Women-led sectors and nations have been at the forefront of the COVID-19 response – despite only a quarter of global leaders being women, speakers at a World Health Assembly side-event noted on Friday. 

“Women have been delivering good health pre-pandemic – and during the pandemic,” said Dr Farah Shroff, head of the Maternal and Infant Health (MIH) Canada, which co-sponsored the event with the Geneva Graduate Institute’s Global Health Center.

Calling women’s leadership during the pandemic “a game-changing moment for women at the helm,” Shroff said a “big difference” in COVID-19 response effectiveness was found in two groups: countries with female leadership and countries that prioritize the well-being of society, as opposed to more individualistic or business-oriented leadership. 

“[They] have really been the unsung heroes and ‘she-roes’ of this pandemic; 2021 is the tipping point for female leaders.”

Female Leaders Acted Sooner 

Marcia Castro, chair of the Department of Global Health and Population at the Harvard TH Chan School of Public Health

Women-led countries have flattened curves, implemented efficient vaccine rollouts and taken effective economic measures, she said. Research shows that these leaders were quicker to respond to the crisis, increasing public health spending, closing borders and enforcing mandatory stay-at-home orders.  

“Countries that have had some of the best responses are led by women,” Harvard University Professor Marcia Castro agreed. “Although women are still the minority in leading countries, we need to take that as an example — and carefully look at the differences in leadership, particularly when we face a major public health emergency.”  

Rwanda is noted for leading the world in women’s leadership – 67% of parliamentarians are female –  but its public health progress is just as noteworthy. Despite low resources (per-capita GDP is US $820), Rwanda has a vaccination rate of 90%.

Ninety-three percent of girls ages 12 to 22 are vaccinated against the human papilloma virus (HPV) to prevent cervical cancer, said Agnes Binagwaho, Vice Chancellor of Rwanda’s University of Global Health Equity. 

“Even during the time of COVID today, where primary health care resources are pulled out of health care systems to respond and be prepared for COVID-19, [Rwanda] has kept that line of primary care and family planning,” she said. “Despite the huge gender discrimination women are facing, we are making the difference.” 

Agnes Binagwaho, Vice-Chancellor of the University of Global Health Equity, Rwanda

Satya Lakshmi, director of India’s National Institute of Naturopathy, spoke about the unsung heroes of the pandemic, from doctors to community health workers, including Accredited Social Health Activists (ASHAs), local women trained as health educators and promoters with health ministry funding. 

Lakshmi also said collective self-help groups helped Kerala’s women by spurring local production and exchange of goods during lockdowns. 

Leadership Lessons For Future Pandemics

Speakers emphasized that compassionate leaders governing on behalf of society as a whole made a difference in the current pandemic, and they asked that these qualities not be forgotten in future crises.

“We know there’s going to be other pandemics – not just viral pandemics, but a whole variety of other pandemics that have been brewing and stewing for a long time,” said Shroff. Giving racism, neo-colonialism, violence against women, and other issues as examples.

She said leaders must “not go back to business as usual. … This COVID moment can catalyse a kinder, gentler world where we prioritise science, we prioritise human health, and we can collaborate with each other across borders.”

Image Credits: Graduate Institute Geneva.

Indonesia’s Health Minister, Budi Gunadi Sadikin

Indonesia could manufacture 550 million COVID-19 vaccine doses a year if pharmaceutical companies were prepared to share the know-how, Health Minister Budi Gunadi Sadikin told a World Health Organization event Friday.

Sadikin was addressing the first anniversary of the WHO’s COVID-19 Technology Access Pool (C-TAP), set up to encourage countries and manufacturers of COVID-19 products to voluntarily share knowledge, intellectual property and data to facilitate the rapid expansion of manufacturing.

C-TAP has failed to live up to expectations largely because large pharmaceutical companies have been unwilling to join it, preferring to pursue lucrative bilateral deals with wealthy countries instead.

“We’re holding the door open for pharmaceutical companies that have become household names, although too few households have benefited from the lifesaving tools they have developed,” Director-General Dr Tedros Adhanom Ghebreyesus said.

