Pfizer’s COVID-19 vaccine during the manufacturing process.

In a bid to better respond to both domestic and global needs, as well as future threats, the Biden Administration plans to spend billions of dollars to expand US vaccine manufacturing capacity enabling production of 1 billion vaccine doses a year by mid-2022, two top White House officials told US media on Wednesday. 

The announcement comes just ahead of another move whereby the US Food and Drug Administration is expected to approve booster shot doses of the Pfizer-BioNTech Covid vaccine for all adults later this week. 

Currently, boosters are only recommended for Americans age 65 and older, but as US infection rates begin to rise again, leading experts such as Anthony Fauci, chief White House Medical advisor, have said that they think booster doses for most people will be inevitable to head off a mid-winter virus surge.  

Despite rising infection rates in many countries – WHO continues to oppose boosters 

In most African countries, less than 15% of people have received even one vaccine dose, and in many countries, less than 5%.

WHO and health equity advocates have continued to strongly oppose the administration of booster doses by rich countries, saying that these rob poorer nations of doses for their first and second vaccines. 

On Sunday, WHO repeated its call for a “moratorium on COVID-19 boosters until the end of 2021” so that other countries could get first shots. 

“No more vaccines should go to countries that have already vaccinated more than 40% of their population until COVAX has the vaccines it needs to help other countries get there too,” said WHO, citing earlier remarks by WHO Director General Dr Tedros Adhanom Ghebreyesus.

“No more boosters should be administered except to immunocompromised people. Most countries with high vaccine coverage continue to ignore our call for a global moratorium on boosters at the expense of health workers and vulnerable groups in low-income countries who are still waiting for the first dose.

White House manufacturing expansion – focused on domestic producers  

Dr David Kessler, chief science officer for White House COVID-19 response

The White House moves to expand manufacturing should help ease supplies abroad, officials pointed out. 

However, while Africa and other low- and middle-income regions have called for more investments on the continent and in other LMICs, the planned new US new investments will be based around manufacturing by US domestic suppliers:

“This effort is specifically aimed at building U.S. domestic capacity,” White House vaccine czar Dr David Kessler was quoted as saying. “But that capacity is important not only for the U.S. supply, but for global supply.”

Kessler, who helped speed the development and approval of AIDS drugs in the 1990s, is the White House Chief Science Officer for COVID Response – the initiative the former Trump administration had called ‘Operation Warp Speed’.

Speaking with reporters at a briefing on Wednesday, White House COVID-19 Response coordinator Jeff Zients said that along with battling COVID, the programme would help prepare the US and the world for a future pandemics, enabling production:  “within six to nine months of identification of a future pathogen.”  

Initiative expands government partnerships with private sector

Insufficient progress on delivering pledged doses to COVAX – across most high-income countries

The investment in vaccine manufacturing capacity is happening in the context of a thrust by the Biden administration to both challenge and woe industry. 

On the one hand, the government has waged a high-profile battle with Moderna, contending that three scientists at the National Institutes of Health should hold co-inventor rights over Moderna’s core mRNA vaccine patent – a demand that Moderna now seems to be conceding, at least partially. 

On the other, the need for expanded collaboration with the private sector was also a theme of statements last week by US Secretary of State Anthony Blinken after a virtual COVID-19 ministerial conference with about 40 other foreign ministers from around the world.

The investments would focus on US vaccine manufacturers with experience in producing mRNA vaccines – who need more help to scale up their capacity rapidly.  

As a first step, Biomedical Advanced Research and Development Authority (BARDA) will issue a call for inputs from experienced vaccine manufacturing companies, asking for responses within the next 30 days, Zients and Kessler said. 

Funding for the scale-up, estimated to cost “several billion” according to Kessler in an interview with the New York Times, which first reported on the initiative.  

The funding would come from the $1.9 trillion coronavirus relief bill that President Biden signed into law in March.

Biden has pledged to donate more than 1 billion coronavirus vaccine doses to other countries in order to vaccinate the global population as the international community struggles to overcome the pandemic, including 800 million doses through the WHO co-sponsored COVAX global vaccine facility initiative.  However only a fraction of those donated doses – or others promised from high -income countries, have so far been delivered. 

Zients said at the COVID-19 briefing that the administration has now shipped 250 million doses to 110 countries as of Wednesday.  A little more than 100 million US doses have been delivered through COVAX, while the rest were donated in bilateral arrangements.  

Some observers say that it is stockpiling of unused doses by wealthy countries, rather than boosters, remains a bigger factor foiling attempts to distribute vaccines more equitably.

In either case, it’s clear that vaccine hoarding is also a powerful driver.  According to independent reports by both civil society groups like Medicins Sans Frontiers, as well as industry observers such as AirFinity, between 600-900 million excess vaccine doses are currently languishing in rich country stockpiles – after existing vaccine priorities and boosters are considered. At least 241 million of those doses will also expire by the year’s end.

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

 

Image Credits: NBC, Pfizer, Twitter , https://covid19globaltracker.org/, MSF.

The number of tobacco users globally has dropped from 1.32 billion in 2015 to 1.3 billion, and is expected to decline to 1.27 billion smokers by 2025, according to the fourth World Health Organization (WHO) global tobacco trends report.

The report, released on Tuesday, revealed that 60 countries are now on track to achieving the global target of a 30% reduction in tobacco use between 2010 and 2025. Two years ago, only 32 countries were on track. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus described the findings as  “encouraging” but noted that the world still had a long way to go. 

“Tobacco companies will continue to use every trick in the book to defend the gigantic profits they make from peddling their deadly wares,” said Dr Tedros. “We encourage all countries to make better use of the many effective tools available for helping people to quit, and saving lives.”

Tobacco kills an estimated 8.1 million a year, 7 million smokers and another 1.2 million people from second-hand smoke, according to the most recent WHO numbers. 

While the WHO report covers use of smoked tobacco, such as cigarettes, pipes, cigars, and smokeless tobacco products, such as oral and nasal tobacco, the use of electronic cigarettes was not analyzed in the report. This could distort the data provided, as e-cigarette use is on the rise, particularly among young people. 

To further reduce the number of people at risk of becoming ill and dying from a tobacco related disease, the report also urges countries to accelerate the implementation of measures outlined in the WHO Framework Convention on Tobacco Control (FCTC). 

Investment in cessation could help 152 million tobacco users quit 

Investing a mere $1.68 per capita each year in evidence-based cessation interventions such as brief advice, national toll-free quit lines, and SMS-based cessation support, could help 152 million tobacco users successfully quit by 2030, according to the new WHO Global Investment Case for Tobacco Cessation. 

