression, and suicide provide a return on investment of US $21.50 for every US $1 invested over 80 years. 

“Mental health is a part of physical health – we cannot afford to continue to view it as otherwise,” said Fore. “For far too long, in rich and poor countries alike, we have seen too little understanding and too little investment in a critical element of maximizing every child’s potential. This needs to change.”

Suicide, the fourth leading cause of death for 15 – 19 year olds

Tragically, almost 46,000 children and adolescents between the ages of 10 and 19 end their own lives every year – about 1 every 11 minutes.

 

The cost of how mental disorders impacts human lives is incalculable, with families, schools, and communities deeply affected by suicide – the fourth leading cause of death among 15 – 19 year olds. 

Every year almost 46,000 children and adolescents between the ages of 10 and 19 end their own lives – about 1 every 11 minutes. 

‘Increased Urgency’ in the aftershocks of pandemic 

During the COVID-19 pandemic there has been increased recognition of the importance of mental health

The synergism of the The Lancet study, UNICEF report, and WHO Atlas has shown how the COVID-19 pandemic has created an increased urgency to strengthen mental health care in most countries.

“The risk is that the aftershocks of this pandemic will chip away at the happiness and well-being of children, adolescents and caregivers for years to come – that they will pose a risk to the foundations of mental health,” the UNICEF report reads. 

Image Credits: WHO/NOOR/Sebastian Liste, UNICEF, AMSA/Flickr.

A woman in Africa’s Sahel region shows how her maize corn ears have dried up in a drought, which are occuring with greater frequency in the world’s most food insecure regions as a result of climate change.

A sweeping World Health Organization report on Climate and Health, published just ahead of a critical Glasgow climate conference (COP 26)  that begins 31 October, has declared that “the burning of fossil fuels is killing us” –  the bluntest denunciation to date by the global health agency of societies’ fossil fuel addiction. 

“Climate change is the single biggest health threat facing humanity,” adds the report, whose publication was accompanied by an open appeal to governments, signed by some 300 health organizations representing 45 million health workers worldwide – two-thirds of the global health workforce.  

The “COP26 Special Report on Climate Change and Health” provides little in the way of brand-new data on a much-discussed issue.  But it is the boldest yet of WHO’s recent statements on increasingly alarming trends – leading to more extreme heat episodes, fires, floods, and droughts, and air pollution – which in turn create a cascade of health effects. 

“There are 45 million plus health care professionals who are witnesses to the health emergency that is unfolding in plain sight,” said Howard Catton, CEO of the International Council of Nurses. 

Health professionals, including WHO staff, demonstrate for clean air and climate action outside of the Geneva United Nations headquarters in 2018.

“They see and work with young … and old people struggling with respiratory disorders caused or exacerbated by poor air quality and pollution… people with heatstroke, exhaustion and hypothermia,” said Howard Catton, CEO of the International Council of Nurses, which played a major role in mustering the health community to its appeal for action. 

“They support people who are not coping with extreme temperature changes from heat stroke and exhaustion to hypothermia….

“And they see and experience extreme events and disasters like flooding and forest fires which resulted from spreading infectious diseases, including vector borne diseases, the contamination of food and water that people can’t avoid. 

“They see that the impact is not just on people’s physical health, but on their mental health, depression, anxiety, grief, isolation symptoms of post traumatic stress disorder,” he added.

“The planet has become the patient.” 

An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors.

Reducing climate change could save 5.6 million lives annually from air pollution-related deaths

Despite its harsh tone, the report provides no new estimate for how many lives a year are being lost to climate change directly, said Dr Diarmid Campbell-Lendrum, one of the leaders of the report.  He acknowledged that the most recent WHO study estimated projected deaths from climate change at around 230,000 people a year by the year 2030 – which admittedly only looked at a “small proportion of the ways in climate change affects health.”  Those estimates also omitted a critical issue, the impacts of extreme heat on health – which is increasingly affecting not only older people but also workers in construction, agriculture and other outdoor occupations.  