“They control the [intellectual property] that can save lives today, end this pandemic soon, and prevent future epidemics from spiralling out of control and undermining health economies and national security.”

Vaccines with Halal Certificates

Sadikin said Indonesia is the largest vaccine manufacturer in Southeast Asia, and has the capacity to “upscale our vaccine productions to meet regional and global demand”. What it lacks, he said, is the know-how and technology needed to make some COVID-19 vaccines, particularly mRNA vaccines.

“Currently, we have six manufacturers with a production capacity of 550 million doses per annum,” said Sadikin. In addition, he said, the Indonesian vaccines would come with halal certificates, which are crucial in some vaccination programmes. 

Abdul Muktadir, Managing Director of Incepta Pharmaceuticals in Bangladesh, said his company was also ready to produce vaccines if know-how and technology were shared.

“We have seen some statements like ‘Low- and middle-income countries do not have the ability to acquire the technology and deliver quality products,’ ” he said. Yet he pointed out that the vast majority of the world’s medicines are made by generic companies, particularly in Southeast Asia.

Bilateral Deals Trump Multilateral Sharing

Costa Rican President Carlos Alvarado Quesada

Costa Rican President Carlos Alvarado Quesada said that C-TAP – which his country has championed – was intended to foster multilateral sharing of information. But instead, he said, the world contends with “overcoming the challenges generated by bilateral negotiations and property rights”.

WHO expects more countries and manufacturers will join C-TAP, and is currently in talks with two vaccine manufacturers and five therapeutics companies, said Mariangela Simao, WHO Assistant Director-General for Access to Medicines.

Spain’s Foreign Affairs Minister Arancha González Laya also announced at the event that her country had decided to join the 42 current C-TAP members, and said she hopes this will help to boost global vaccine production.

Jesús Marco, vice-president of the Spanish National Research Council (CSIC), elaborated on this hope, saying that his country would share CSIC technologies and was considering licensing its vaccine candidates on a “non-exclusive basis”.

Untapped Vaccine Manufacturing Potential 

“We succeeded in developing vaccines at an unusual speed, but we failed to share COVID-19-related technology and knowledge and to speed up their production,” said Belgian Minister of Development Cooperation Meryame Kitir. “According to UNICEF, only 43% of the world production capacity for approved vaccines is used.”

Referring to the capacity in Indonesia and Bangladesh, WHO Chief Scientist Soumya Swaminathan said that the two countries have the “capacity, interest, and willingness to ramp up production”. 

“There’s really a call for those who have the know-how and the capacity to come and collaborate with us at the Manufacturing Task Force and through C-TAP,” she said.

Meanwhile, Health Access International (HAI) said that the “high expectations of C-TAP to halt the global catastrophe as it unfolds have not been realised”. 

“This is largely down to the refusal of the pharmaceutical industry to engage, preferring instead to protect short-term profits over global public health,” said HAI, which also blamed countries for lack of will to make C-TAP work.

“The need for an effective and functioning C-TAP remains as strong today as it did last year, as evidenced by the insufficient manufacturing capacity of patent holders to deliver on signed contracts and the difficulties endured by the COVAX facility to secure enough vaccine doses for LMICs,” the HAI statement said. 

“There is still a time and place for C-TAP within the global response to COVID-19, and that time is now. WHO should lead the efforts to secure the implementation of a game-changing mechanisms – if we can just agree that status quo is no longer acceptable.”

Image Credits: AstraZeneca.

The US reaffirmed its support for COVID-19 vaccine intellectual property waivers Friday as World Health Assembly delegates and experts discussed how to promote local production of medicines in low- and middle-income countries (LMIC).

US delegate A Lipstein Fristedt,

An Ethiopia-led resolution to stimulate local production of medicines and health technologies has the support of WHO’s African Region, the European Union, the United States, China, Brazil and other nations.

“The United States believes strongly in intellectual property protections, but in service of ending this pandemic supports the waiver of those protections for COVID-19 vaccines,” said US delegate A Lipstein Fristedt, US FDA deputy commissioner for policy, legislation and international affairs.

