COVAX / vaccine equity
COVAX vaccine deliveries in Africa.

Without urgent action to boost supply and ensure equitable access to vaccines across every country, COVID-19 vaccine inequity will profoundly impact and impede socio-economic recovery in low- and middle-income countries (LMICs).

This is according to the Global Dashboard for COVID-19 Vaccine Equity, a joint initiative of the United Nations Development Programme (UNDP), the World Health Organization (WHO), and the University of Oxford’s Blavatnik School of Government.

A high price per COVID-19 vaccine dose, in addition to other vaccine and delivery costs, has the potential to place a strain on fragile health systems, undermining routine immunization and other essential health services. 

Alternative, accelerated scaled-up manufacturing and vaccine sharing with LMICs could have added $38 billion to the countries’ GDPs, if these countries had similar vaccination rates as high income countries. 

“Vaccine inequity is the world’s biggest obstacle to ending this pandemic and recovering from COVID-19,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“Economically, epidemiologically and morally, it is in all countries’ best interest to use the latest available data to make lifesaving vaccines available to all.”

According to the new dashboard, richer countries are projected to vaccinate quicker and recover economically quicker from COVID-19, while poorer countries haven’t been able to vaccinate even their health workers and most vulnerable populations. 

Some low- and middle-income countries have less than 1% of their population vaccinated, said UNDP Administrator Achim Steiner. These countries may not achieve pre-COVID-19 levels of growth until 2024. 

In addition, Delta and other variants are forcing some countries to reinstate strict public health social measures, further worsening social, economic, and health impact.

Steiner called for ‘swift, collective action’ on behalf of governments and policymakers to promote vaccine equity worldwide. 

“It’s time for swift, collective action – this new COVID-19 Vaccine Equity Dashboard will provide Governments, policymakers and international organizations with unique insights to accelerate the global delivery of vaccines and mitigate the devastating socio-economic impacts of the pandemic.”

The Dashboard is facilitated by the Global Action Plan for Healthy Lives and Well-being for All, which aims to improve collaboration across the countries and organizations, in support of an equitable and resilient recovery from the pandemic. 

Image Credits: UNICEF.

Arid soils in Mauritania, crops have failed and the region faced a major food crisis in 2012. Over 700,000 people were affected in Mauritania and 12 million across West Africa.

Biodiversity sits at the heart of the simultaneous fight against both COVID-19 and the climate crisis, said experts during a Wednesday event hosted by the Society for International Development (SID). 

At the event, ‘The Vaccine for Biodiversity’, panelists discussed re-focusing attention on the current health and climate crisis, and how new pandemics should and can be prevented in the future by looking at humankind’s relationship with nature. 

Two competing approaches have emerged – one that focuses on the interconnectedness between planetary health and human health and the other that sees health as a commodity – noted Ruchi Shroff, Director of Navdanya International based in Italy.

The view of health as something to be purchased through the pharmaceutical industry or found in biomedical vaccines “separates us from nature”, said Shroff. 

“[We see ourselves] as those that can control and can predict nature, and can also manipulate nature without any thought of the consequences.” 

Such a paradigm has led to disastrous effects, both on the planet’s health and our health. 

“It has exposed the extent and the interconnective precarities of all our global systems, and has shown the health emergency we are facing is deeply connected to the health emergency the earth is facing.” 

New zoonotic diseases rise from global food industry 

biodiversity
Antibiotics are commonly used in animals—often without the input of veterinarians—to boost their growth and keep them from picking up infections

Safeguarding biodiversity has provided a “heavy blanket of resilience”, but the global industrial food system threatens this protection with new zoonotic diseases arising as a result. 

Neglected zoonotic diseases kill at least two million people annually, mostly in low- and middle-income countries. 

“We are, ironically, becoming connected to disease rather than to diversity,” said Shroff. 

The evolutionary interaction between people and nature in the past has built up an extraordinary reservoir of biodiversity. 

But in spite of biodiversity’s impact and calls to curb mass extinction, none of the 20 Aichi Biodiversity Targets have been met for the second consecutive decade. 

Biodiversity loss has worsened, with ten million hectares of forests cut down globally between the years 2015 and 2020, for industrial and agricultural use. Pesticides have led to soil erosion and water depletion, and plant varieties that have existed for generations have also been substituted by highly uniform and commercial varieties. 

In addition, the growing use of antimicrobials in farm animals has become a major contributor to drug resistance. 

Shroff proposes that the upcoming UN 2021 Food Systems Pre-Summit shifts away from existing models that sideline real solutions, and instead focuses on a holistic and integrated response, bringing back an agro-ecological and biodiversity-based paradigm.

“This means farming in nature’s way, as co-creators, as co-producers with diversity, respecting nature’s ecological cycles, respecting people’s rights.” 

Food crisis worsened by COVID-19 

Inka Santala of Woolongong, Australia

A study conducted by the Community Economies Research Network (CERN) that examined the food systems of various countries during the pandemic, found that Finland, typically considered a relatively stable and secure state within the European Union, had several structural weaknesses in its food production and distribution systems in the early onset of COVID-19.  

Since the national recession of the 1990s, Finland has been heavily dependent on food aid distributed by local profit organizations, and has supported the import of products from overseas. 

However, COVID-19 restrictions and border closures placed even more pressure on already trained charity organizations, with their limited capacity, to respond to growing demand. 

This only fueled the currently inequitable and distracted food system, eventually escalating the unfolding climate crisis, said Inka Santala of Woolongong in Australia. 

Santala called for just and sustainable food systems during and post-pandemic to tackle the climate crisis. This includes more climate-friendly agricultural programs and support for organic farmers, subsidies to focus on social enterprises and local food initiatives, and the introduction of more progressive taxes that balance growing income inequalities. 

“It remains necessary to expand food systems not only locally, but also on a planetary scale, considering we are all sustained by the same biosystem.” 

Alternative community-based food systems turn food into ‘common good’  

Vegetable seller at Gosa Market in Abuja, Nigeria. Traditional markets provide access to healthy, fresh foods that play critical roles in feeding individuals and households globally.

With COVID-19 essentially hitting a ‘pause button’ on normal life, CERN researchers also found sustainable food systems that provided for those most vulnerable during the pandemic, and examined how such community-based programs could serve as a transitional process towards more just and equitable ways of dealing with the pandemic. 

This includes food distribution networks in cities such as Sydney that were able to coordinate and expand the use of emergency use provisioning, and the New Zealand National Food Network that redirected food surpluses to people who needed it most. 

There are also traditional markets, where food safety is well-assured, that support food security, local farm production, and more sustainable agro-ecosystems. 