Diarmid Campbell-Lendrum, Head of WHO Climate Change Unit

Even so, dramatically reducing the burning of fossil fuels, as well as domestic burning of wood and biomass for cooking and heating, would slash deaths from air pollution by 80%, saving some 5.6 million lives a year, said Dr Maria Neira, Director of WHO’s Department of Environment, Climate and Health, which coordinated the report.  

Dr. Maria Neira, Director of WHO Environment, Climate Change and Health

“One of the things that has become very clear in the past few years is this compounding nature of the climate crisis,” added Campbell-Lendrum referring to the synergies. “We have increasing extreme heat also combining with other vulnerability factors. We have urbanizing populations, we have older populations, we have populations living with other previous [health] conditions.”

And while the most heavy health burden from climate change tends falls upon people living in low- and middle-income countries whose homes, food security and livelihoods are more directly impacted by more extreme weather, people in high-income countries are feeling, more and more, the impacts of climate-related drought, fires and flooding, and extreme heat – as evidenced by the wildfires, flooding and heat extremes, seen over the past two years in countries ranging from Australia, to Germany and the United States. 

 … Populations that we thought were relatively immune from climate change, those living in developed countries are in fact much more vulnerable than we thought, including to things like heat stress,” Campbell-Lendrum said. 

Template for Greener COVID Recovery   

The report calls for sustainable, health urban design and transport systems, with improved land-use, access to green and blue public space, and priority for walking, cycling, and public transport.

Billed as a template for action in 10 critical areas – from healthier cities to healthier energy supplies – the report strikes a forward-looking note, citing the solutions available if only sufficient money and political are invested in the climate issue.

The report zeroes into more detail on four key areas of action:  

  • Healthier energy systems; 
  • ‘Reimaginging’ urban environments, transport and mobility – a major source of climate emissions and air pollution in cities;
  • Promoting healthy, sustainable food systems that deliver more nutritious diets with a smaller carbon footprint than current meat- and processed food heavy diets. 
  • Protecting and restoring natural biodiversity, which is essential to the regeneration of   clean water, clean air and food production systems.   

The emphasis, said Neira, should be on the positive benefits that can be generated for people with the right set of climate actions.

“The positive message on the health argument is that whatever you do to tackle the causes of climate change will have enormous benefit for the health of the people,” Neira pointed out – and that argument goes beyond the 5.6 million lives that could be saved from cleaner air. 

“If you do the transformation that is needed in terms of sustainable force food systems, the healthy diets that will result, will prevent as well 5.1 million deaths every year. Plus, all the benefits will come from transport, physical activity. Our society needs to understand that tackling the causes of climate change …probably have a big opportunity,” Neira stressed, adding that whatever investment is spent would be far outweighed by the savings obtained in human lives, productivity and healthcare costs.

Presently, however, as economies around the world continue to pump billions into economic recovery from the COVID pandemic, monies still aren’t being invested into climate-friendly economic stimuli, Campbell-Lendrum pointed out:

“We still see that about 80% of those are investments according to the OECD, are either neutral or harmful for the environment, we have to bring that balance more towards a greener recovery.”

Greening the health sector

The report calls to build climate-resilient and environmentally sustainable health systems and facilities.

The report also calls upon the health sector to start greening its own backyard – by creating more sustainable and climate resilient health facilities.

“If the health sector was a country it would be the fifth largest climate emitter in the world,” declared Neira, referring to the very high carbon footprint of health facilities in most developed countries – second only to the leisure industry in terms of building energy and water demand.

The same facilities are also major generators of plastic and other types of waste from the use of single use health products – often unavoidable. At the same time, facilities in low- and middle-income countries may lack adequate access to electricity and safe water supplies for hygiene and basic health care operations, like maternal and newborn delivery.  Extreme heat in poorly designed and ventilated facilities create huge risks for women in labour, increasing risks of haemorrhage, as well as their newborns – and particularly premature babies – who are more vulnerable to dehydration and lack adequate physiological mechanisms for heat control.

“This report shows that there are ways to limit climate change that can also improve our wellbeing,” said Cheryl Moore, Director of Research Programmes at Wellcome Trust, which has made climate change one of its premier strategic priorities: 

“We’ve spent too long thinking about these issues in isolation; now is the time to focus our efforts on a global, unified strategy to safeguard human health, and that of the planet. It will require all of us working together – now and for the decades to come.”

