Front line healthcare workers at Thailand Bamrasnaradura Infectious Disease Institute faced workforce shortages and had limited access to personal protective equipment as violence against healthcare workers worsened globally.

An unprecedented number of healthcare workers were seriously assaulted last year, even as health workers risked their lives on the front lines of the COVID-19 response. 

Over 412 COVID-related attacks on health workers, including kidnappings and murders, occurred between January and December 2020, experts reported at a World Health Assembly side event. The session Monday was co-organized by the Global Health Center; the Safeguarding Health in Conflict Coalition; the Swiss Confederation; and the Government of Spain. 

Panelists said that as most countries went into lockdown last year, public frustration, anger and anxiety fuelled violence against health workers worldwide. 

Violence against health care in the context of the COVID-19 pandemic in 2020. Reported COVID-19-related violence (in green) peaked in the early weeks of the pandemic and has since fallen.

The majority of perpetrators of pandemic-triggered violence were patients and their family members, or local community members. In 59% of cases, violence was triggered by opposition to COVID diagnostic testing or a decision to hospitalize a patient, said a “Threats and Violence against Health Care during the COVID-19 Pandemic” report by Insecurity Insight.

Healthcare workers faced abuse while traveling to and from work in 30% of cases. In 11% of incidents, health workers were threatened or injured for speaking out against challenges they experienced at work, including protests over the lack of personal protective equipment and masks. 

“Sadly, these violations in dozens of countries and situations of conflict are the new normal. And this normal is not acceptable,” said Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights. 

Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights.

“It is especially unconscionable during the time of a global health crisis, the COVID-19 pandemic, which compounds the situation of devastation from attacks on health in war and other situations of conflict,” Sirkin added

While generally there were fewer assaults in 2020 compared to previous years, the nature of the events became more severe, with an increase in the number of health workers killed and kidnapped. 

Assaults on Health in Conflict Situations

Beyond COVID-related attacks, deeply-entrenched patterns of violence against health workers in conflict-ridden countries also continued. 

This included attacks on health workers and destruction of health facilities associated with the ongoing conflicts in Libya and Yemen – which continued despite the UN Secretary’s call for a ceasefire due to the pandemic. 

The Central African Republic, plagued by armed conflict, social unrest and political instability, also has seen a high proportion of health facilities destroyed or rendered non-functional.

“Killings, assault, kidnapping, verbal threats and overt acts of intimidation against healthcare workers are commonplace,” said Minister of Health Pierre Somse. 

Pierre Somse, Minister of Health of the Central African Republic.

He said that in the country, the number of attacks against healthcare workers rose 79% from October 2020 to February 2021.

The Central African Republic has one of the world’s lowest physician-to-patient ratios and among the highest rates of maternal and infant mortality. 

In one district in the Central African Republic with high levels of violence against health personnel, tuberculosis vaccination rates also dropped to 45%, as compared to the national average of 81%. 

“Conflict and violence against healthcare workers is worsening inequality and inequities in access to health services,” said Somse. “Addressing all forms of violence against healthcare workers in conflict settings is an urgency. It is needed today more than ever, as we confront COVID-19.”

Trends in Violence Against Health Workers for 2021 

Over the past five years, a health facility in a conflict zone was destroyed or severely damaged every other day, on average. Every two days a health worker was kidnapped or injured, and every three days a health worker was killed. At least 600 health workers were killed and over 1000 health facilities were damaged. This violence was concentrated in Syria, Nigeria, Afghanistan and the Democratic Republic of Congo. 

“Where does this leave us for this year? I’m afraid the picture doesn’t look good,” said Christina Wille, Director of Insecurity Insight, a Geneva-based NGO. “I’m afraid we’ll probably be here next year again with a report that has a few little positive notes to report.”

In 2021, increasing attacks on healthcare workers were witnessed and reported in Tigray, Gaza, and in Myanmar. In Myanmar, there were over 500 arrest warrants issued against healthcare workers since the coup in February.