The Trade-Related Aspects of Intellectual Property Rights (TRIPS) Council set an informal meeting Monday (31 May) to discuss an Indian and South African proposal for an IP waiver on COVID-19 products. 

The council’s power balance shifted in the weeks since the US voiced support for a vaccine-related waiver, although the European Union is trying to broker a “third way” rather than a waiver.

Price Transparency

Ethiopia’s Alegnta Gebreyesus Guntie

The resolution urges member states to take into account “the rights and obligations” listed in the TRIPS Agreement, including those affirmed by the Doha Declaration: “to promote access to medicines and other health technologies for all”.

The resolution calls for “transparency of prices and economic data along the value chain of medicines, including locally produced medicines, and other health technologies” to address the non-disclosure agreements between countries and pharmaceutical companies that contribute to higher prices. 

“The COVID-19 pandemic has revealed the vulnerabilities of many low- and middle-income countries, most of them African countries with no or low local production capacities, exacerbating their challenges of inadequate access to the most-needed vaccines, medicines, diagnostics and other health technologies,” Alegnta Gebreyesus Guntie, Ethiopia’s representative, said on behalf of 47 WHO Africa Region countries.

She explained: “The draft resolution strengthens local production and know-how, promotes technology transfer and innovation, considers the TRIPS agreements and intellectual property rights in the context of local production, and strengthens the mandate for the WHO to work with continental bodies such as Africa Union, to provide member states with support to build capacity for local production.”.

Meanwhile, Kenya’s Dr W Kariuki said acute shortage of COVID-19 vaccines “is contrary to public health goals, as it erodes public trust, breeds vaccine hesitancy and prolongs the acute phase of the pandemic”. 

The resolution, which has the support of over 100 countries, is likely to be adopted by this year’s WHA.

Meanwhile, WHO’s Africa Region revealed this week that the continent only has enough vaccines to cover 1% of the population. African countries that received AstraZeneca vaccines from COVAX now urgently need 20 million additional doses to give those who have had one dose their second vaccination, but India’s Serum Institute has stopped supplying COVAX with vaccines.

 

.

 

Health experts have called on global leaders to tackle environmental issues affecting health and health systems.

A paradigm shift towards health systems and societies that emphasize health promotion, disease prevention and environmental protection could prevent and reduce 50% of the global disease burden worldwide, experts at an informal session on the margins of the 74th World Health Assembly  said on Thursday.

The COVID-19 pandemic has highlighted the inextricable relationships between environments and health while revealing health systems’ weaknesses, according to WHO director-general  Dr Tedros Adhanom Ghebreyesus at the event, Safe Societies and Environments for Health: The Path to Build Forward Better, Healthier and Greener.   

World leaders should hold a “Nature Summit” that would focus heads of state more squarely on delicate relationships between health, climaste and environment – and the “planetary” crisis facing ecosystems, said Inger Andersen, executive director of the United Nations Environment Programme (UNEP), in an apperance at the WHO forum. 

“There’s evidence that the more we fragment nature, the more we encroach into nature, the more we push biodiversity stress, by encroaching and destroying, then the greater likelihood of human pathogens developing out of contact with wildlife and wild diseases,“ said Andersen. 

Maria Neira, WHO director, Environment, Climate Change and Health shared Andersen’s sentiments: “We need to stop this war we are having with nature. We need to recover our relationship as it is the only way towards a safer world that is green and healthy.”

Maria Neira, WHO director, Environment, Climate Change and Health

The events coincided with a landmark decision by a court in the Netherlands, against the multinational fossil fuel giant Royal Dutch Shell – which was cheered by WHO climate and health advocates such as Neira.

The court in The Hague ordered Shell to reduce it’s CO2 emissions by 45% within the next 10 years in its response to a legal suit by Friends of the Earth Netherlands (Milieudefensie) together with 17,000 co-plaintiffs and six other organizations.  The ruling has far-reaching consequences for the rest of the fossil fuel industry worldwide – opening up the possibility of liability claims and suits in other countries against fossil fuel companies for the damage that they are wreaking on the health of the planet and its people.