Stephen Healy of Western Sydney University called these diverse forms of food systems a way of making food “common”, shifting the way we access resources that nourish, sustain, and protect us into a good that can be shared worldwide, and can be extended for the “common good”.

“The pandemic does offer us an opportunity to think about how mutuality can be made to endure through time.” 

Image Credits: Oxfam International/Flickr, Commons Wikimedia, SID, Michael Casmir, Pierce Mill Media.

Since the high hopes of February, when a plane carrying the first shipment of COVID-19 vaccines distributed by the COVAX Facility landed at Kotoka International Airport in Accra, the promise of massive COVAX vaccine deliveries to the continent have crashed.

CAPE TOWN – The two men at the centre of Africa’s COVID-19 response – John Nkengasong and Strive Masiwiya – vowed that the pandemic would not follow the same pattern as for HIV, where millions of Africans died because they could not get access to the life-saving antiretroviral (ARV) medicine available in wealthy Western countries.

For over a year, Nkengasong, director of Africa Centres for Disease Control and Prevention (CDC), and Masiwiya, the African Union’s (AU) Special Envoy on COVID-19, have been meeting virtually every night between 9pm and 11pm to plan how to get vaccines for the continent.

“Before I joined this position, I spent 29 years in the area of HIV/ AIDS. I saw firsthand the suffering, the trauma of our continent between 1996 and 2006, where about 12 million Africans died because ARV drugs to treat HIV patients were available, but they were not accessible to the continent,” Nkengasong told a recent briefing on vaccine access. 

“We say to ourselves when we meet every evening to discuss [COVID-19]: never again, never should history repeat itself on our watch.”

But as the Delta variant tears through African countries and promises of COVID-19 vaccines have repeatedly failed to materialise, that familiar divide between wealthy nations with access to medicine and poorer countries without has re-emerged.

The global vaccine access facility, COVAX, has only been able to deliver 25 million of the 700 million vaccines the AU had expected this year. Deliveries ground to a halt in March when its main supplier, the Serum Institute of India (SII), halted all deliveries outside India – due to the huge spike seen in domestic cases. Although Aurélia Nguyen, Managing Director of the COVAX Facility recently promised that the pace will pick up again in the fall with the dispatch of hundreds of millions more doses around the world  – clearly senior African officials are also wary. Too many unmet promises have littered the way, while lives also are being lost every day. 

COVAX – undermined and outmanoeuvred

Effectively, COVAX has largely been undermined and outmanoeuvred by wealthy countries that have struck bilateral deals with pharmaceutical companies – the “vaccine nationalism” that has made many wealthy nations’ platitudes about global solidarity sound like cynical spin-doctoring.

But COVAX is also accused of being opaque about its operations, unable to be honest about its supply problems, and unable to escape the paradigm of a charity-based approach to Africa. 

Critics on all sides also point to one singular tactical failing of the initiative. Despite pledges from major donors, COVAX’s lack of adequate cash in hand in late 2020, left it at the back of the line when rich countries were placing their major pre-orders. For an initiative that was anchored in the status quo, this inability to compete in the open marketplace was a fatal design flaw. 

COVAX Left AU in the dark about financial shortfalls 

Zimbabwean-born billionaire Masiwiya, who also heads the AU’s African Vaccine Acquisition Task Team (AVATT), has become increasingly vocal about COVAX’s lack of transparency at critical moments.  

He recently charged that the vaccine facility withheld “material information” about its supply problems early in 2021. And once vaccine supply problems surfaced more visibly,  it was too late for the AU to plug the holes.

One key moment was in January 2021, when COVAX provided AVATT with a written schedule of vaccines that would be delivered from February.  But according to Masiwiya, COVAX  “failed to disclose that they were still trying to get money, that pledges [of $8.2 billion] which had been made by certain donors had not been met.

“That’s pretty material information,” added Masiwiya, who took leave from his telecom firm, Econet Global, to support the AU response to the pandemic. “Had we known that actually this was hope and not reality, we may have acted very differently. 

“We found ourselves in March, scrambling. Now we are told that is India’s problem. And we think the problems are much deeper than that.”

Masiwiya also questioned COVAX’s reliance on vaccines from the Serum Institute of India (SII), saying that it had been evident to AVATT after meeting the SII late last year that the company would be unable to meet all its orders.

Strive Masiyiwa, African Union Special Envoy and head of the AU COVID-19 Vaccine Acquisition Task Team (AVATT)

Slow performance and secrecy

Kate Elder, Senior Vaccines Policy Advisor at Médecins Sans Frontières (MSF) Access Campaign, agrees with his critique of COVAX.  Along with opaque decision-making, she criticised the secrecy around the terms of advanced purchase agreements signed between COVAX and the pharmaceutical industry, as well as “deals made with “self- financing countries”, for which key details such as monies paid and vaccines procured, have not been disclosed publicly. 

“The global rollout of COVID-19 vaccines has been grossly inequitable, largely due to wealthy governments hoarding vaccines, but also due to the very slow performance of the COVAX facility”, which has failed to deliver on “big promises’,” Elder told Health Policy Watch.

“We heard from many developing countries that they were under a lot of pressure to join COVAX, but that they had difficulty getting information on what they could expect to receive from COVAX, what volumes of vaccines and in what timeframe,” Elder said.

“But it was presented as the global solution so many governments, rightly so, signed up to it and put their reliance in COVAX to deliver vaccines. Fast forward to July 2021 and we see all the challenges that COVAX has experienced, most importantly what that’s meant for developing countries in terms of accessing COVID-19 vaccines, which is absolutely devastating as Africa now enters a third wave of the pandemic with such low vaccination coverage rates.”

In South Africa, the African country worst affected by COVID-19, Cyril Ramaphosa’s government has come under intense pressure from opposition parties, medical professionals and civil society for failing to procure vaccines. However, Ramaphosa had been the chairperson of the AU for most of 2020, and pursued a continental approach to vaccine procurement – but continental negotiations struggled to secure vaccine deliveries as a January deal for 270 million doses failed to materialise.

After South Africa’s brutal second COVID-19 wave in December and January, the country pursued bilateral deals with pharmaceutical companies, including an order for AstraZeneca vaccines from SII for which it was charged double that paid by the European Union. Since June, the country – now in a deadly third wave – has been receiving the BioNtech-Pfizer vaccine – but at “prohibitive cost”, according to government officials. It is also using the Johnson and Johnson vaccine and had covered 13,6% of its population with at least one dose by Wednesday.