WHO called for cessation services to be scaled up, along with strengthening tobacco control measures, and subsequently established a tobacco cessation consortium, which will bring together partners to support countries in scaling up tobacco cessation.

Currently, only about 30% of the world’s population has access to appropriate tobacco cessation services, with many countries still lacking a national tobacco cessation strategy and only a few countries dedicating both personnel and budgets to cessation programs. 

Implementing cessation measures has been shown to result in a 2 – 15% increase in the proportion of tobacco users who quit tobacco use for 6 months or more, as opposed to no intervention. 

Notably, over 60% of smokers report that they want to quit, and over 40% have attempted to do so in the past year – though the report notes that many will fail without much-needed cessation assistance. 

Americas, Africa and SE Asia on track for 30% tobacco reduction

Key findings from the report show that reductions in tobacco have been seen across the Americas, Africa, and Southeast Asia.  

The WHO Americas region reports the steepest decline in tobacco prevalence rate, which has gone down from 21% in 2010 to 16% in 2020. 

The WHO regions of Africa and South-East Asia have also joined the Americas region to be on track to achieve a 30% reduction by 2025. 

However, the WHO Western-Pacific region is projected to become the region with the highest use rate among men, with more than 45% of men still using tobacco in 2025. 

Additionally, the WHO European region has more women using tobacco than any other region – 18%, with women in Europe the slowest to cut tobacco use. 

Approximately 231 million women used tobacco in 2020, with the highest use seen among women aged 55 – 64. 

All other regions are on track to reduce tobacco rates among women by at least 30% by 2025. 

In 2020, 22.3% of the global population used tobacco – accounting for 36.7% of all men and 7.8% of all women. 

E-cigarette research missing from report 

E-cigarettes
Observed estimates show e-cigarette use among young people is increasing.

While e-cigarettes were notably left out from the report, observed estimates did reflect the rise in use among adolescents, with the most startling prevalence rates found in Monaco of 41% of children aged 15 and 16 years old, followed by Lithuania (31%) and Poland (30%). 

Trends in the use of e-cigarettes and other nicotine delivery devices were not included in the report due to the lack of country data. But the data that does exist reveals the need to address a fast-growing and relatively unregulated market that continues to influence children and adolescents. 

Newer tobacco and nicotine products, including e-cigarettes, have evaded regulation, with the tobacco industry using deceptive advertisements to market these products to children and teens.   

Children who use these products are up to three times more likely to use tobacco products in the future, according to a WHO 2021 report on the tobacco epidemic released in July. 

Approximately 28 million children aged 13 – 15 currently use tobacco, despite the fact that most countries have made it illegal for minors to purchase tobacco products. 

Aggressive tobacco control needed

Although the report indicates notable progress in many regions of the world, Ruediger Krech, WHO Director of the Department of Health Promotion, emphasizes the need to push ahead in moving aggressively with tobacco control. 

“It is clear that tobacco control is effective, and we have a moral obligation to our people to move aggressively in order to achieve the Sustainable Development Goals,” said Krech.

“We are seeing great progress in many countries, which is the result of implementing tobacco control measures that are in line with the WHO FCTC, but this success is fragile. We still need to push ahead.” 

While one in three countries are likely to achieve the 30% reduction target, especially in low-income countries, upper-middle countries, on average, are making the slowest progress in reducing tobacco use. 

Some 29 countries lack sufficient data to know tobacco trends and need additional monitoring. 

WHO Meeting of the Parties to address illicit trade in tobacco products  

Starting also this week, in line with the release of the report and the investment case, is the Second Meeting of the Parties (MOP2) to the Protocol to Eliminate Illicit Trade in Tobacco Products.  

Up to $47 billion is lost globally to illicit trade in tobacco products. To further reduce this loss and improve the effectiveness of tobacco control legislation, representatives at MOP2 will consider ways of implementing the protocol, including securing the supply chain of tobacco products through tracking and tracing technologies.

Eliminating illicit trade could reduce cigarette consumption by almost 2% and increase tax revenues by an average of 11%. 

Ahead of MOP2, Head of the WHO FCTC Secretariat Adriana Blanco Marquizo highlighted the need to address illicit trade in tobacco, which has undermined global tobacco reduction efforts. 

“We have serious work to conduct at this meeting. Not only does the illicit trade in tobacco products undermine progress being made on taxing tobacco products, but illicit trade is linked to cross-border organized crime and other activities which threaten our security, ” she said. 


Discussions at MOP2 will be held from 15 – 18 November, days after the close of the Ninth Conference of the Parties (COP9), which convenes every two years to discuss ways in which the FCTC and its implementation can be improved. 

 

 

Image Credits: Johannes Zielcke, Mahdi Bafande/ Unsplash, Bastien Hervé / Unsplash.

Opening ceremony for the second meeting of the Protocol to Eliminate Illicit Trade in Tobacco Products (MOP2) at WHO headquarters in Geneva.

While it pales in comparison to tobacco industry marketing, two new capital investment funds worth some $75 million to support low- and middle-income countries in their fight against tobacco are being created by signatories to the Framework Convention on Tobacco Control and a related Protocol on illegal sales.  Together, the funds would yield an estimated $3 million a year for developing new systems to regulate, track and reduce tobacco use.

While all eyes last week were on the Glasgow Climate Conference (COP26), another Conference of Parties – on the Framework Convention on Tobacco Ccntrol (FCTC) was taking place in Geneva and virtually. 

The FCTC’s COP9 is being followed this week by a Meeting of Parties to a new FCTC protocol that aims to eliminate illicit trade in tobacco products.  That trade, including both physical and online sales,  is a growing concern of countries – because of its potential to undermine new tax laws and other measures that curb tobacco’s harmful influence. 

The first fund, for $50 million, was approved by the FCTC’s COP9 last week, at the close of the week-long meeting of the Convention’s 181 member states.  

The second fund, for $25 million, is being considered during this week’s meeting of signatories to a related FCTC Protocol to Eliminate Illicit Trade in Tobacco Products, which has now been ratified by 64 FCTC member states. 

The new capital investment funds, aim to recruit investors from beyond the health sector, and create annual yields of earned revenues that may be put at the disposal of countries to help them refine and adapt their policy and regulatory tools in the tobacco control battle, Samuel Compton, FCTC spokesperson, told Health Policy Watch.

The funds will bolster the long-term stability of FCTC activities – which currently rely upon a biennial budget of some $19.1 million, covered by assessed contributions to FCTC signatories, and extra budgetary support.

In terms of managing the funds it is likely that the World Bank make take over the task, Compton said, supported by a board of experts in financial and investment management representing the six World Health Organization Regions, as well as civil society.