WHO’s Green Manifesto

In May 2019, the 72nd WHA adopted a Global Strategy on Health, Environment and Climate Change. The WHO strategy aims to “provide a vision and way forward on how the world and its health community need to respond to environmental health risks and challenges up to 2030, and to ensure safe, enabling and equitable environments for health by transforming our way of living, working, producing, consuming and governing.”

The pandemic provides a unique opportunity to rebuild health systems while also tackling environmental issues affecting health, said Tedros at the session, while also lamenting the lack of sufficient investment today. . 

For instance, global health budgets allocate only 3% to addressing preventable causes of disease and to promoting and enabling healthier environments and lifestyle choices. Increased investment could reduce global disease burdens by half, Tedros said, and this would greatly benefit individuals, families, communities and nations.

That is despite the fact that  “preparation is not just better than cure — it’s cheaper”, he said. 

In fact, an investment of $US 1 per person per year in more disease prevention and health promotion could save 8.2 million lives and US$ 350 billion by 2023, Tedros said in his opening WHA remarks on Monday.

On Thursday he again emphasised the need for more investment. “For every dollar invested in basic sanitation, there is a return of $5.50 in terms of reduced waterborne disease … which is still one of the largest killers of children.”

“Safer air, food and roads, better nutrition, and reduced injuries and violence will save lives. But we’ll also save money by preventing health care costs and [by] contributing to employment, productivity, and inclusive economic growth. Healthy populations are also more resilient populations.”

WHO Director-General  Dr Tedros Adhanom Ghebreyesus

In May 2020, after the COVID pandemic laid bare the underlying vulnerabilities of global health, social and environmental systems, WHO issued a Green Manifesto for healthy and green recovery with several 80 action points for so-called “building back better.”

The manifesto also lists opportunities for actions to enhance the WHO global strategy, which is likewise embedded in WHO’s 2019-2023 workplan – encouraging more cross-sectoral actions on unhealthy urban environments, lifestyles, poor diets and unsustainable food systems – areas where the worst risks often hit hardest on the poor – exacerbating existing social inequalities. 

A Healthy Planet Makes Healthier People

That has been all the more vividly illustrated during the COVID pandemic, in which access to clean water and sanitation, clean air, and decent urban housing conditions have all been understood as critical to reducing disease risks and disease transmission. 

UNEP Director Andersen said the argument for climate action is at an “historic crossroads” due to the COVID-19 pandemic.

Pandemic-related policies thus need to also address climate, biodiversity, nature and pollution, because otherwise “We would just be in a systematic loop … We have been taking nature for granted.”

Although the world has for far too long assumed that climates and environments would remain stable, she said, “A healthy planet is a precondition for healthy lives.”

Referring to research pointing to vast potential losses of genetically diverse animal and plant species over the coming years, Andersen also called for more research into food systems. “Why does this affect us? Because nature is a finely-tuned ecosystem where each relies on the other. And that is what produces the food, the water, the air” that humankind relies upon for life and livelihoods.

Education to Promote Environmental Awareness

Along with high-level efforts like a summit, education also is a critical tool to raise environmental awareness and contribute to improved health, according to  Desmond Appiah, resilience and sustainability advisor in the city of Accra, Ghana. 

Appiah said there is a need to work across sectors and with communities from the ground up to address water, waste, sanitation and air pollution issues critical in developing and building healthy cities. For example, he said the city government and its partners in a WHO and UNEP co-sponsored “Urban Health Initiative,” visits local churches, faith-based organisations to educate them on  air pollution’s health impacts as well as contributing factors, from waste-burning to motor traffic and the dearth of walkable green spaces.  In line with those efforts, Accra in 2018 was also the first city in Africa to join the BreatheLife initiative, dedicated to building awareness and more local action around linked, health, environment and climate.   

In two decades of work on World Bank digital health initiatives, global health policy specialist Akiko Maeda found many fell short of their promises. She suggested these underperforming digital health initiatives focused too much on delivering hardware — but they failed to provide means to ensure stable electricity supplies, and similarly failed to provide adequate human resources to manage data, or to design initiatives that the most vulnerable groups could benefit from.