The only other African countries that have managed to vaccinate more than 10% of their populations – Seychelles, Mauritius, Comores, Morocco, Djibouti, Zimbabwe and Botswana – have done so primarily with vaccines supplied by China, according to Africa CDC.

Paternalistic and donor-driven? 

Catherine Kyobutungi

Ugandan epidemiologist Catherine_Kyobutungi, head of the African Population and Health Research Center in Nairobi head, has described COVAX as being “paternalistic, donor-driven” and based on a “rich-countries-helping-poor-countries mentality”.

“COVAX is unravelling,” and there is a need to go back and fundamentally re-think the approach, Kyobutungi told Development Today.

“A small group of ‘experts’ sat down and defined the problem and defined the solution for a continent of 1.3 billion people. They packaged it in an attractive way, marketed it, and drove the narrative. Until the rubber hits the road, and you run into headwinds, and you see that this solution is not working. Africa is getting one percent of the global [vaccine] total. So, you have to ask yourself, who thought this up? What was on their minds?”

Gavi, the Global Vaccine Alliance, which manages COVAX, declined requests by Health Policy Watch for comment on this article, and on the criticisms that have been levelled at COVAX by Masiyiwa, MSF and others.  

After initially promising a response from Gavi CEO Seth Berkley, a Gavi spokesperson later deferred. She said only that a response from Berkley was not possible as COVAX is “anticipating some announcements on upcoming partnerships with the AU”.

However, COVAX’s managing director, Aurelia Nguyen, addressed a WHO Africa media briefing shortly after Masiwiya’s criticisms, reporting that the facility expects to deliver some 520 million COVID-19 vaccine doses to Africa this year, but mostly from September onward – and stressed that she was unhappy with the lack of progress.

By Wednesday, COVAX had delivered 134,6 million doses to 134 countries globally – but planned to deliver two billion doses by the end of 2021.

Europeans return to football stadiums – Africans remain trapped in lockdowns

The anxiety of Africans about vaccine access comes as the continent is seeing its biggest peak yet in daily COVID cases, along with the biggest wave of COVID-related mortality due to the lack of vaccinations combined with woefully inadequate hospital infrastructure. 

“Just talked to the Manager of Heal Africa,” related one appeal for aid from Goma, DR Congo on a private chat group Monday. “Three died tonight of Covid, one of them because they ran out of oxygen. He can produce 15 bottles per day but would need 20. He said they also ran out of protective material [PPE for health care workers].” 

In some developed countries, like the UK and Israel, new COVID-19 infections, driven by the Delta variant, also are rising sharply again. But there, hospitalizations and deaths have risen much more slowly – due to high rates of vaccination coverage of 60% or more. Similarly, in Europe, as well as the United States, where 57% of the population over the age of 12 is fully vaccinated, deaths continue to decline, or plateau at levels not seen since the beginning of the pandemic – despite gradually rising numbers of Delta-driven infections. 

Even countries like India, where nearly 30% of the population is now vaccinated, are finally seeing lower hospitalization and death rates as a result of mass vaccination, permitting a slow return to normalcy. 

In contrast, with only 1.3% of Africans are fully vaccinated, African countries have been forced to impose new lockdowns as their public health weapon of last resort – resulting in  hunger, unemployment and political instability. 

“Europe has vaccinated a large chunk of its population and so has the United States,” lamented Nkengasong at a recent Africa CDC special vaccine briefing. 

He pointed to the recent Euro Cup seen the world over, with televised images of “stadiums full with young people shouting and hugging and doing what we cannot in Africa”.

“If we have a predictable supply of vaccines, we can break the backbone of this pandemic by the end of next year,” says Nkengasong. “But if vaccines are not available to enable us to vaccinate at speed and at scale then, past next year we’ll be moving towards the endemicity of this virus on our continent and the consequences will be catastrophic.

“Our economy will continue to be damaged, the death rate will continue to increase. We will see the fourth, fifth, sixth waves, and it will be extremely difficult for us to survive as a people.”

Changing the narrative – African Union makes its own plan

 Masiwiya is determined to ensure that the narrative is different this time around. 

“We are not going to allow this pandemic to become like HIV, and go on and on and on and on killing our people,” he said recently.  

“We’re not going to allow the fourth, the fifth and the sixth wave of this pandemic. That’s what I wake up every day to do. I spend 10 hours a day on it. I don’t go to my business office because I believe that we can defeat it, and we must.”

As a result, AVATT is moving ahead with its own procurement programme, including securing a commitment for the supply of some 400 million vaccines from Johnson & Johnson.  AVATT is also holding talks with Chinese vaccine manufacturers, and others. 

Interestingly, the US is channeling the African portion of its newly-pledged 80-million vaccine donations via both the AU and COVAX.  A similar split is expected for the recently announced US donation of 500 million doses of Pfizer vaccines, to be distributed over end 2021 and 2022.

For Masiwiya, reliance on donations is a non-starter: “We will not solve our problem because of donations. We will solve our problem because we’ve gone out and we have bought our vaccines,” he added, disclosing that all but two African countries had secured loans to pay for the AVATT-acquired vaccines.

Ultimately, AIDS on the continent was brought under control when ARV prices were slashed once they were made by generic producers and African countries, assisted by donors, negotiated directly with these producers. 

Local Production is Key Long-term Goal 

Most African leaders now agree that for COVID-19 vaccines to start flowing more freely, they also need to be produced in Africa, for Africans. 

Wednesday’s announcement by Pfizer/BioNtech that it had signed a letter of intent with South African company, Biovac, to  manufacture its COVID-19 vaccine for distribution within the African Union, has been widely hailed as an important step in the right direction for the continent – even if the 100 million plus doses to be produced in 2022, still  remain relatively small in comparison to the needs today. 

South African President Cyril Ramaphosa described it as  “a breakthrough in our effort to overcome global vaccine inequity”. 

Masiyiwa added his support, saying: “The only way to guarantee Africa’s access to vaccines now and in the future is through this type of strategic manufacturing partnerships, which we welcome greatly.”

But global health experts also were quick to note that the deal will not solve the immediate shortfalls faced – which can be addressed only through more dose-sharing by rich countries.

At the same time, medicines access critics have already slammed the deal.

Although this is the first African company to pay a part in the production of an mRNA vaccine, it will relegate Biovac to the task of vaccine “fill and finish” – as compared to production of active vaccine ingredient.  Production of active ingredient, access advocates say, would involve a higher level of technology and capacity-building for African companies.

The arrangement also effectively maintains the exclusivity of Pfizer/BioNTech mRNA manufacturing knowledge with the pharma firms, the critics charge.