Tobacco kills an estimated 8.1 million people a year, according to the most recent WHO numbers, including 7 million smokers and another 1.2 million people from second-hand smoke. 

And market projections show that industry continues to expand – with expected growth of over  % 2.7 this year.  This expansion is occurring despite evidence that consumption of traditional tobacco products, according to a 2019 WHO report. Although those reports have not included e-cigarette use in their tracking.  

Illicit trade driving market expansion

Illegally manufactured or trafficked tobacco products also driving market expansion.

Along with e-cigarettes, another one of the drivers of expansion is the illicit trade in tobacco products – which is easier than ever before thanks to online trade, says FCTC spokesperson Samuel Compton, told Health Policy Watch. 

“WHO estimates that eliminating illicit trade could reduce cigarette consumption by almost 2% and increase tax revenues by an average of 11%,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus, in his opening remarks to the meeting of members of the protocol (MOP2) the second such meeting to take place.

“The global tax revenue potential from eliminating illicit trade in tobacco is about 47 billion US dollars annually,” he added, noting that the illicit tobacco trade is rooted in a wide range of driving forces, including, “weaknesses in governance and regulation, corruption, insufficient enforcement capacity, and organized crime networks.”

It includes both the black market sale of legally produced tobacco products – as well as black market production of tobacco products.

Both types of products are marketed and sold in informal markets, and online, at prices that undercut legal, taxed tobacco sales.  Under the terms of the FCTC, such tobacco taxes are supposed to designed and use in a way that deters tobacco consumption as well as providing funds to support public health programmes to fight tobacco addiction and use.  

Added Adriana Blanco Marquizo, Head of the Secretariat of the WHO FCTC, in her opening remarks at Monday’s MOP: 

“We know the tobacco industry tries to mislead governments, using the illicit trade argument to oppose the adoption of highly effective tobacco control measures, like increasing tobacco taxes. Refraining from increasing taxes is not the solution. But implementation of the Protocol is. Parties should respond with a comprehensive strategy to fight illicit trade by fully taking up its provisions.

David and Goliath struggle with tobacco – parallels that of fossil fuels

All tobacco products, including electronic cigarettes, increase the risk of heart disease

Other than timing, there are other comparisons between the David and Goliath battle against big tobacco seen at COP9 and the battle to phase out fossil fuels waged at Glasgow’s COP26. 

While the oil and gas sector will earn about $2.1 trillion in 2021 – and were said to have the largest contingent of lobbyists at this year’s COP26 – climate conference participants failed to come up with a clear way forward to raise the estimated $100 billion annually in finance that low- and middle-income nations say that they need to fight climate change effectively – and wind down fossil fuel dependency more rapidly. 

Similarly, as compared to the tens of billions spent on marketing by the tobacco industry, which will earn revenues of $786 trillion in 2021, global and national budgets to fight big tobacco remain miniscule. 

Only about $66.2 million of international development assistance for health was dedicated to tobacco control activities in 2019, according to a 2020 analysis published in the peer-reviewed journal, Tobacco Induced Diseases. 

Considering that, along with the roughly $9.55 million annual FCTC budget, still leaves an estimated $27.4 billion funding gap in monies urgently needed to fight tobacco use, according to a 2019 report by the Framework Convention Alliance, FCA. 

Tracking and reporting on progress

And in the world of tobacco control, there are also challenges in tracking and reporting progress against global goals – comparable to those faced by countries tracking fossil fuel phase-out, or “phase-down” – as per the final language adopted by the Glasgow Climate Conference on Saturday.

For instance, while WHO says tobacco use worldwide is declining, recent WHO reports have tracked only smoked tobacco products – excluding the growing market in e-cigarette sales. 

And there are clear signs that e-cigarette use is on the rise, particularly among young people.

That raises questions about how much of the decline in tobacco use is real – and how much is merely a shift to another form of tobacco dependency?

At the same time, WHO points to progress made by countries in adopting more health-conscious tobacco legislation, regulation and taxing.  

“Even during the COVID-19 pandemic, there has been progress on tobacco control,” said Dr Tedros Adhanom Ghebreyesus, in his remarks to the MOP.

“5.3 billion people are now covered by one of the best practice tobacco control measures, including increased taxes on tobacco,” he said, referring to the WHO basket of best practices for health, tax and educational that countries can adopt to stop tobacco use. 

Image Credits: WHO/Pierre Albouy, Chris Vaughan, WHO.

A protest banner highlighting COP26’s exclusion of indigenous communities from talks.

While China and India’s last-minute refusal to commit to an end to fossil fuel at COP26 has caused depression and despair amongst many developing country delegates and climate activists, the mental health of millions is already severely affected by what climate disasters have done to their lives.

Humidity and heatwaves are linked to increased suicides, according to a new report released on Monday. Almost one-third of people caught in floods experience post-traumatic stress. Predicted massive climate-related conflict and increased climate migration are also triggers for mental distress.

“When we talk about the mental health impact of climate change, many people think I am talking about eco-distress and eco-anxiety but that’s not really what I’m talking about,” said psychiatrist Dr Lisa Page, co-chair of the UK Royal College of Psychiatry’s Planetary Health and Sustainability Committee.

Instead, said Page, she was referring to the direct and indirect impacts of climate crises on mental health.

“A systematic review that was published recently showed that around if you’re flooded, around 30% of people will develop post-traumatic stress disorder (PTSD) and probably around 20% of people will develop either depression or anxiety,” Page told a meeting hosted by the UK Royal College of Psychiatrists, Royal College of Paediatricians and Child Health Workers and Royal College of Physicians on the sidelines of COP26 last week.

Turning to heat, Page pointed to statistics from the UK Office for National Statistics for summer 2020 which showed that all-cause mortality went up during each of the three recorded heatwaves, with over 2500 excess deaths in England alone.

“That’s mostly in the over 65. But we know from other evidence that it’s not just the frail elderly. It is also people with major mental illness, examples being dementia, severe and enduring illnesses like psychosis, and people with substance misuse problem,” said Page.

Monday’s report in Nature, based on data from 60 countries between 1979 and 2016, found statistically significant increases in suicide – but related to more to humidity than heatwaves. Women and younger people were particularly affected, and the countries affected were as varied as Sweden and Guyana.

One of the scientific reasons advanced for this is that some medicines for mental health inhibit the body’s ability to effectively thermoregulate. This results in heat stress and the exacerbation of certain mental health conditions, including bipolar ‘disorders’, schizophrenia, dementia and developmental ‘disorders’ including autism.

Page cited indirect impacts such as loss of land, forced migration, and changes patterns in infectious diseases as possibly more significant than heat and floods.