Image Credits: Commons Wikimedia, Pablo Tosco/Oxfam, WHO, Planetary Health Eastern Africa Hub, WHO/Bill & Melinda Gates Foundation.

Inactivated COVID-19 vaccine candidate produced by Beijing Institute of Biological Products and Sinopharm Group.

The World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) has recommended that people over the age of 60 who received the Chinese Sinovac and Sinopharm vaccines, should get a third shot – possibly with another vaccine.

“The use of a heterologous platforms vaccine for the additional dose may also be considered based on vaccine supply and access considerations,” according to a preliminary report from last week’s SAGE meeting, an indication that the experts believe that stronger immune responses may be initiated when a different vaccine is used.

“When implementing this recommendation, countries should initially aim at maximizing two-dose coverage in that population, and thereafter administer the third dose, starting in the oldest age groups.”

Scrupulously avoiding calling them boosters, SAGE also recommended that third doses should be offered to “moderately and severely immunocompromised persons” as part of “an extended primary series”.

SAGE also reviewed Bharat Biotech’s COVID-19 Vaccine, Covaxin, and would issue a policy recommendation when the vaccine is Emergency Use Listed (EUL) by WHO – an indication that EUL is close.

SAGE also recommends that all countries consider implementing seasonal influenza vaccination based on the burden of disease, the cost-effectiveness, competing public health priorities, and programmatic feasibility. 

For countries implementing seasonal influenza vaccinations, SAGE recommended prioritising health workers, people with chronic medical conditions, older adults and pregnant women.

 

Image Credits: Sinopharm.

Brazil’s flag draped over a coffin.

Brazil’s official death toll from COVID-19 reached 600,000 late Friday, the second-highest in the world after the US – and a leading epidemiologist blames the Bolsonaro administration for deliberately spreading the virus to achieve “herd immunity”.

“Brazil’s federal government put in place a deliberate policy of exposing the population to the pandemic,” according to Cesar Vitora, Emeritus Professor of Epidemiology at the University of Pelotas and renowned global child health expert.

“In the beginning, we thought they were just incompetent but it was actually deliberate because they tried to reach herd immunity soon so that the economy could go back and start growing. Those 600,000 deaths were not due to incompetence or lack of knowledge but due to deliberate efforts,” he told a meeting last week convened by the Swedish medical university, Karolinska Institutet.

Active dissemination of patients to other states

According to Vitora, instead of isolating people in the Amazon region who had been infected with a new and more potent Gamma (P1) variant, government health officials “actually started sending critically ill patients to all 27 states in the country, an active dissemination strategy, that now is more understandable because that was part of their effort to reach ‘herd immunity’ as a deliberate policy.”

The World Health Organization (WHO) has expressly warned that “herd immunity against COVID-19 should be achieved by protecting people through vaccination, not by exposing them to the pathogen that causes the disease”.

Earlier in the year, human rights researchers from the Conectas Human Rights organisation and the Center for Studies and Research on Health Law (CEPEDISA) at the University of São Paulo also asserted “the existence of an institutional strategy that attempts to spread the virus, promoted by the Brazilian government and spearheaded by the Presidency of the Republic”.

The researchers came to this conclusion by analysing federal government rules and presidential vetoes during the pandemic; “acts of obstruction” to state and municipal government efforts to respond to the pandemic; and “propaganda against public health” aimed at “discrediting health authorities, weakening popular adherence to science-based recommendations, and promoting political activism against the public health measures required to contain the spread of COVID-19”.

The research reveals the “commitment and efficiency of the federal government’s work in favor of the extensive spread of the virus in Brazilian territory, with the stated goal of resuming economic activity as quickly as possible and at any cost”, concluded the researchers headed by Professors Deisy Ventura, Fernando Abujamra Aith and Rossana Reis.

Bolsonaro ‘dereliction of duty’ probe

Brazilian president Jair Bolsonaro

They subsequently submitted their research to a parliamentary inquiry into the federal government’s pandemic response which was convened between April and late June, coinciding with the country’s deadliest two COVID-19 waves that averaged 74,000 to 76,000 new cases per day.