Barely a day has gone by without violence against health workers being reported in Myanmar. Some 19 health facilities were damaged in Gaza over the past two weeks, including its main COVID-19 laboratory. 

“It seems that whenever there’s violence, it’s accompanied by violence against healthcare,” said Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition. 

Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition.

The violence is sometimes the collateral damage associated with larger strategic objectives. Other times it is an end in itself, as in Afghanistan, where the Taliban forces closures of health facilities in order to exert their leverage over health services. Health workers are sometimes punished for providing care to enemy combatants, although occasionally the violence is a result of recklessness, said Rubenstein.

Actions Needed by States, the UN and WHO

This month marks five years since the United Nations Security Council adopted a resolution against attacks on health workers in situations of armed conflict. On this anniversary, little progress has been made on implementing the resolution and reducing violence. 

“A few states have demonstrated their commitments and followed through on them, but these unfortunately are exceptions,” said Rubenstein.

The resolution was prompted by the 2015 US bombing of the Kunduz Trauma Center in Afghanistan, operated by Médecins sans Frontières, which killed 42 patients and health-care workers. 

An operating room in the Kunduz Trauma Center in Afghanistan, operated by Médecins Sans Frontières, that was destroyed in a US airstrike in 2015.

“In the darkness of the night, my hospital was on fire and I was hearing the screams of patients, caretakers, and staff for help. No one could help them. And all of them, the ones who had been trapped inside, died,” said Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

“I have seen terrible consequences of attacks on healthcare: patients and medical personnel directly killed and injured, and essential in life saving medical services lost for current and future patients,” said Nasim.

Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

Calling for Five Concrete Steps by Global Community

“After five years of inaction, the international community must take a much more vigorous stance,” said Rubenstein.  He laid out five concrete steps to be taken by the international community:

  • A special representative of the UN Secretary General should be appointed to monitor and report on the compliance of states with the resolution;
  • Political leaders must demand that ministers of defense get involved in reforming operational procedures and protecting healthcare;
  • WHO should convene health ministers to address the issue of violence against health workers at the ongoing 74th World Health Assembly;
  • WHO must take action to address the underreporting of data collected on violence against healthcare;
  • States and the UN must stop taking actions that undermine protection and legitimize violence against healthcare.

Multiple times over the past five years, the Security Council has blocked referrals to the International Criminal Court. In response, the General Assembly should establish new tribunals to prosecute perpetrators. 

Additionally, member states that sell arms to perpetrators of violence against healthcare must start adhering to laws prohibiting such sales. 

“These five steps take commitment and political will,” said Rubenstein. “We don’t want to meet in another five years and have the same discussion.”

“We all have a role to play in preventing these terrible events, which continuously reduce and impair the capacity of the impact of healthcare systems around the world,” said Maciej Polkowski, Head of the Health Care in Danger Initiative at the International Committee of the Red Cross. 

“The very least we can ask is that people stop attacking medical facilities and healthcare workers who are trying to save human lives,” said Nasim. “It must stop.”

Image Credits: Global Health Center, UN Women Asia and the Pacific.

Keva Bain of the Bahamas and WHO Director General Tedros Adhanom Ghebreyesus

Strengthening the World Health Organization’s pandemic response is a key focus of the 74th World Health Assembly, which started on Monday – and WHO Director General Dr Tedros Adhanom Ghebreyesus has already secured agreements with powerful European member states to do just that.

WHA discussion on a report from the Independent Panel on Pandemic Preparedness is expected on Tuesday., which details the slow, antiquated pandemic response mechanisms of the under-resourced global body. 

To bolster international pandemic surveillance, Switzerland will provide a biosafety laboratory in Spiez for a WHO BioHub Facility. This laboratory will share pathogens with global laboratories and other partners, according to a WHO announcement Monday.

“The facility will serve as a centre for the safe receipt, sequencing, storage and preparation of biological materials for distribution to other laboratories, in order to inform risk assessments and sustain global preparedness against these pathogens,” the announcement said.