Akiko Maeda, health economist with over 30 years of experience in international development in over 40 countries

“It’s not just the infrastructure and the hardware, but how we design the software that goes with it,” Maeda said Thursday. She spoke at a World Health Assembly side event co-hosted by the Geneva Graduate Institute’s Global Health Centre, the Lancet & Financial Times Commission, and Digital Square, which is supported by USAID and the Bill and Melinda Gates Foundation. 

“Digital infrastructure is more than just a bunch of cables and devices,” said data literacy consultant Gulsen Guler, who is also co-chair of My Data Global, a civil advocacy group promoting equitable digital societies – adding that the stakes are high:

“Digital technologies can determine what the future of a child will look like…or even more, they can determine between life and death.”

Digital Health Saves Resources to Reach Universal Health Coverage 

Roger Kamba, Special Advisor to the Democratic Republic of the Congo (DRC), called digital technologies crucial in low-income countries. He said these tools can help countries reach universal health coverage and that digital health can help to meet Sustainable Development Goals. 

“Digital health is not an option, but rather a necessary step towards universal health coverage,” Kamba said. “I remain personally convinced that there can be no universal health coverage without a substantial contribution from digital health.”

However, he said that for that to happen, governments must prioritize digital transformation through a multi-sectoral approach that goes beyond the health ministry. 

In 2019, the DRC adopted its digital technology strategic plan, Kamba said. Implemented by a newly-created ministry, the plan engages all sectors, including health. “All governments need to take a systems approach to digital transformation. It’s not just the health ministry that needs to be working on health care anymore.”

An Epidemiological Nerve Centre – The Emergency Operations Centre

Kamba said existing digital health initiatives, notably the nation’s Emergency Operations Centre (EOC), have proven useful in quickly containing infectious disease outbreaks like Ebola. Set up two years ago by PATH, USAID, and the Bill and Melinda Gates Foundation in collaboration with the DRC Centers for Disease Control, the EOC acts as the country’s epidemiological nerve centre to coordinate efforts to prevent, detect, and rapidly respond to public health emergencies. 

“The center uses tools such as digital mapping, Geographic Information System (GIS) mapping, and mobile health technologies to produce layers of information that help reveal  patterns that enabled more effective interventions during the Ebola epidemic,” he said.

“Actionable surveillance data and digital epidemic maps made the response faster and more focused, and was the first time that response data was digitized and centralized”. Recently the EOC expanded its scope to investigate regional and local malaria trends; it also facilitates disease control strategies using advanced data analyses. 

Kamba warned that digital health initiatives depend on reliable and affordable electricity, which can be a challenge in low-income countries: “We’re talking here about the potential of digital solutions to help us overcome long standing infrastructure challenges in sub-Saharan Africa … Investments in digital health in DRC must be coupled with energy solutions at the national level.”

“These [digital] infrastructures are also faced with a fundamental financing gap,” said Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. “To really have sustainable financing that’s also reflected in the budgets of countries is a truly, truly big challenge.” 

Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030.

Digital Health in Burkina Faso Improves Care Quality

Meanwhile in Burkina Faso, Swiss NGO Terre des Hommes (Tdh) has worked for over a decade with the Ministry of Health to develop Ieda – a digital job aid tool that enhances the clinical diagnosis of childhood diseases and improves health workers’ performance using artificial intelligence (AI) algorithms.

Ieda already is available in 80% of health-care facilities in the country and has helped with a whopping 10 million digital consultations. This generates savings of US$1.6 million every year, Tdh health programmes research head Riccardo Lampariello said. “Digital health solutions at scale bring financial savings for the authorities, of course after the initial national investment, of $1.6 million every year. Hence the importance of investing in digital health.”

Lampariello stressed that the bulk of digital health expenditure is not on infrastructure but on human resources required to build necessary technical and regulatory capacity. He noted that governments need to run local data centers, extract and analyze data, update software and fix data platforms when they crash.

Riccardo Lampariello, head of Tdh’s health programmes

“Digital health is human resource-intensive, and we should equally invest in infrastructure — which is not only tablets and solar power panels, it is also data centers, for example — and in human resources, including local authorities, including the government, the MOH, in technical skills … and also look to teach them the governance skills to regulate labor use.”