The inquiry also probed possible corruption in a $300-million deal in which Bharat Biotech offered to sell its indigenously-made COVID-19 vaccine, Covaxin, to Brazil for a whopping $15 per dose – yet after 18 months, not a single dose had materialised.

In July, after the televised inquiry, Brazil’s top prosecutor said he would request an investigation of President Jair Bolsonaro for dereliction of duty during the process of procuring Covaxin.

Vitora said that Bolsonaro and his officials “minimised the health effects of COVID at first, then they opposed lockdowns and social distancing. They discouraged the use of face masks. They delayed the procurement of vaccines. We were very late to start vaccinating. And they constantly challenged the effectiveness of vaccines. As you well know, the only president in the United Nations General Assembly recently who had not been vaccinated was Bolsonaro.”

Poor Black Brazilians and indigenous people have been particularly badly affected by the pandemic, said Vitora.

While the US has more deaths than Brazil, Brazil’s per capita death toll is considerably higher – 2,847 deaths per million to the US’s 2,162 deaths per million. The nation of over 212,6 million people has officially recorded over 21 million deaths although the figure is likely to be much higher.

A large study that Vitora was involved in that was aimed at assessing the impact of the pandemic in 133 Brazilian cities had to be stopped because the government sent out messages to people on WhatsApp telling them “not allow our interviewers to collect a fingerprint blood sample antibody test”, he added.

Fake cures

Bolsonaro, who has gone through three health ministers in the past 18 months, has promoted ivermectin and hydroychloroquine to treat COVID-19, frequently said that the virus would ‘soon’ pass and also used his veto powers to undermine state governors’ attempts to contain the pandemic through lockdowns and social distancing measures.

“Everything right now is pandemic this, pandemic that. Come on, this has to stop. I am sorry for the dead, I am. We’ll all die one day. There’s no use trying to escape it, to escape reality. We can no longer be a country of sissies, come on,” Bolsanero said in a public address last November.

Last December, 11 former Ministers of Health from different political parties published an article denouncing the “disastrous and inefficient conduct of the Ministry of Health in relation to the Brazilian strategy of vaccinating the population against COVID-19”.

The following month, a supreme court injunction allowed states to vaccinate citizens with approved vaccines and to import vaccines.

Shortly afterwards, Bolsanero said that Pfizer was “tampering with people’s immune systems” and was refusing to take responsibility for side effects, including “if you turn into an alligator… If you become Superman, if some woman is born with a beard, or if a man starts to have a thin voice”.

“Fake news has been a cornerstone of the Bolsanero government’s handling of the pandemic,” said Vitora, stressing that the medical and scientific community had to work out “how to communicate science in a way that it reaches the whole population, counterbalancing, the massive dissemination of fake news by people with bad intentions, who are not interested in science”.

However, Brazil finally seems to be turning the tide on the pandemic, and has vaccinated almost 48% of its population. Meanwhile, Bolsonaro was denied entry to a soccer match over the weekend because he is unvaccinated.

Image Credits: Rafaela Biazi/ Unsplash.

The redistribution of available vaccine doses could avert an estimated one million deaths by mid-2022, found a new MSF report, renewing calls for increased dose redistribution.

The hoarding of more than 870 million excess doses of COVID-19 vaccines in just 10 high-income countries is likely to deprive hundreds of millions of healthcare workers and vulnerable populations in low- and middle-income countries of the opportunity to get even a first vaccine dose, according to a new report by Medecins Sans Frontieres (MSF).

The report maps doses that will be available until the end of 2021 in the United States, Canada, Great Britain, Australia and seven other European countries – even after all people age 16 and over were fully vaccinated and third booster doses administered to those at risk. 

The excess doses of COVID-19 vaccines by the end of 2021 after vaccinating people ages 16 and up in ten high-income countries.

Those forecasts of excess doses are conservative – in light of the fact that most high income countries have only reached 70% vaccination coverage of those groups, at best, with vaccine campaigns leveling off after that.  