That is in comparison to earlier WHO efforts to engage Biovac in an open-license vaccine technology transfer hub arrangement  – which nonetheless failed to gain the required support from a pharma partner.

“The world so badly needs actual tech transfer and expanded mRNA production in the global South that it’s deeply disappointing to see so much good PR for what I’d call a deeply colonial arrangement,” Matthew Kavanagh, professor of global health at Georgetown University, told Health Policy Watch.

“Pfizer keeps control of the entire production process and distribution; does not share the know-how to make mRNA vaccines; and Biovac gets the privilege of putting vaccine made in the global North into vials in 2022.”

The IP waiver alternative 

Winnie Byanyima, Executive Director of UNAIDs, challenges Germany’s position on COVID IP waiver at Global Health Centre session last week in Geneva.

Meanwhile, voices like UNAIDS Executive Director Winnie Biyanyima and WHO Director-General Tedros Adhanom Ghebreyesus have sharply challenged the pharmaceutical  industry for failing to more dramatically expand voluntary sharing of vaccine technology – or else agree to a waiver on COVID vaccine-related intellectual property – as proposed by India and South Africa. 

Speaking at one recent Geneva event featuring the German Health Minister, Jens Spahn, Byanyima warned that history was repeating itself – and challenged the European minister’s contention that voluntary industry collaborations are the best route for expanding vaccine access. 

She questioned why pharmaceutical companies should have the power to determine “when and with whom to share [vaccine know-how] with, at the time they want.” 

“Here is my challenge, my dilemma,” she told Spahn.  “When antiretrovirals were first found in the west, in Europe and America, people in the south continued to die. It was only when a global movement came to demand access to ARVs.  And it took six more years before the prices came down. 

“Nine million people died who could be alive today…. Now their survivors are now at risk of severe disease and deaths from COVID,” said Biyanyima. “How many years will they have to fight to have a vaccine that would protect them?”

Rich countries and dose-sharing

At the same time, pharma industry leaders have pointed out that no manufacturing arrangement can change the status quo immediately – and in fact global health leaders should be putting more pressure on rich countries, as compared to industry, to share doses right away.

Either way, while HIV/AIDS has not yet seen a vaccine for the disease that killed millions in low- and middle-income countries before the turn of the millennium, the tools to end the COVID-19 pandemic are ‘in our hands”,  Tedros declared Wednesday. 

“Our common goal must be to vaccinate 70% of the population of every country by the middle of next year. The reason why we’re not ending it is the lack of real political commitment,” he told the International Olympic Committee on the eve of the start of the summer Olympics. 

“If they choose to, the world’s leading economies could bring the pandemic under control globally in a matter of months by sharing doses through COVAX, funding the ACT Accelerator, and incentivizing manufacturers to do whatever it takes to scale up production.”

 

Image Credits: UNICEF, WHO, Billy Miaron/ Wikipedia, Africa CDC, Health Policy Watch.

‘Free the Vaccine’ activists in Seattle call on wealthy nations to support the WTO TRIPS Waiver.

The World Trade Organisation’s (WTO) Council for Trade-Related Aspects of Intellectual Property Rights (TRIPS) remains deadlocked on the “fundamental question” of whether a waiver on intellectual property rights of COVID-related products is the best way to address equitable vaccine access during the pandemic.

This is according to a draft oral status report adopted at Tuesday’s TRIPS Council meeting, along with a WTO statement issued late Wednesday.

“Disagreement persists on the fundamental question of whether a waiver is the appropriate and most effective way to address the shortage and inequitable distribution of and access to vaccines and other COVID related products,” according to the oral statement.

Positions remain polarised between those countries that support the India-South Africa waiver proposal and the European Union’s (EU) proposal submitted on 21 June, that such a waiver is not necessary.

“The EU proposal calls for limiting export restrictions, supporting the expansion of vaccine production, and facilitating the use of current compulsory licensing provisions in the TRIPS Agreement, particularly by clarifying that the requirement to negotiate with the right holder of the vaccine patent does not apply in urgent situations such as a pandemic, among other issues,” according to a statement issued by the WTO on Wednesday.

“The two texts discussed in the TRIPS Council reflect that positions remain divergent” about the most effective way to ensure fast, equitable and affordable access to vaccines and medicines for all, according to the WTO.

Ambassador Dagfinn Sørli of Norway, the TRIPS Council chairperson, reported that text-based discussions on the waiver discussed “scope” both from the perspective of products and of IP rights, “duration”, “implementation” and “protection of undisclosed information”, said the WTO. 

“In the area of implementation, discussions focused on a number of specific questions, including transparency and provisions to limit the long-term impact of disclosure of confidential data during the waiver period.”

The waiver proposal is currently co-sponsored by Kenya, Eswatini, Mozambique, Pakistan, Bolivia, Venezuela, Mongolia, Zimbabwe, Egypt, the African Group, the Least Developed Countries Group, the Maldives, Fiji, Namibia, Vanuatu, Indonesia and Jordan.

Nine Months Later and No Progress

This means that the TRIPS General Council meeting on 27 and 28 July will not be asked to formally consider a TRIPS Waiver and negotiations on the proposal will begin again in September.

The TRIPS waiver proposal was made nine months ago, and has been discussed at numerous forums, receiving a huge boost in May when the US announced its support for an IP waiver related only to COVID-19 vaccines.

However, the EU has refused to budge, claiming that a waiver is not necessary and would jeopardise pharmaceutical industries.

World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus reaffirmed his organisation’s support for the waiver at Wednesday’s High Level Dialogue with the WTO on “Expanding COVID-19 Vaccine Manufacture To Promote Equitable Access”. 

Stressing that 11 billion vaccine doses were needed to vaccinate 70% of the world’s population by next year, Tedros said this “can be done by removing the barriers to scaling up manufacturing, including through technology transfer, freeing up supply chains, and IP waivers”. 

“I want to emphasise that WHO values highly the role of the private sector in the pandemic and in every area of health. The intellectual property system plays a vital role in fostering innovation of new tools to save lives,” said Tedros.

“But this pandemic is an unprecedented crisis that demands unprecedented action. With so many lives on the line, profits and patents must come second. 

“Of course, we can’t snatch your property. What we’re proposing is for high-income countries to provide incentives to the private sector because you deserve recognition, and we don’t want you to have financial problems because of IP waiver.”

The COVID-19 pandemic has carried secondary impacts on children orphaned or bereft of their caregivers, adding to the “hidden pandemic of orphanhood.”

An estimated 1.5 million children worldwide have lost a parent, grandparent, or caregiver due to COVID-19, according to a new study published in The Lancet on Tuesday. 