“Forced migration, particularly migration that might involve unexpected migration, or migration after conflict, has very significant and very serious effects on mental health, and can  lead to higher incidence of psychosis, for example, in migrating populations,” said Page.

“There have been recent dire predictions about increases in conflict as a result of climate change and I can’t think of any other human activity that leads to more mental disorder than conflict,” said Page. “And finally, we get to eco-distress and eco anxiety.”

What about grief and loss?

Child psychiatrist Dr Lynne Jones, has been establishing and running mental health programmes in conflict areas and after natural disasters since 1990, including Iraq, Sierra Leone, Ethiopia, Uganda, post-tsunami Indonesia, post-Earthquake Haiti and with migrants in Europe and Central America.

“For millions of people, climate change is not a future threat but a current catastrophe,” said Jones, speaking from Bosnia where she is working with migrants. 

“Climate-fuelled disasters were the number one driver of internal displacement in the last decade. The word climate change is totally inadequate. These disasters are the result of climate breakdown and ecological collapse and I prefer the term planetary crisis to encompass both.”

In 2020, Central America suffered the worst Atlantic hurricane season ever recorded, which displaced more than half a million people, while Madagascar has been in a climate-induced famine for the past four years, said Jones.

“The developing brain needs adequate nutrition, maternal love, play and stimulation. And if any of these absent, there’s likely to be lifelong damage and an enormous loss of human potential,” stressed Jones.

Jones worked in a refugee camp in Chad following a climate-induced conflict and was struck by how mothers were too depressed and lacking in energy to interact with their babies.

“I know that PTSD and traumatic stress and acute stress problems are a major issue of the conflict. But what doesn’t get talked about, as a direct effect of conflict and disaster, is grief and loss. It is the most important mental health effect. It’s not a disorder,” said Jones.

“The problem is how do you mourn if you can’t hold a funeral because your house has been destroyed? Or all the neighbours are also mourning and feel they can’t come because they’re dealing with their own grief so you don’t have that community connection? And what if there’s no body because it was lost at sea, or buried in a mass grave, or abandoned in flight? These are the problems of grief and loss that I don’t see discussed?”

Image Credits: Disha Shetty .

A French official checks a woman’s COVID-19 certificate, providing evidence of vaccination or a recent PCR test.

It may be too late for many European countries to avoid harsh measures to try to curb the intense transmission of COVID-19, according to World Health Organization (WHO) officials on Friday.

“Almost two million cases of COVID-19 were reported in Europe last week, the most in a single week in that region since the pandemic started,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the global body’s media briefing.

“Almost 27,000 deaths were reported from Europe, more than half of all COVID-19 deaths globally last week.”

High rates of infections are being experienced both in more vaccine-hesitant countries in Eastern Europe, as well as in countries with some of the world’s highest vaccination rates in Western Europe – reflecting the fact vaccinations alone are not enough to halt the virus, according to the WHO.

A number of European countries have already started to clamp down on public activities. The Netherlands is poised to introduce a three-week partial lockdown including a 7pm closing time for restaurants this weeked, while Austria expects to introduce more restrictions on unvaccinated people.

Last month, Russia – part of the WHO Europe region – ordered all unvaccinated people over 60 and with underlying conditions to stay at home until February as it battles its worst case load amid vaccine hesitancy.

At least 12 European countries including Italy, France, Germany, Portugal, Greece and Belgium now require people entering public places such as restaurants, museums and concernts to show proof of vaccination or a recent test with a COVID digital certificate, with Denmark being the most recent to introduce such a measure this week. Some countries are also applying the passes in workplaces, particularly schools and health facilities.  

Restrictive measures

“Quite frankly, some countries are in such a difficult situation now that they’re going to find it hard not to put in place restrictive measures at least for a short period of time to reduce the intensity of transmission,” said Dr Mike Ryan, WHO’s head of health emergencies.

“Other countries can re-engage with communities around masks, around avoiding crowded spaces, around limiting their contact with others, work from home and many other initiatives and very importantly increasing vaccine coverage in high-risk populations,” stressed Ryan.

However, each country would have to assess their own unique situations – weighing vaccination levels and “what level of compliance can be expected from the implementation of personal measures versus government-mandated measures”, he added. 

Predictable surge after curbs lifted

WHO’s COVID-19 lead, Dr Maria Van Kerkhove described the surge in Europe as “predictable” given that most restrictions on social mixing and masks had been lifted.

However, the European surge was also showing “quite strongly how effective vaccines actually are in terms of reducing hospitalizations and reducing deaths”, she added.

New research from the UK has shown that an unvaccinated person has a 32 times higher risk of death than a vaccinated person, said Ryan, but these vaccines had to reach the most vulnerable people.

Places with high vaccination rates of vulnerable people were seeing cases increase but this had not translated into pressure on health systems. But in countries where there were significant pockets of vulnerable people unvaccinated, the same incidence or even lesser incidence of disease will lead to pressure on the health system, added Ryan.

WHO remains opposed to boosters in Europe

Despite the stiff WHO warnings about the possible need for stricter lockdown measures, WHO officials have continued to recommend against the wider uptake of booster shots in Europe or other high-income countries.

WHO has maintained that there is insufficient evidence for boosters, which also divert vital vaccine supplies from countries that haven’t even yet had one jab.  And on Friday Tedros once again appealed for a moratorium on boosters until the end of 2021, so that available doses can be channelled to countries that have not yet reached the WHO goal of 40% vaccination coverage.  He pointed out that, every day, there are six times more boosters being administered globally than first or second doses in low-income countries.

Even so, it appears that boosters are being administered with ever increasing frequency in high-income countries seeing surges – with 92 high- to -middle income countries initiating booster programmes for at least some population groups.

US Chief Medical Officer Anthony Fauci recently hailed the successful Israeli booster campaign as a model that others will have to follow. Israel was one of the first countries to initiate mass administration of boosters in August after it became clear that vaccine immunity from the first two shots had waned significantly after five month. The campaign  drove down new infections from one of the word’s highest levels to levels below that of almost any country in Europe or North America today.

There are now signs that boosters are helping to reduce new infection rates and hospitalizations in the United States, although they are only available to people over age 65, and at least stabilise persistently high rates in the United Kingdom, where people over age 50 can now get a third jab.

According to WHO, 25% of the doses administered every day worldwide are now booster doses, as compared to only 5% two weeks ago.

WHO remains mum on COVID-passes requiring proof of vaccination or testing

Resistance to both lockdowns, as well as much milder measures “COVID pass” rules, is strong in a number of European countries. Large protest rallies have taken place recently in a number of Swiss, German and French cities.

In Switzerland a national referendum is planned for 28 of November to vote on whether to maintain the new system of COVID passes required in almost any indoor venue outside of a private home.