Thanks to this already-existing digital health infrastructure, when the coronavirus hit it took only a few weeks for Burkina Faso’s Ministry of Health to deploy digital tools to support training, awareness-raising and triage, and to reach vulnerable groups in remote and unsafe areas, Lampariello said.

But he warned that the digital health landscape is still fragmented in low-income countries, challenged by duplication, a lack of interoperability and waste of precious devices and electricity.

“Even before COVID, it wasn’t rare to pay a visit to a health-care facility in a very poor country, open a cupboard and find two or three tablets or smartphones [for] dealing with different platforms and databases. In a context of limited resources, this represents a lot of wasted tools,” Lampariello said. “And not to mention, for example, the additional unnecessary e-waste and energy consumption related to that.”

Speakers Ask For Well-Designed & Equitable Digital Health Initiatives

Digital health initiatives are likely to be more impactful if they designed to be equitable, added panelists on Thursday. In Japan, for example, vaccine uptake in older age groups was hampered by the country’s response plan failing to consider that booking vaccine appointments online can be a struggle for older people. “It’s a design issue, and it’s not a complex issue, but it was not adequately designed for the elderly, so there’s a huge problem going on right now in Japan,” said Maeda.

Ann Aerts, Head, Novartis Foundation

“Every solution, digital- or AI-driven, has to be human-centered,” said Novartis Foundation head Ann Aerts. “And that’s quite obvious, although it’s not always the case. The best way is to use a human-centered design with input from the people who will have to use a solution, and by thinking up-front how the solution will be integrated in the processes of the health workforce, or the workflow.”

According to a World Bank study, successful digital health initiatives tend to share characteristics like strong leadership and regulatory systems, substantial financial commitments to digitize health systems, and national frameworks to facilitate data flows between systems, added Aerts. 

Disability services should be incorporated into primary health care programmes at the community level, states a resolution adopted at the 74th WHA.

A new resolution adopted on Thursday by the 74th World Health Assembly aims to scale up access to services and treatment for people living with disabilities – using a more “gender-sensitive and inclusive” approach.

The resolution co-sponsored by Israel and Australia,  calls upon member states to ensure that disability services are incorporated into primary health care programmes at the community level – and that conversely disabled people also have full access to health services.

It also calls for special attention to be paid to the “unique vulnerabilities of those who may be living in care and congregated living settings in times of public health emergencies such as COVID-19, and for special protection against infections in particular for at-risk groups,” including more education for health care workers. 

And, the resolution calls upon WHO to etch out a global research agenda on disabilities, as well as to develop, by the end of 2022, a global report on disabilities, updating estimates on the numbers of disabled people worldwide, from a decade old World Report on Disability (2011).

Countries Said Community-based Interventions Are Key 

Israeli diplomat Nitzan Arny speaks about the resolution on persons with disability led by Israel.

One in seven persons worldwide experience some form of disability. The numbers are increasing due to factors such as ageing populations and widespread chronic health conditions. 

Many countries highlighted the roles community-based interventions can play in improving access – in reactions that warmly supported the initiative overall. 

The resolution broadly calls for collection of reliable data that allow for disaggregation by disability. It also advocates equal access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. 

Persons with disabilities face inequality in social, economic, health and political spheres and are more likely to live in poverty than those without disabilities. They are also more likely to have risk factors for noncommunicable diseases and less likely to have access to essential health services.  

“Nothing about us without us’ is not just a catchphrase. Meaningfully involving persons with disabilities in decision-making processes is a precondition for ensuring disability inclusion,” said Israel’s delegate to the WHA,  Nitzan Arny, in presenting the initiative. 

Australia, the resolution’s co-sponsor said: “We recognize the importance of promoting disability inclusion in the health sector to ensure persons with a disability enjoy the highest sustainable highest attainable standard of health, including access to quality disability inclusive health services, information and education across their lifetimes.”

Israel, Australia, the United States, European Union, Kenya, Botswana, the United Kingdom, Japan, Mexico and a dozen other countries co-sponsored the resolution.