The study, which was conducted by international researchers, including scientists from the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), and the University of Oxford, offers the first global estimates of the secondary impacts of the pandemic on children.

Worldwide, the COVID-19 pandemic caused over 190 million cases and four million deaths. Beyond morbidity and mortality, the pandemic carries indirect impacts, such as robbing children of their caregivers. 

Children who lose a primary caregiver have a higher risk of experiencing mental health problems; physical, emotional and sexual violence; and family poverty. These raise the risk of suicide, adolescent pregnancy, infectious diseases, and chronic diseases, such as heart disease, diabetes, cancer, or stroke. 

Children that go into institutional care can experience developmental delays and abuse.

Modelling to Estimate Magnitude of Hidden Impact of Pandemic on Children

The researchers used mortality and fertility data to model minimum estimates of COVID-related deaths of primary and secondary caregivers of children younger than 18 years of age in 21 countries. The data collected accounted for nearly 76.4% of global COVID deaths as of late April. 

A primary caregiver was defined as parents and custodial grandparents and secondary was considered co-residing grandparents or older kin. Caregivers provide psychosocial support; feeding, teaching, or supervising; and financial support.

In 21 countries, the researchers estimated that by April 2021, 862,365 children had been orphaned or lost a custodial grandparent due to COVID-19-associated death. Of these, 788,704 children lost one or both parents; 73,661 lost at least one custodial grandparent; and 355,283 lost at least one co-residing grandparent or older kin. 

South Africa, Peru, the US, India, Brazil, and Mexico were the countries with the highest numbers of children losing primary caregivers. In Peru, 14.1 children lost a primary or secondary caregiver per 1000 children, compared to 6.4 children in South Africa and 5.1 children in Mexico.

In India, the researchers estimated a 8.5-fold increase in the number of children newly orphaned between March 2021 and April 2021. This was associated with India’s catastrophic surge from the end of March to mid-June. 

COVID-related deaths were more common in men than women, particularly in middle-aged and older parents, leaving a greater number of paternal versus maternal orphans. 

Between two and five times more children had deceased fathers than mothers. 

The model was used to extrapolate global figures. 

Over a Million Children Globally Left Behind by COVID Deaths

Between March 1, 2020 and April 30, 2021, the researchers estimated that 1.5 million children experienced the death of primary or secondary caregivers, 1.13 million experienced the death of primary caregivers, and 1.04 million were orphaned by their parents. 

“For every two COVID-19 deaths worldwide, one child is left behind to face the death of a parent or caregiver,” said Dr Susan Hillis, one of the lead authors of the study and senior advisor to the CDC. 

“By April 30, 2021, these 1.5 million children had become the tragic overlooked consequence of the 3 million COVID-19 deaths worldwide, and this number will only increase as the pandemic progresses,” said Hillis.

A rapid escalation in the study estimates was observed between March 2021 and April 2021, with the total number of children that lost a caregiver increasing by 220,000. This coincides with third waves of the pandemic across Europe and Southeast Asia. 

The more transmissible SARS-CoV2 variants are driving the current global increase in both cases and deaths, after the world saw a nine consecutive week decline in the number of weekly deaths. 

“Our study establishes minimum estimates…for the numbers of children who lost parents and/or grandparents. Tragically,…the true numbers affected could be orders of magnitude larger,” said Dr Juliette Unwin, a lead author and member of the Imperial College COVID-19 response team. 

The under-reporting of deaths around the world could underestimate the number of at-risk children.

For instance, in Brazil, the actual number of deaths at the start of the pandemic are estimated to be 33.5% higher than the officially reported deaths. 

“In the months ahead, variants and the slow pace of vaccination globally threaten to accelerate the pandemic, even in already incredibly hard-hit countries, resulting in millions more children experiencing orphanhood,” said Unwin. 

The increase in orphanhood associated with COVID adds to the existing 140 million orphans worldwide, who are in need of global health and social care prioritisation, said the authors.

The adverse psychosocial consequences of children bereft of caregivers can be compounded by the COVID mitigation measures, leading to school closures, isolation, and disruptions to bereavement practices. 

Solutions to the ‘Hidden Pandemic of Orphanhood’

The study authors called for urgent investment in services to support children who lost their caregivers, specifically focusing on strengthening family-based care. Programmes should combine economic interventions, positive parenting, and education support, said the authors. 

“Our findings highlight the urgent need to prioritise these children and invest in evidence-based programmes and services to protect and support them right now and to continue to support them for many years into the future – because orphanhood does not go away,” said Hillis. 

“We need to support extended families or foster families to care for children, with cost-effective economic strengthening, parenting programmes, and school access,” said Lucie Cluver, study author and Professor of Child and Family Social Work at Oxford University and the University of Cape Town.

In addition, deaths of caregivers can be prevented by accelerating equitable access to diagnostics, therapeutics, and vaccines.

“We need to vaccinate caregivers of children – especially grandparent caregivers. And we need to respond fast because every 12 seconds a child loses their caregiver to COVID-19,” said Cluver. 

The global community needs to capitalise on the momentum from the pandemic to mobilise resources and implement systemic, sustainable support for bereaved youth around the world, said the authors. 

“The hidden pandemic of orphanhood is a global emergency, and we can ill afford to wait until tomorrow to act,” said Dr Seth Flaxman, one of the study’s lead authors and a lecturer in statistics at Imperial College London.

Image Credits: Unicef.

A Tanzanian mother and her baby.

Children living with HIV in six African countries will soon get access to the antiretroviral (ARV) drug, dolutegravir (DTG), which is more effective, easier to take and has fewer side effects than many other ARVs.

DTG will soon be recommended for children in Uganda, Benin, Kenya, Malawi, Nigeria and Zimbabwe, Kenyan AIDS activist Jacque Wambui told Health Policy Watch. Wambui has been advocating for DTG for a number of years following her own struggles with ARV side effects.

“The drug I was using before was giving me dizzy spells and nightmares and I could not sleep. So when I heard about dolutegravir, I told myself, this is the kind of drug that I would like to use and I also want it in my country as soon as possible,” said Wambui, who is as an alternate representative for Kenya on the African Community Advisory Board (AfroCAB), a network of African HIV treatment advocates.

“We are excited that what happened for us will now happen to the children. With dolutegravir, treatment outcomes are better and you notice you are no longer lethargic. We’re having more productive lives,” said Wambui.

Drug also suitable for toddlers

DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to efavirenz and nevirapine-based regimens.

The World Health Organization (WHO) last week welcomed results of a study presented at the International Pediatric HIV Workshop on the superiority of dolutegravir (DTG)-based regimens in young children.