Scope of Switzerland’s COVID Pass

In anticipation of the vote, a series of large demonstrations have been underway – protesting the COVID certificates that are the main focus of controversy. French and Italian opponents of COVID certificates also are eyeing the Swiss debate and the precedent that may take shape on referendum day.

WHO has largely recommended against the use of COVID vaccine or PCR test passes for international travel – pointing to the inequalities between rich and poor countries in accessing vaccines.

But it has refrained from entering into the fray over domestic use of COVID certificate in countries where vaccines are universally available.

Asked about the issue by Health Policy Watch, a WHO spokesperson responded Friday evening saying that the organization was “still checking” for a response.

–Elaine Fletcher contributed to this story

  • Updated 14.11.2021

Image Credits: Mat Napo/ Unsplash, https://www.ge.ch/en/covid-19-certificate/scope-covid-certificate.

moderna

Moderna has fired back against claims made by US National Institutes of Health (NIH)  that its scientists at the National Institute of Allergy and Infectious Diseases (NIAD) helped to invent the crucial component of the pharma company’s COVID-19 vaccine, stating that the mRNA sequence was “selected exclusively” by Moderna scientists. 

“We do not agree that NIAD scientists co-invented claims to the mRNA sequence of our COVID-19 vaccine,” a tweet from a thread on intellectual property by the company said on Thursday.

The thread continued: “The mRNA sequence was selected exclusively by Moderna scientists using Moderna’s technology without input of NIAID scientists, who were not even aware of the mRNA sequence until after the patent application had already been filed.” 

However, Moderna does recognize the “substantial role that the NIAID has played in helping to develop Moderna’s COVID-19 vaccine,” and has said that it has, in fact, included NIAID scientists as co-inventeres on published patent applications where they have made inventive contributions.  

Genetic sequencing dispute; Moderna turned ‘people’s vaccine into rich people’s vaccine’ 

In a story first reported by the New York Times on Tuesday, Moderna had excluded three NIH scientists as co-inventors of a central patent for the company’s COVID-19 vaccine in its application filed in July. 

But the NIH has asserted that three of its scientists at the NIAD, Dr John Mascola, Dr Barney Graham, and Dr Kizzmekia Corbett, helped design the genetic sequence used in Moderna’s vaccine, and should be included on the patent application. 

Had federal researchers been named as co-inventors in the patent, the government would have almost exclusive right to license the vaccine to other manufacturers, opening access to low- and middle-income countries who are still lagging behind in vaccination rates. 

“Recognition as the vaccine’s joint inventor can help the U.S. government finally responsibly steward the vaccine’s use, including by helping secure access for the billions of people still awaiting a safe path out of the pandemic,” said Peter Maybarduk, director of US-based advocacy group Public Citizen’s Access to Medicine, in a statement.

“But Moderna has turned this people’s vaccine into a rich people’s vaccine; refusing to share technology with WHO or developing country manufacturers and sharing very few doses with COVAX while overcharging poor nations.”

Both Moderna and Pfizer have been lambasted by WHO’s Director General Dr Tedros Adhanom Ghebreyesus in the past for offering and planning COVID boosters while billions in LMICs await their first jab.

NIH not backing down from claims

Speaking to Reuters, NIH Director Dr Francis Collins made clear that the NIH, the government’s biomedical research agency, was not backing down. 

 “I think Moderna has made a serious mistake here in not providing the kind of co-inventorship credit to people who played a major role in the development of the vaccine that they’re now making a fair amount of money off of.”

Advocacy group Public Citizen has pointed out Moderna’s failure to name NIH scientists as joint inventors, imploring NIH to “ensure the contributions of federal scientists are fully recognized,” in a letter to Director Collins last week.  

“NIH is showing a modicum of verve at last, suggesting it will not allow federal scientists’ role in the invention of the NIH-Moderna vaccine to be erased,” said Maybarduk. 

Moderna has received around $10-billion in US government money to develop its vaccine but has not responded to US government pressure to share the vaccine technology with low and middle-income countries.

Image Credits: Gavi .

covaxin
Covaxin

Following World Health Organization approval last week, interim data from a phase 3 trial of BBV152, a COVID-19 vaccine developed in India, reports 77.8% efficacy against symptomatic COVID-19. 

The study, published in The Lancet, indicated that BBV152 induced a robust antibody response, with the majority of adverse events, including headache, fatigue, fever, and pain at the injection site, were mild and occurred within seven days of vaccination. 

BBV152, also known as Covaxin, is an inactivated whole virion vaccine developed by India-based Bharat Biotech. The vaccine has recently received emergency use approval (EUL) from WHO for people aged 18 and older, and is administered in a two-dose regimen, 28 days apart. 

The trial conducted an efficacy analysis of 24,419 randomly-assigned participants across 25 hospitals in India who received either two doses of the vaccine or a placebo between 16 Nov 2020 – 17 May 2021.

Vaccine cold-chain requirements make it suitable for low- and middle-income countries

covaxin
Covishield and Covaxin Drive in India

Covaxin’s ability to be stored and transported between 2-8 degrees Celsius has made it suitable for  low- and middle-income countries.

Jing-Xin Li and Feng-Cai Zhu of the Jiangsu Provincial Center for Disease Control and Prevention in China, who were not involved with the study, say “the roll-out of BBV152 might ease the ultra-cold chain requirements of other SARS-CoV-2 vaccine platforms, increase the finite global manufacturing capacity, and improve insufficient supply of vaccines which disproportionately affects low-income and middle-income countries.” 

Bharat Biotech said the WHO EUL approval will help countries “expedite their regulatory approval processes to import and administer Covaxin.” 

“It allows procurement by UNICEF, the Pan-American Health Organization (PAHO), and the GAVI COVAX for distribution to countries in need,” a company press release said. 

The Gavi managed COVAX global vaccine facility has not  yet  signed an agreement with Bharat Biotech, with India delaying committing supplies to the COVAX global sharing effort, sources told Reuters.  

The world’s biggest vaccine maker resumed exports of COVID-19 doses in October, for the first time since April. It has sent about 4 million doses to countries such as neighboring Bangladesh and Iran, but none to COVAX.  

The vaccine has, however, been distributed widely already in India, with 121 million doses administered since the beginning of the country’s big COVID surge in the spring of 2021. 

Covaxin gears up for major distribution abroad 

Airfinity’s COVID Vaccines Revenue Forecasting predicts 545 million Covaxin doses to be sold to low-middle-income countries in 2022.

Following the WHO approval and publication of its Phase 3 results, Covaxin is gearing up for major distribution abroad.