Meanwhile, the resolution gives new impetus for action, particularly in light of the fact that WHO’s current Global Disability Action Plan 2014–2021 is set to expire this year. 

New Zealand, however, said it supports extending the Global Disability Action Plan because “This would demonstrate continued international commitment to this goal, and provide guidance for how this can be achieved.” 

 

COVID’s Impacts on Persons With Disabilities 

The pandemic has harmed people with disabilities in various ways, yet few member states collect data that are disaggregated by disability.  

Women and girls living with disabilities face particular challenges. “Women, young women and girls who are disabled have a high risk of being marginalized and seriously discriminated against. That reduces their economic and social status, it increases the risk of sexual violence and sexist attitudes against and towards them and [of] limited access to justice,” Canada said. “These challenges have only increased during the COVID-19 pandemic, and disabled women and girls continue to fight for their rights for equality and for changes to the system.” 

The resolution highlighted the role of community health workers in advancing equitable access of persons with disabilities to safe, quality, accessible and inclusive health services.

Stress on Community-Based Rehabilitation

Among the stakeholders invited to collaborate under the resolution are organisations of persons with disabilities, private sector companies, scholars and teachers. 

“Community-based rehabilitation is a strategy to improve access to the services to persons living disabilities in middle-and low-income countries through the optimal use of local resources,” said Colombia. 

 Civil society organisations have welcomed the resolution. “We welcome that the resolution calls on governments to actively involve people living with disabilities in decision-making and programme design. This will ensure that health systems and responses to health emergencies can better deliver on the needs of the people most affected,” said Nina Renshaw of the NCD Alliance. “As we’ve seen in other fields of global health, such as HIV and TB, meaningful inclusion of lived experience is absolutely fundamental to catalyse overdue progress.”

Image Credits: PicPedia.

Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session

China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. 

WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing.  COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge.  

But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. 

“China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna.  

 

The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. 

However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. 

In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. 

“The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. 

Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. 

“However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. 

Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms.  

vaccine
Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.”

Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs).

“While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.”

Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center.

COVID – One Among Many Outbreaks Africa Faces 

Dr Matshidiso Moeti, WHO Regional Director for Africa.

WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases.

Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.”

The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.”

‘Last Pandemic’ Report Approved

The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats.

See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response 

Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind.

Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.”

“We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said.

The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”.

Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics.

‘Two-tiered World’ of Vaccinated and Unvaccinated

Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand.

As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. 

“Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states.  

“At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. 

She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. 

Said Clark: “The return on investment would be enormous – both for people’s health and for economies.”

Image Credits: Paul Adepoju , Paul Adepoju.

World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire

Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre.  And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID.  

“Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” 

Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. 

Travel Measures Must Be Implemented at a Granular Level

travel
Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries

These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan.

She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” 

Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.”

Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” 

Karen Grepin, University of Hong Kong

These measures have been a critical component of national infectious disease response,  Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. 

However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” 

James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.”  

Almost every country in the world has travel measures in place, but those measures are highly inconsistent.  And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the  pandemic is beaten back.

Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” 

High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations

Diego Silva, University of Sydney

University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.”

Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. 

Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” 

He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on  international travel issues: “It’s not enough to act again in a unilateral manner.”

Potential Gap in IHR Compliance and Policy Implementation   

Catherine Worsnop, University of Maryland

Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. 

Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. 

“Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic.

“We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. 

Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. 

The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” 

 

Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva.

Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza

A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states.  

Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. 

A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. 

The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. 

WHO Regional Director for EMRO Ahmed Al Muntari

The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services.  The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report.   

The resolution, anchored upon the report, called mainly for the provision of  more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip.  

However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory.  

This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas  – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters.  In Israel,13 people, including two children, died.  

In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly.  That motion passed without a word of opposition from the WHA plenary on Wednesday. 

Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. 

Objections by Israel and Allies to “Standalone Item” Have Amplified 

The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the  WHA resolution accompanying the report on health conditions. 

That constitutes Israeli pushback over the extra  attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote.    

A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote.  