Based on its analysis, MSF said there is added urgency for high-income countries redistribute excess doses to LMICs, with support for rollout as well. It also repeated previous calls asking pharma companies to prioritize vaccine sales to LMICs.

“If excess COVID-19 vaccine doses are not urgently redistributed, millions of doses could be wasted as they lay idle in HIC storage and are unable to be used before their expiry date.b G7 and EU countries alone could waste 241 million doses by the end of 2021. This would be a tragedy given the urgent need in LMICs,” states the report, published on Thursday.

Timeline critical for dose redistribution – opportunities narrowing fast 

“An additional concern is the timeline for dose redistribution,” the report states. 

“If doses are ‘dumped’ towards the end of the year instead of being steadily redistributed, LMIC health systems may not have the capacity to absorb these doses and they would be wasted, especially if these doses are close to their expiry date. 

This is why it is essential that HICs begin redistributing doses now and commit to clear delivery schedules by the end of October 2021.” 

The report’s authors also stressed that it’s far preferable for  high income countries to redistribute their excess doses through the WHO co-sponsored global COVAX facility – to ensure that doses are redistributed to where there is greatest need and where health systems are able to absorb them. 

This was a message underlined by a COVAX advisory committee recently – saying that bilateral country donations may yield good political capital – but not be as efficient in terms of really getting the doses used effectively. 

Finally, vaccine donations should be accompanied by technical support to actually help LMICs administer the jabs, the report stressed. 

“Not covering these costs will compromise countries’ implementation capacity and therefore the effectiveness of vaccination strategies.”  

World far from WHO’s 40% end-year vaccination goal

The world is currently far from reaching the WHO vaccination targets of vaccinating 40% of the population of all countries by the end of this year and 70% by mid-2022. Some 56 countries failed to meet the goal of reaching 10% vaccination coverage by the end of September. 

In addition, the COVAX Facility has fallen far behind its supply forecast. 

Over 60% of people in high-income countries have received at least one dose of a COVID vaccine, but less than 3% of people in low-income countries have. 

At this stage, healthcare workers and vulnerable people in LMICs will not receive their vaccinations until after the majority of wealthy countries’ populations are fully protected, including with booster shots.

Nearly one million COVID deaths could be averted by dose-sharing

Dose redistribution now is also the fastest way to save lives, said MSF. 

The report estimates that nearly one million COVID deaths could be averted by mid-2022 if available excess doses are redistributed by the end of the year.

“If the world is not urgently vaccinated, it is more likely that ‘variants of concern’ (VOC) will develop and spread globally,” said the MSF report. “The public health, ethical, human rights and economic justifications for ensuring equitable and rapid access to COVID-19 vaccines that can save lives and limit the spread of COVID-19 are clear.”

The doses shared should be suitable, affordable and have sufficient remaining shelf life, MSF added.

Failures of the COVAX Facility

The urgent calls to rich countries for more dose sharing come as the global COVAX vaccine Facility, created with high ambitions to support the development, procurement, and distribution of vaccines, continues to fall far short of its original distribution timeline.

Some fifteen months after the global COVAX was established, the Facility has delivered 230 million doses and is “severely off course” to achieving its goal of delivering two billion doses by the end of 2021, the MSF report noted.  

According to MSF, COVAX failures are related to its “business-as-usual approach,” which allowed pharma companies to decide which countries would be first supplied. 

The inclusion of LMIC governments, regional bodies, and civil society organizations in the design of COVAX would have led to a body more reflective of the needs of LMICs, said MSF. 

As a result, the COVAX model shouldn’t be replicated for future pandemics. Instead regional procurement mechanisms could help regions take better control of their own vaccine manufacturer and supply, the MSF report concluded.

Image Credits: VPalestine/Twitter, WHO PAHO, MSF.

Rwanda
Rwandans queue to receive the AstraZeneca COVID-19 vaccine delivered by COVAX in March.

The World Health Organization (WHO) believes that is possible to get 70% of the world vaccinated against COVID-19 by June – but only if wealthy countries redirect their doses and orders to poorer countries that are lagging behind.

Eleven billion vaccines are needed to reach the 70% target, said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the launch of the global body’s Strategy to Achieve Global Covid-19 Vaccination by mid-2022.