Last year, the ODYSSEY trial demonstrated superior treatment efficacy for DTG plus two nucleoside analogue drugs versus standard-of-care (SoC) ARVs in children over 14 kg with an average age of 12.

A follow-up study completed last month found that DTG is also superior for toddlers with a median age of 1.4 years. Only 28% had treatment failure by 96 weeks in the DTG arm in comparison to 48% in the SoC arm, and 76% of children in the DTG arm had undetectable viral loads (<50copies/ml) compared with half in SOC. 

“​​Children living with HIV continue to be left behind by the global AIDS response,” according to the WHO. “In 2020, only 54% of the 1.7 million children living with HIV received antiretroviral therapy compared to 74% among adults living with HIV.” 

WHO recommends dolutegravir back in 2018

The WHO has recommended DTG as a first-line treatment for adults and children with HIV since 2018, but this has not been rolled out properly in many African countries, according to a presentation at the International AIDS Society (IAS) HIV science conference that opened on Sunday.

Of the 20 sub-Saharan countries with the highest burden of HIV treatment guidelines, only eight – Uganda, Rwanda, Botswana, Eswatini, South Africa, Tanzania, Zimbabwe, and Zambia – recommend DTG for adults in line with the current WHO guidelines.  

Five countries – Kenya, Malawi, Namibia, Côte d’Ivoire and Ethiopia – recommend DTG except for pregnant women.

Lesotho and Nigeria only recommend it as an alternative regimen, while Angola, Mozambique, Cameroon, Democratic Republic of Congo and South Sudan do not recommend it at all, according to researchers Somya Gupta and Dr Reuben Granich.

An initial study in Botswana had highlighted a possible link between DTG and neural tube defects (birth defects of the brain and spinal cord that cause conditions such as spina bifida) in infants born to women using the drug at the time of conception.

This potential safety concern was reported in May 2018 from the Botswana study that found four cases of neural tube defects out of 426 women who became pregnant while taking DTG.

Based on these preliminary findings, many countries advised pregnant women and women of childbearing age to not take it. Activists who met in Kigali and interrupted a meeting in Amsterdam helped to press for more research on DTG.

“There is a lot of exciting science, both in treatment and in prevention, but that is not why we do this work. It’s how people like Jacque and other advocates make it happen in terms of policies and programmes and actual work on the ground,” said Mitchell Warren, the executive director of AVAC, the non-profit HIV prevention organisation. 

The researchers called for speedy processes to translate scientific research into policy and services at the IAS meeting.

“We are going to send out this information to caregivers. We’re even starting to develop materials for advocacy for DTG for children. We are also going to ask different ministers of health across countries to adopt it,” said Wambui. 

Image Credits: WHO.

The health system in Indonesia is being battered by the surge in COVID-19 cases, with hospitals reaching capacity and oxygen supplies running low.

Indonesia has overtaken Brazil and India to claim the highest number of new COVID-19 cases and deaths, becoming the new epicenter of the pandemic. The surge is part of a third wave hitting all across Southeast Asia.

Countries in Southeast Asia emerged from the first year of the pandemic relatively unscathed, but SARS-CoV2 variants, inconsistent enforcement of public health measures, and slow vaccine rollouts have led to large outbreaks in Vietnam, Malaysia, Myanmar, Thailand, and Indonesia. 

As the highly transmissible Delta variant, first identified in India and classified as a WHO variant of concern in mid-May, sweeps across the world, cases, deaths, and nationwide restrictions are increasing. 

The Delta variant has been recorded in 111 countries. The three other variants of concern (Alpha, Beta, and Gamma) have been found in Malaysia, Thailand, Philippines, Singapore, and Indonesia. 

Indonesia Facing Massive Surge and Overwhelmed Health System

Over the past month, daily new cases in Indonesia have increased five-fold and the number of new deaths has doubled since the beginning of July. On Sunday, the country of 276,5-million recorded 44,721 new cases and 1,093 deaths, bringing the total cumulative cases to 2.8 million and deaths to 73,582, according to the Indonesia Health Ministry. 

The figures, however, are likely underestimated due to the limited testing capacity. 

“We predict that the real number of those who died from COVID-19 should be three to five times higher than the official number,” Irma Hidayana, Co-founder of LaporCOVID19, a citizen coalition for data disclosure on COVID, told Al Jazeera.

“We miss many cases and we don’t identify maybe 80% of these cases in the community,” Dr Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia, told the Guardian. 

“In Indonesia, the testing is passive, it’s not active. The one who comes to the healthcare facility is the one who gets tested if they show symptoms, or if they also identify as the contact,” said Budiman. 

According to WHO, one indicator that the epidemic is under control in a country is a positive rate of less than 5%. In Indonesia, some 29.3% of tests conducted return positive results. This suggests that the level of testing in the country is inadequate relative to the size of the outbreak. 

The health system is being battered by the third wave, and hospitals on the island of Java have reached capacity, oxygen supplies are running low, and four of the five designated COVID burial grounds are nearly full. 

Some 33 patients at Dr. Sardjito General Hospital in Yogyakarta died this month after the supply of oxygen ran out. 

Hospitals have set up large tents and added thousands of beds to increase capacity and meet the demands of the surge, but there is also a shortage of healthcare workers which has been exacerbated by healthcare workers succumbing to the virus. 

Tents have been set up outside of hospitals on the island of Java to treat the surge in COVID patients.

Some 114 doctors in Indonesia have died so far this month, accounting for 20% of the 545 total health worker deaths from SARS-CoV2 since the beginning of the pandemic. 

Many expect the situation to worsen, but government officials say they have the situation under control. 

“If we talk about the worst-case scenario, 60,000 or slightly more [daily cases], we are pretty OK,” said Luhut Pandjaitan, a senior minister assigned to tackle the COVID-19 pandemic. “We are hoping that it will not reach 100,000, but even so, we are preparing now for if we ever get there.” 

The government has implemented restrictions on the islands of Java, Bali, and 15 other cities, closing places of worship, schools, shopping malls and sports facilities, reducing public transit capacity, and limiting restaurants to takeout. 

The restrictions are set to end on Tuesday, but officials are considering extending them.

Malaysia Experiences Dual Health and Economic Crisis

As of 13 July, the Southeast Asia region saw a 16% increase in new cases and a 26% increase in new deaths over the course of one week. India, Indonesia, and Bangladesh are responsible for the greatest numbers of cases and deaths from the region. 

Malaysia has recorded the worst COVID infection rate per capita, with 354 new cases per million people, compared to 182 in Indonesia, 137 in Thailand, and 97 in Myanmar. 