As the United Kingdom stated:  “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed.

“We supported the report, and the associated decision be considered alongside other WHO assistive programs. 

“We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza –  and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. 

“However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories.  And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way.

Palestine & Syria Retort – What is New?

Syrian delegate to the WHA

Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: 

“It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” 

The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. 

“What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.”

Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text….  which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.”

The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services –  as well as a pathway to citizenship. 

“This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.”

Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. 

Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva

“Let’s stop the politicization of this forum, by deleting this  from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” 

Image Credits: www.laprensalatina.com.

Ajoke Sobanjo-ter Meulen, Princess Nothemba (Nono) Simelela, Wiweka Kaszubska, Alwyn Mwinga, Jamie Nishi, Andrew Tuttle, Lisa Goërlitz (from top left to right)

Although gender is increasingly factored into health research, much remains to be done, experts reported at a Tuesday event co-organised by the Geneva Graduate Institute’s Global Health Centre.

But despite growing awareness, health research continues to conceptualize gender in binary terms. Very little research concerns those who identify as LGBTQ+, according to speakers at the event, which was co-sponsored by the Medicines for Malaria Venture, the Global Health Technologies Coalition, Deutsche Stiftung Weltbevölkerung (DSW International), and the International Geneva Global Health Platform. 

Panellists explained how diseases can have vastly different impacts on different genders because of social and economic factors. Women are under-represented in pre-clinical and clinical trial research, leading to limited data on risks and benefits of tested medicines and vaccines. Later impacts of this bias eventually may limit women’s therapeutic options.

Pregnant women are an especially vulnerable category, often left out of clinical trials altogether.  

Involve Communities, Improve Trust

Alwyn Mwinga, CEO, Zambart Project; Zambia DNDi Board Patient Representative said the key to involving more women in research is to improve trust.

Panellists repeatedly stressed the need to work closely with communities while designing solutions, as currently researchers have inadequate consultations with women.

“This element of trust actually underscores the importance of important community research, and this is more impactful,” said Alwyn Mwinga, Zambart Project CEO and Zambia DNDi Board Patient Representative.

She said the take-home message is that pregnant women are willing to participate in research, provided they are given sufficient information to make a considered decision. She added that while more women are included in recent clinical trials, a lot more needs to be done.  

Among the barriers to including more women in clinical trials were onerous paperwork involved in the consent process and cultural issues surrounding consent: if women must refer such decisions to a spouse or parents, this calls into question the process of informed consent. 

Neglected Diseases and Skewed Funding

Bias isn’t limited to gender issues — inequities also mark funding for research into various diseases. Some diseases get more funding than others, and those that concern women the most may be neglected.  

“In 2018 we saw $US 1.7 billion invested across these health issues … and, maybe unsurprisingly, the lion’s share of that — nearly 85% — went to HIV/AIDS,” said Andrew Tuttle, Policy Cures Research research director. Research is lacking about pregnancy-related conditions, and this slows development of drugs and technologies for pregnancy-related conditions.

Poverty-related neglected diseases are another neglected area. “The same disease might have different consequences on different genders or different sexes because of the role of women and girls in society or because of expectations towards different gender roles and so on,” said Lisa Goërlitz, DSW Brussels Office EU Advocacy Unit head.

She said there is almost no data on how these diseases affect LGBTQ+ community members.

Gender dimensions have significant impact on health outcomes depending on stigma and discrimination, as well as different financial and social outcomes.

Ajoke Sobanjo-ter Meulen, lead of Maternal Immunisation, Bill & Melinda Gates Foundation said that maternal immunisation can serve as an example for other health programmes

While stakeholders like manufacturers, policy-makers and communities can make a difference, women have made direct efforts to be included in research.
“Women’s autonomy and agency — I think that played a very important role. The Zika example and Ebola example are very critical here, because in both instances pregnant women demanded to be included in clinical trials, which initially did not happen,” said Ajoke Sobanjo-ter Meulen, maternal immunisation lead at the Bill & Melinda Gates Foundation.

Thanks to these milestones, subsequent outbreaks have seen pregnant women included in earlier stages of research.