Airfinity’s COVID-19 Vaccine Market Forecast 2021 – 2022, which covers global demand scenarios, supply and production, and revenue of COVID vaccine, has predicted 545 million Covaxin doses will be sold to low-middle-income countries in 2022.

As many as 96 countries have already recognized Covaxin, with Hong Kong the latest to approve the vaccine for international travelers. 

Canada, the US, Australia, Spain, the United Kingdom, France, Germany, Belgium, Russia, and Switzerland, are among the 96 nations to recognize both Covaxin and Covishield, another India-manufactured vaccine. 

Further research needed against COVID-19 variants 

The next step for studies of BBV152, noted Li and Zhu, should be long-term monitoring of vaccine efficacy against COVID-19 and its efficacy against variants. 

This is to “identify whether the vaccine provides ongoing protection when any variation of concern replacement (other than the variants of concern investigated in the study) has occurred,” they said. 

Preliminary analysis of efficacy found Covaxin to be 65% effective against symptomatic COVID-19 from the delta variant. 

Additionally, there was no decrease in efficacy against the alpha variant (B.1.1.7) and marginal reductions in efficacy against other variants of concern, including delta and gamma variants.

Image Credits: Mohammed Naseeruddin/Twitter, Airfinity.

COVID-19 Ministerial meeting, convened by US Secretary of State Antony Blinken

Pakistan and eight other countries, mostly in or around conflict zones, face the largest gaps in vaccine commitments needed to reach a WHO goal of 70% coverage by September 2022. 

The data is part of a new “COVID Global Tracker” – launched Wednesday during a first-ever meeting of the world’s foreign ministers, convened by US Secretary of State Anthony Blinken.  At the meeting, the US also announced that it had brokered a deal to deliver more J&J one-shot vaccines to countries in humanitarian crisis.  

Pakistan, which has a population of some 221 million people, is short nearly 60 million doses, according to the new data tracker. Data from the other countries, locked in prolonged crises or conflict, reflects the fact that, so far, most of the doses that will be needed have not yet been secured at all.

For instance, Afghanistan, with a population of 39 million people, remains short 22 million vaccine doses.  Yemen, with a population of 30 million, is short some 18 million doses.  And the Democratic Republic of Korea (PRK), with a population of some 26 million people, is some 16 million doses.  The gaps between demand and supplies available to the countries with the biggest long-term needs would be narrowed if one-shot J&J shots are deployed. 

Syria with a population of 17.5 million people is short 11 million doses, and Haiti (HTI), with 11.4 million people, is short some 7 million doses. Other countries on the list include Papua New Guinea (pop: 9 m), Nicaragua (pop: 6.6 m) and Laos (pop: 7.3 m).  

Top 9 Countries with Largest Gaps to Reach 70% Coverage (millions of doses)

Data published on the “COVID Global Tracker, highlights in vivid detail the shortfall in vaccine access that low- and middle-income countries face, including a large swathe of Africa – and which is likely to persist throughout 2022.  

First-ever meeting of foreign ministers on COVID pandemic 

The meeting marked the first time that the US had convened foreign ministers to discuss responses to the COVID-19 pandemic since it began in February of 2020. 

Ït brought together some 40 ministers, including China’s, said Gayle Smith, State Department coordinator for global COVID-19 response in a press readout following the meeting. 

Noting that the pandemic is not just a health crisis but a security, economic and humanitarian crisis, Blinken said, “we need foreign ministers to step up and lead as well.” 

In press statements after the meeting, Blinken also called for expanded government and private sector collaborations to expand vaccine manufacturing, unlock supply logjams, and support expanded vaccination efforts in low- and middle-income countries.

Only 13% of COVAX contracted doses delivered so far – ministerial meeting fails to yield more concrete commitments on delivery 

But the meeting did not translate into any immediate commitment to close the gap in dose deliveries to low- and middle WHO Director General Dr Tedros  Adhanom Ghebreyesus, asked ministers to immediately set up a working group to deliver the estimated 514-680 million vaccine doses that would be needed needed to ensure 40 percent of each country’s population is vaccinated by year’s end.

Some some 74 countries, mostly in sub-Saharan Africa, remain off track for meeting that 40% coverage goal, according to the data on the newly-released COVID19 Global Tracker.  Sixty of those countries are among the 91 low- and middle-income countries that are primarily depending on COVAX, or the African Vaccine Acquisition Task Team (AVATT), for deliveries. The remainder are in fact  upper-middle income countries that have fallen through the cracks. 

Expected Effective Vaccine Supply at End-2021 (% of Total Population): Most of sub-saharan Africa, and parts of Asia, could, at best, only reach 10-20% coverage – as compared to the 40% WHO goal.

Only 13% of doses contracted by COVAX, and 6% of doses contracted by AVATT have actually been made available for delivery so far by manufacturers, the COVID Global Tracker also shows. That translates into a whopping 3.45 billion COVAX doses still missing from supplies, according to the Global COVID Tracker. 

Civil Society groups issue new call to prioritze LMICs in new dose deliveries as well as donations

Along with WHO’s call on rich countries to release more dose donations, civil society groups called upon the ministers to let low- and middle-income countries jump the line – and receive first priority for forthcoming vaccine deliveries. 

The ministers should  “agree to share all doses between those needed for domestic demand, as soon as they come off the production line,” in coordination with COVAX and AVATT, stated the open letter signed by nearly 40 civil society groups, including the Rockefeller and Open Societies Foundations:  

“HICs must publicly commit to send their expected deliveries straight to COVAX and regional mechanisms in Q4 2021 and organize this without delay with pharmaceutical and delivery companies. Ministers must use all routes available, including donations and ‘queue swaps’, to deliver doses to LMICs quickly.”

But far those appeals have failed to get a response – including at the recent meeting.  G-20 countries also remain far off course in delivering doses against promised donations. 

Insufficient progress on delivering pledged doses to COVAX – across most high-income countries

Waiving Indemnity – eases vaccine delivery to crises regions

On a brighter note, the US deal with J&J should ease the flow of those one-shot vaccines, including US vaccine donations, to a range of states in crises. The arrangement involves the company’s waiving of liability requirements that vaccine manufacturers typically demand of countries before vaccine acquisition deals are signed. 

“I’m pleased to share that the United States has helped broker a deal between J&J and COVAX to facilitate the first delivery of J&J vaccines to people living in conflict zones and other humanitarian settings,” Blinken said at the meeting.   

“We’re eager for people in these difficult circumstances to get protection against COVID-19 as soon as possible. We know the urgency of this fight,” he added.  “We’ve got to be relentless because this pandemic is relentless. And we have to be coordinated, united, because that’s what a global health emergency like this requires.”