On Monday, Malaysia recorded 10,972 new cases and 129 deaths, bringing the total cumulative cases to 927,533 and 7,148 deaths, according to the Malaysian Ministry of Health. 

Fatalities have tripled since early May.

Malaysia is also facing an economic crisis and thousands are in need of assistance from the government after the most recent lockdown, which was introduced on 1 June. 

“Generous and comprehensive welfare protection to support nutrition, mental health and the ability to stay home for all Malaysians” is needed, Dr Khor Swee Kheng, an independent health policy consultant for WHO, told the Guardian. 

Health experts have blamed the continued rise in cases on the government’s inconsistent implementation of restrictions and failure to close loopholes.  

Frustration Mounting Over Government’s Handling of COVID-19 in Thailand

Thailand recorded 11,784 new cases and 81 deaths on Sunday, marking the third consecutive day of cases over 9,000. As the country attempts to tackle its worst outbreak to date, a protest was held to criticize the government’s handling of the pandemic. 

The country has recorded a total of 415,170 cases and 3,422 deaths since the pandemic started. Over 90% of cases and deaths have occurred since April. 

COVID restrictions were expanded on Sunday to include limits on travel, shopping mall closures, and a curfew in 13 provinces, making these the strictest social and public health measures implemented in over a year. 

On the same day, protesters, armed with N95 masks, gloves and hand sanitizer, broke the ban on gathering of more than five people, to call for the Prime Minister’s resignation. Prime Minister Prayut Chan-o-cha has been criticized for his failure to secure adequate supplies of COVID vaccines and his inability to prevent the mounting infections and deaths. 

The police used teargas, water cannons, and rubber bullets to disperse protesters.

Areas of Vietnam Experiencing ‘Very Complicated Epidemics’

Vietnam has put its southern region in a two-week lockdown starting on Sunday after three consecutive days of record cases, deemed “very complicated epidemics,” by Vietnam’s Prime Minister Pham Minh Chinh.

On Sunday, Vietnam recorded 3,218 new cases and 16 deaths, the majority of which took place in the Mekong Delta and Ho Chi Minh City. Some 84% of the COVID deaths have occurred since April, after months of no recorded cases.

“The situation is getting serious with a high rate of transmission, especially with the dangerous Delta variant,” said Vietnam’s Prime Minister Pham Minh Chinh. “We have to put the health and safety of the people as the top priority.”

“We have to keep the transmission rate at the lowest possible to ensure the health system functions effectively and is not being overloaded,” said Vu Duc Dam, Deputy Prime Minister and head of the Committee for COVID-19 Pandemic Prevention. 

The surge has come as Vietnam struggles to speed up its vaccine rollout.

Booster Shots Planned to Bolster Sinovac

Vaccination rates across Southeast Asia remain low, with 30.3% of Malaysia’s population having received one dose, 15.4% of Thailand’s, 15.2% of Indonesia’s, 4% of Vietnam’s, 3.5% of Bangladesh’s, and 3.3% of Myanmar’s. 

Even Malaysia, which has done the best out of this group of Southeast Asian countries, has only fully vaccinated 9.6% of its population, compared to 52.9% in the United Kingdom and 48.1% in the United States.

Not only have fewer people across Southeast Asia received COVID jabs, but there are growing concerns that the Chinese-made Sinovac vaccine may not be performing as well as expected – particularly against rapidly spreading variants of SARS-CoV-2.

Both Indonesia and Thailand, which have vaccinated their healthcare workers with Sinovac, have announced plans to offer a booster dose of the Moderna or Pfizer/BioNTech vaccines. 

“There’s a lot of doctors and medical workers who have been vaccinated twice but endured medium and severe symptoms, or even died,” said Slamet Budiarto, Deputy Chief of the Indonesian Medical Association, to Parliament in early July. 

“It is the time for medical workers to get a third booster to protect them from the impact of more vicious and worrying new variants,” said Melki Laka Lena, Deputy Chairman of the Indonesian Parliamentary Commission Overseeing Health.

Image Credits: Sky News, ABC News (Australia), ABC News (Australia).

Max Appenroth of Global Action for Trans Equality (GATE)

Almost one in five trans women globally are living with HIV – 49 times greater than the general population – while HIV in trans men is woefully understudied. 

Yet trans and gender-diverse (TGD) people are “frequently and often systematically left out of HIV prevention research and responses”, according to No Data No More, a global HIV prevention manifesto launched on Monday with the support of the non-profit HIV prevention organisation, AVAC.

“Forty years into the global HIV pandemic, which is endemic to most trans communities, it’s beyond time to align HIV prevention research with trans and gender-diverse realities,” Max Appenroth of Global Action for Trans Equality (GATE), told the launch.

“The best way to reduce HIV in TGD communities is to invite our communities to participate meaningfully in the response. The ‘No Data No More’ manifesto is an invitation to recognize the fundamental and critical role that empowered TGD communities can play in protecting our own wellbeing and reducing the global toll of HIV.”

Warning to Academia

Even when TGD people are included in research, they are considered as subjects rather than collaborators with agency, according to Leigh-Ann van der Merwe, from the Social, Health and Empowerment Feminist Collective of Transgender Women in South Africa.

“I want to caution academia that transgender people are no longer willing to be recruited as as data collectors only,” said Van der Merwe, adding that transgender people needed to be included in all the various stages of decision-making from research design, to implementation and dissemination.

The manifesto, which was written by TGD advocates from South Africa, Europe and the United States, argues for an HIV TGD research agenda that “considers diversity, including the full range of participants along the gender spectrum” and accurately tracks epidemiological data on HIV incidence and prevalence in TGD populations.

Immaculate Nyawira Mugo, consultant on gender, intersectional sexual and reproductive health and rights in South Africa, also called for more research into drug interactions between gender-affirming hormone therapy and antiretroviral drugs, including ARVs taken to prevent HIV as pre-exposure prophylaxis (PrEP)

“Much work remains to make the perspective and participation of trans and gender diverse communities central to HIV response, but this manifesto charts an essential path forward for researchers, advocates and implementers worldwide,” said AVAC Senior Manager for Partnerships Cindra Feuer.

The manifesto was launched in association with the International AIDS Society’s Conference on HIV Science which started on Sunday and runs until Wednesday.

 

Relief supplies that were stockpiled through the UN Humanitarian Response Depot hub in Brindisi, Italy were sent to Somalia in the wake of Cyclone Gati. The new project plans to utilise this existing infrastructure for health emergencies.

The World Food Program (WFP) and World Health Organization (WHO) launched a health emergencies project, INITIATE2, on Monday.