More than 6.4 billion doses had already been administered globally, and one-third of the world’s population is fully vaccinated against COVID-19,” said Tedros.

“Contracts are in place for the remaining five billion doses, but it’s critical that those go where they are needed most, with priority given to older people, health workers and other at-risk groups,” said Tedros.

“We can only achieve our targets if the countries and companies that control vaccine supply put contracts for COVAX, and the African Vaccine Acquisition Trust (AVAT) first for deliveries, and donated doses.”

Tedros added that there was “horrifying inequity” as high and upper-middle-income countries had used 75% of all vaccines produced so far while low-income countries have received “less than half of 1% of the world’s vaccines”.

Earlier this year, WHO set three global vaccination targets to end the pandemic: 10% of the world’s population vaccinated by the end of September, 40% by December and 70% by next June.

Failed to meet 10% target

But 56 countries, mostly in Africa and the Middle East, failed to meet the 10% target last month. The average vaccination rate in Africa is 4.4%.

However, WHO’s Dr Kate O’Brien, head of vaccines and immunisation, said that around 200 million vaccines were needed for all countries to reach 10% coverage – less than a week’s production, as around 1.5 billion vaccine doses are being produced every month.

Bruce Aylward, Tedros’ special adviser, added that 40% of people were already fully vaccinated in North America, South America and Asia, while the Western Pacific was close to that. 

“Of course, the problem in sub-Saharan Africa,” said Aylward. “There’s enough vaccine in the world, but we have a distribution and delivery problem. If we can’t solve that problem in 12 weeks, that speaks poorly for the urgency we need to end the pandemic.” 

He challenged every country with over 40% coverage, saying that if they were not prioritising helping lower-income unvaccinated parts of the world and COVAX then “they’re simply not doing enough to help achieve global equity”. 

‘Costed, coordinated and credible’

United Nations Secretary-General António Guterres

Describing the WHO strategy as a “costed, coordinated and credible path out of the COVID-19 pandemic for everyone, everywhere”, United Nations Secretary-General António Guterres said that $8-billion was needed to meet the 70% target, both to buy doses and support in-country delivery.  

Guterres expressed frustration that neither the UN nor the WHO had the power to compel wealthy countries or vaccine manufacturers to distribute vaccines fairly.

“I’ve long been pushing for a global vaccination plan to reach everyone everywhere sooner rather than later; a plan that should be implemented by an emergency task force made up of present and potential vaccine production countries, the WHO, COVAX partners, international financial institutions, working with the pharmaceutical companies to guarantee the production of enough doses and their equitable distribution,” said Guterres.

“Unfortunately, I have not been heard. Yet instead of global, coordinated action to get vaccines where they are needed most, we have seen vaccine hoarding, vaccine nationalism and vaccine diplomacy.”

He warned that vaccine inequality is the best ally of the COVID-19 pandemic. 

“It’s allowing variants to develop and run wild condemning the world to millions more deaths and prolonging an economic slowdown that could cost trillions of dollars,” said Guterres.

Three steps

The WHO strategy proposes a three-step approach to vaccination, with all older adults, health workers, and high-risk groups of all ages, in every country vaccinated first, followed by the full adult age group in every country and finally adolescents.

It directs all member states to establish updated national COVID-19 vaccine targets and plans that “define dose requirements to guide manufacturing investment and vaccine redistribution”.

It appeals to countries with high vaccine coverage to swap their vaccine deliveries with COVAX and AVAT, accelerate donation commitments, and establish new dose-sharing commitments aimed at reaching the 70% target in every country.

It also calls for COVID-19 vaccine manufacturers to prioritize and fulfil COVAX and AVAT contracts, and be transparent about their monthly production.

 “We’ve heard the commitments. We’ve heard the talk. The DG has called for actions, and those are very clear in the strategy,” said O’Brien.

“Countries that have a substantial number of doses already and have achieved high vaccine coverage can swap their place in line for additional doses for the coming weeks and the coming months. The critical feature here is to get the doses to those places that are still lagging behind the target. The second part of this is that funding is needed for those countries to actually deliver the doses.”

Image Credits: WHO.