Only a handful of other  Chinese firms have also waived such indemnity requirements, including: Sinopharm and Sinovac, which have WHO-approved jabs on the market, as well as the biotech firm Clover, whose vaccine R&D was has been supported by the Oslo-based Coalition for Epidemic Preparedness (CEPI), followed by a recent IPO that raised $240 million on the Hong Kong stock exchange just last week.

While still undergoing WHO review, Clover has already signed a deal with Gavi, the Vaccine Alliance, to supply its vaccine to COVAX following successful results of a Phase 2/3, multi-country trial of 30,000 people.

In that trial, Clover announced that it’s vaccine had been 84% efficacious against moderate-to-severe COVID, and 100% efficacious against severe COVID. 

Image Credits: US Department of State, https://covid19globaltracker.org/, https://covid19globaltracker.org/.

COP26 president Alok Sharma

A draft agreement released by UN Climate on Wednesday “calls upon parties to accelerate the phasing out of coal and subsidies for fossil fuels” – as countries work toward reaching consensus by the time the Glasgow Climate Conference (COP26) ends on Friday.

The word ‘health’ also was noticeably absent from the draft text, reflecting the continued failure of the global community to recognise and address the intrinsic linkages between planetary and human well-being.

Despite a recent spate of promises, including new pledges by the US and China, limiting global warming to 1.5° Celsius remains well out of reach.  Even if all commitments are met, the world would still see 2.4°C warming by the end of the century, experts now predict.

That was the conclusion of the non-profit Climate Action Tracker, which added up the most recent country pledges – or Nationally Determined Contributions (NDCs) – for CO2 reductions – translating those into forecasts for expected temperature rise. 

Target shortfalls reported by Climate Action Tracker.

Earlier calculations had estimated a 2.7°C temperature rise – showing slight gains in the slow race to carbon neutrality.  

Dr Stephen Cornelius, the World Wildlife Fund’s chief advisor on climate change, described the country pledges as “woefully inadequate”.

“COP26 has gotten further than Paris, but we are nowhere near the 1.5°C needed to avoid the worst impact of climate change,” Cornelius told a media briefing on Wednesday.

However, he welcomed the draft’s recognition of the importance of science, including reference to the “code red” warning contained in a recent report issued by the Intergovernmental Panel on Climate Change (IPCC) on the urgency of climate action.

‘Wreckers’ like Saudia Arabia and Australia will try to weaken text

Greenpeace International Executive Director Jennifer Morgan described the draft declaration as “a polite request that countries maybe, possibly, do more next year”. 

“We’ve just had a landmark study showing we’re heading for 2.4°C of warming,” said Morgan. “The job of this conference was always to get that number down to 1.5°C, but with this text, world leaders are punting it to next year.”

Greenpeace wants an agreement that is much stronger on finance for countries to mitigate and adapt to climate change.  

It also wants a commitment from countries to report annually – instead of every five years – on “new and better” plans until the world is able to reduce the global warming trajectory to the 1.5°C goal. 

While the language calling for an accelerated phase out fossil fuel subsidies, estimated to exceed $5 trillion annually, is seen as a signal of progress, there is no timeline for that to take place. 

And Morgan predicted that “wreckers like the Saudi and Australian governments” would try to delete the call for an accelerated phaseout of coal and fossil fuel subsidies from the draft. 

UK Green MP Caroline Lucas also condemned the draft, saying that it “utterly fails to rise to the moment” by failing to phase out all fossil fuels not just coal.

COP26 delegates ignore warnings that fossil fuel subsidies are dangerous to health 

Fossil fuel subsidies have been repeatedly decried by the World Health Organization and other health experts at a series of health-focused COP26 events as particularly pernicious. 

Such subsidies, WHO points out, fuel dirty energy and transport sources – leading to air pollution emissions that kill an estimated 7 million people a year – while also discouraging investments in cleaner solutions that would be more cost-effective for societies overall.

But the draft final COP statement had nary a word about health – or the climate-air pollution nexus plaguing many developing cities, particularly in South-East Asia.  

“Nearly half a billion will suffer severe health harm from north India’s air pollution even as COP26 offers up unambitious targets to a world at the brink of extinction,” stated the Indian NGO Care for Air. 

Paradoxically, COP will be concluding just as northern India’s seasonal air pollution emergency begins – a situation seen every autumn when smoke from crop stubble-burning in rural areas drifts toward Delhi, where it combines with a potent mix of fumes from construction, traffic, waste burning, and firecrackers celebrating the Hindu Diwali festival.  

Grand promises by politicians last year to devise more sustainable alternatives for farmers – such as composting or machine threshing of crop stubble – to have so far failed to materialize.   

‘Massive credibility gap’, absence of clear targets for fossil fuel phase-out

In Glasgow, politicians seemed anxious to avoid making the potent linkages between climate change and millions of deaths a year from air pollution.

Language in the draft agreement remained general and non-specific around critical points, such as setting a target or timeline for actually phasing out fossil fuels. 

The draft agreement merely “invites parties to consider further opportunities to reduce non-carbon dioxide greenhouse gas emissions”.

The statement does, however, go further than previous COP declarations in suggesting that a more holistic approach to the climate crisis is needed, emphasising the “critical importance of nature-based solutions and ecosystem-based approaches, including protecting and restoring forests, in reducing emissions, enhancing removals and protecting biodiversity”.

Even so,  “at the midpoint of Glasgow, it is clear there is a massive credibility, action and commitment gap that casts a long and dark shadow of doubt over the net zero goals put forward by more than 140 countries, covering 90% of global emissions”, Climate Action Tracker’s briefing document observed.

The country targets for 2030 remain “totally inadequate”, added the report, estimating that they “put us on track for a 2.4°C temperature increase by the end of the century”. 

Another significant unresolved issue: LMIC financing  

COP26 President Alok Sharma confirmed at a plenary on Wednesday that while “some significant issues remain unresolved”, he expected “near-final” texts from the various negotiating groups by Thursday morning and a consensus document for adoption by the close of the summit on Friday.

Aside from the inadequate emission targets, other sticking points concern financing, including agreement on finance for countries’ claims of climate change-related loss and damage – most of which are likely to be filed by low- and middle income countries. 

UK lead climate negotiator Archie Young told the plenary that more work also needs to be done on the “significant finance agenda and the $100-billion goal” – the annual finance target set by the Paris Agreement to be available by the end of 2021 to assist LMIC countries to mitigate and adapt to climate change.

The draft appeals to “the private sector, multilateral development banks and other financial institutions to enhance finance mobilization in order to deliver the scale of resources needed to achieve climate plans, particularly for adaptation”.