The joint INITIATE2 project will gather health emergency actors, research and academic institutions, and international and national partners to facilitate knowledge sharing and skills transfer to improve emergency health responses. 

The project will develop innovative solutions to health crises, including disease-specific facilities and kits. Healthcare workers and those working in logistics will be trained to implement and adjust the solutions to local contexts. 

The agencies plan to leverage existing infrastructure, such as the UN Humanitarian Response Depot (UNHRD) – a global network of hubs that procures, stores, and transports emergency supplies for the humanitarian community – to stockpile relief items. 

Currently, there are six strategically located hubs around the world in Italy, Ghana, Malaysia, Panama, Spain, and the United Arab Emirates. 

The UNHRD Lab will be used to research and develop improved logistics support equipment, cost-effective and sustainable solutions, and standardised field items for health responses. 

“Health emergencies like the West Africa Ebola response and the current COVID-19 pandemic have shown just how crucial working together as a humanitarian community is, and so we’re extremely pleased to be able to further cement our role as an enabler of humanitarian response through this collaboration with WHO,” said Alex Marianelli, WFP Director of Supply Chain, in a press release. 

COVID Health Emergency Program

During the COVID-19 pandemic, WHO and WFP developed the COVID-19 Supply Chain System to address the acute shortage of essential supplies, including personal protective equipment (PPE), biomedical equipment, and diagnostics supplies. 

WHO has worked with partner agencies to provide a channel for countries to request critical healthcare supplies. 

“The WHO-WFP-led COVID-19 Supply Chain System has already illustrated an end-to-end integration of technical and operational capacities for impact,” said Dr Ibrahima Soce-Fall, WHO Assistant Director General for Emergencies Response. 

“With INITIATE2, WFP and WHO are now extending the collaboration to build synergies among different actors and foster innovation in this critical field, to quickly respond to health emergencies and create a conducive environment for knowledge sharing and skills transfer,” said Soce-Fall.

This is an excellent example of how we can scale and harmonise emergency preparedness, readiness, and response,” he added.

Image Credits: UNHRD.

Almost half of Sudanese households are concerned about food security.

KHARTOUM – A telemedicine programme is helping Sudanese medical students to both treat community members with mild COVID-19 in their homes and educate their communities about the pandemic.

Many medical students, who have been sitting at home since medical schools were closed last year due to the pandemic, joined the community medical response teams (CMRT) established earlier this year by US-based Sudanese physician Dr Nada Fadul, an infectious disease physician at University of Nebraska, and Dr Reem Ahmed from Emory University.

Over the past five months, Fadul,  Ahmed and other Sudanese physicians outside the country, have trained more than 120 medical and healthcare students in over 50 Sudanese neighborhoods to manage patients with COVID-19 in their homes. 

“The students wanted to do something, but they didn’t know what to do or how to do it safely,” said Dr Fadul.

“In addition to the impact they’re having on patients, students benefit from pursuing their learning in a hands-on way. When they return to their classrooms, they will be better equipped to take on new challenges.” 

The CMRT training focuses on the principles of home management for mild to moderate cases; home isolation and quarantine methods; and identifying life-threatening symptoms that require immediate medical attention.

Access to up-to-date information

Last month, the CMRTs linked up with Project ECHO, a US-based initiative that connects the students to medical experts who offer case-based telementoring and collaborative problem-solving.

Asmaa Alhadi, a fifth year medical student studying at the National Ribat University in Khartoum, joined the first cohort of CMRT facilitators in January, and said that the programme has enabled her to access up-to-date information on scientific studies and data on the pandemic.

“All this has made it easier for me to speak comfortably to community members

since I am equipped with a huge amount of knowledge and skills to overcome community hesitancy and fears towards the disease and vaccines,” she said.

Alhadi explained that there is a lot of stigma surrounding the virus in Sudan, particularly in rural areas where there is greater vaccine hesitancy. 

“The real change I believe the project has had is through the number of awareness and educational campaigns held in different local neighbourhoods,” she said.

These campaigns, she maintains, have played a big role in convincing people to get the vaccine by sharing with them the benefits of being vaccinated and how it will help in saving lives.

“From my point of view, even changing only one individual’s misconceptions about COVID-19 is quite satisfying, especially in a closed country like Sudan,” she said.

The CMRT, with support from ECHO, hopes to reach 400 students in Sudan by the end of 2021.

Rising hardship caused by pandemic

A World Bank report published in May highlighted the massive economic impact of the pandemic on the country, with 67% of people reporting that they had been unable to return to work, almost half of households (47%) concerned about food security and one-fifth unable to buy basics such as bread and milk because of rising prices.

The country has vaccinated approximately 0.8% of its population against COVID-19 using vaccines provided by COVAX, according to Reuters. 

Project ECHO was founded in 2003 at the University of New Mexico in the US, and has launched about 1000 programmes in nearly 50 countries, addressing more than 70 health conditions. 

In Sudan, the University of New Mexico is collaborating with the University of Nebraska Medical Centre (UNMC) and the Sudanese Federal Ministry of Health (MoH). It is also working with the Sudanese American Medical Association (SAMA) and Sudan NextGen (SNG), both of which are coalitions of Sudanese organisations against COVID-19.

Dr Bruce Baird Struminger, senior associate director of the ECHO Institute at the University of New Mexico, said that the pandemic had challenged Sudan’s health system that was already weakened by years of civil war and unrest. 

“We hope to continue to expand the use of ECHO more broadly in future years to enable the CMRT volunteers to target other priority communicable and non-communicable diseases,” Struminger told Health Policy Watch.

One of the main challenges facing the initiative is power outages and poor internet connectivity. The programme is seeking solutions to strengthen internet connectivity and power access at local medical schools and other sites to transform these locations into local ECHO learning sites. 

Students can either join learning sessions remotely or at the Sudanese American Medical Association main office and at the Federal Ministry of Health offices.

Almost 50 community outreach activities have been conducted in Sudan by volunteers in the programme. This includes education sessions on COVID-19 prevention and vaccination in schools, local mosques and neighbourhood clubs.

Alhadi believes that attracting more players, not only medical field partners like the Federal Ministry of Health, could help improve the initiative.

“I do believe that being in touch with different partners from different fields will make it similar to a multidisciplinary team who are working side-by-side to achieve the project”s goals, starting from democratisation of medical knowledge through to reaching community members and changing their thoughts and practices towards the disease,” she said.

Since April 2020, more than 180,000 people have participated in ECHO video-conference-based virtual learning sessions across Africa, most of which have been focused on COVID-19. 

 

Image Credits: Sarah Farhat/World Bank.