Glasgow flooded with fossil fuel lobbyists

While the global business and finance community is said to have an unprecedented presence at COP26 – the largest contingent at the entire conference – is in fact the fossil fuel industry, an analysis of participants found.  

Some 503 fossil fuel lobbyists are registered at Glasgow, according to the analysis by the civil society groups, Corporate Europe Observatory (CEO) and GlobalWitness.org. 

The report “Glasgow Calls Out Polluters” found that if the fossil fuel lobby were a country delegation at COP it would be the largest with 503 delegates – two dozen more than the largest country delegation. In addition, the report found that: 

  • Over 100 fossil fuel companies are represented at COP with 30 trade associations and membership organisations also present;
  • Fossil fuel lobbyiests are members of 27 official country delegations, including Canada, Russia and Brazil.
  • Fossil fuel lobbyists dwarf the UNFCCC’s official indigenous constituency by around two to one.
  • The fossil fuel lobby at COP is larger than the combined total of the eight delegations from the countries worst affected by climate change in the last two decades – Puerto Rico, Myanmar, Haiti, Philippines, Mozambique, Bahamas, Bangladesh, Pakistan.

Image Credits: Climate Action Tracker., Climate Action Tracker.

Solar panels provide electricity to Mulalika Health Clinic in Zambia.

Fifty countries have committed to building sustainable, low-carbon and climate-resilient healthcare systems, and 14 of these have set net-zero carbon emission target dates from as early as 2030. 

This emerged from a health and climate change session at COP26, the United Nations climate conference in Glasgow, that was co-hosted by the World Health Organization (WHO).

“As part of a green and resilient recovery from COVID-19, we need to recognise the role of health systems as emitters accounting for 4% to 5% of global emissions,” said Dr Rachel Levine, US Assistant Secretary in the Department of Health and Human Services.

If the global health care sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet, according to Health care’s climate footprint, a report produced by Health Care Without Harm.

“These emissions are predicted to increase as health systems develop, and demographic changes lead to increasing healthcare demand,” said Levine, adding that the countries that had committed to building low carbon health systems were responsible for about one-third of all health sector emissions globally.

The US has committed to decarbonizing the nation’s health systems by reducing  greenhouse gas emissions in the federal health system, as well as the private sector via  “incentives, guidance, technical assistance and regulatory approaches and partnerships”, Levine added. 

“The United States action on health system decarbonization is influential and critical. The US accounts for approximately 25% of the world’s health sector greenhouse gas emissions. This commitment to reducing greenhouse gases will also result in decreasing the negative health impacts of air pollution, such as premature death, heart disease, stroke, and more,” said Levine.

Josh Karliner, International Director of Program and Strategy at Health Care Without Harm, said that “there is a growing global movement of hospitals and health systems” that were already reducing their carbon emissions.

“There are more than 54 institutions in 21 countries representing more than 14,000 hospitals and health centres committed to race to zero,” said Karliner. “This is from Newcastle to New York. It’s from Sao Paulo to South Africa. It’s from Kerala to California.” 

Karliner explained: “We’re seeing hospitals and health systems taking action by investing in renewable energy by investing in zero-emission buildings and transport; by substituting anaesthetic gases with more sustainable alternatives; by implementing sustainable procurement programmes to purchase sustainably produced food, energy-efficient medical devices and lower carbon pharmaceuticals.” 

However, ‘greening’ health systems is a massive, expensive undertaking that requires many fundamental changes covering architecture, waste disposal, energy, and water.

 

A flash flood in Fiji in 2018

Small island states struggle to make health services climate-resilient

Dr Satyendra Prasad, Fiji’s permanent representative to the UN, told the meeting that his country struggled to keep health services running when faced with superstorms and other adverse weather events.

“It is quite tragic when your doctors and nurses are being evacuated when they should be providing frontline services to people who have been injured and who need care,” said Prasad. 

“This conundrum is very tough, and it is a conundrum that exists for so many countries,” said Prasad, adding that Fiji is in the process of relocating health services to higher ground and equipping facilities with renewable energy to enable them to remain operational after major cyclones of flooding.

“We losing fewer lives to extreme weather catastrophes. We are losing more lives to waterborne diseases and all the diseases that come following a major catastrophe such as flooding, and cyclone,” he added.

Similarly, the Maldives has seen the emergence of vector-borne tropical diseases such as Dengue, which it didn’t use to have, said Aminath Shauna, Minister of Environment, Climate Change and Technology in the Maldives.

“The Maldives is one of the most vulnerable island nations to climate change. We are experiencing things that we thought would happen towards the end of the century,” said Shauna.

“Our coral reefs are dying. We are running out of fresh water. Our islands are eroding, and our islands are getting more frequently flooded, which poses a significant challenge to our public health system,” she added.

To mitigate these risks, the Maldives has integrated climate risks into health policy, developed climate-sensitive disease programmes and is promoting climate-resilient healthcare facilities that are able to withstand climate events. It is also working to ensure that its essential services such as water, sanitation, waste management and electricity can still function during extreme weather events. 

“The Maldives health sector is also committed to initiating the greening of the health sector by adopting environment-friendly technologies and using energy-efficient services,” said Shauna.

Finances for adaptation

However, finances to make these changes are a challenge for countries like Fiji and the Maldives. Lack of finance has been a recurrent theme at COP26, with smaller countries with small carbon footprints appealing for reparations from large polluting countries to assist them to mitigate climate change.

Former UK prime minister Gordon Brown and WHO Ambassador for Global Health Financing told the meeting that “you cannot cut investment in health at the expense of climate change – and you cannot cut investment in climate finance at the expense of health”.

“We really have to recognise that we’re dealing with global public goods – the control of infectious diseases, a clean environment, clean air and a clean environment,” said Brown.

“And we need to have a system of global burden-sharing where the richest countries that are responsible for the historic emissions and have the wealth and the capacity to pay, make good the funding that is necessary for mitigation and adaptation, and that includes the adaptation of healthcare systems, particularly in the poorest parts of the world,” said Brown.

Despite the global commitment made at Paris COP to ensure $100 billion a year in financing to mitigate climate change by the end of this year, it looks like this target will only be reached in 2023.

However, Brown stressed that if this target was not reached, it would deprive developing countries “of the opportunity not only to build coastal defences and renewable industries, but to build the healthcare systems that are necessary for resistance to droughts and famine, and also to pollution in the air”.

Addressing the meeting via a recorded message, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the changes the world needed to make to energy, transport and food systems to meet the Paris climate goals “would bring massive health gains”.

He added that the WHO is committed to working with the countries that had committed to building greener health systems “for a healthier and more sustainable future”.

Image Credits: UNDP/Karin Schermbrucker for Slingshot , World Meterological Organisation.