Swiss Health Minister Alain Berset addressed the WHA opening session, expressing support for “predictable, independent funding” for the WHO and a pandemic treaty to “enhance and strengthen the role of the WHO, and also to ensure better implementation of the International Health Regulations.”

Meanwhile, French President Emmanuel Macron announced that a WHO Academy to train health workers would open its doors in Lyon in 2023. Macron also stressed the importance of ensuring that the WHO’s funding  was “more sustainable, more predictable, and less dependent on several big donors”.

In addition, said Macron, WHO needs “rapid response missions” with access to all territories to investigate pathogens that might lead to a pandemic. This follows unhappiness with how long it took China to admit a WHO-led team into Wuhan to research the origin of SARS-CoV2.

German Chancellor Angela Merkel expressed her country’s support for a pandemic treaty as well as a Global Health Threats Council to monitor member states’ adherence to international health regulations. Earlier this month, Germany and the WHO announced the establishment of a global hub in Berlin to gather data on pandemics and epidemic intelligence.

German Chancellor Angela Merkel

Push to Vaccinate 10% by September

When Tedros addressed the assembly, he was characteristically frank: “There is no diplomatic way to say it: a small group of countries that make and buy the majority of the world’s vaccines control the fate of the rest of the world.

“The number of doses administered globally so far would have been enough to cover all health workers and older people, if they had been distributed equitably,” he added. “We could have been in a much better situation.”

He then appealed to all member states to “support a massive push to vaccinate at least 10% of the population of every country by September, and a drive to achieve our goal of vaccinating at least 30% by the end of the year.” 

United Nations Secretary-General Antonio Guterres described the COVID-19 pandemic as bringing a  “tsunami of suffering.” He noted the costs of 4 million lives, 500 million jobs and trillions of dollars in economic and industrial impacts.

Guterres reiterated his call made at Friday’s G20 Global Health Summit for a task force that “brings together all countries with vaccine production capacity, WHO, ACT Accelerator, its partners and essential financial institutions able to deal with the pharmaceutical companies”.

The aim, Gutteres added, would be to double global vaccine production by exploring “all options — from voluntary licences and technology transfers to patent pooling and flexibility for intellectual property rights”.

South African president Cyril Ramaphosa, who also co-chairs the ACT Accelerator, decried the “huge divide in the provision of COVID-19 vaccines… [M]illions of people in wealthier nations have been vaccinated while billions of people in poorer countries still wait & are vulnerable to infection.”

Ramaphosa also expressed support for a global health council to collaborate with WHO to support regional and national pandemic response mechanisms.

Appeal for Travel Restrictions to be Eased

Meanwhile, Prime Minister of Antigua and Barbuda Gaston Brown stressed how difficult it was for small island states that suffered massive economic losses to buy vaccines through COVAX because they were deemed middle-income countries. Brown appealed for access to COVAX vaccines to be relaxed, and for travel restrictions and access to be eased.

Reiterating Spain’s commitment to sharing vaccines with Latin American countries, the country’s Prime Minister, Pedro Sanchez, proposed a public-private partnership between airlines, governments and international organisations to facilitate vaccine distribution.

Dechen Wangmo, Minister of Health of Bhutan

Dechen Wangmo, Minister of Health of Bhutan, was elected president of the WHA, which is the main governing body of the WHO, and will steer the complex discussions until the assembly ends next Tuesday. 

Over 70 health issues are on the agenda, from COVID-19 response and preparedness to mental health; patient safety; non-communicable diseases; antimicrobial resistance; health workforces; laboratory biosafety; violence against women, girls and children; finances; and the health-related 2030 Sustainable Development Goals.

Rich countries need to cough up 1 billion vaccine doses by September, and big pharma should significantly expand its network of voluntary license sharing and manufacturing – in order to avoid a vote by World Trade Organization members on a controversial proposal to waive all COVID-related intellectual property for the duration of the pandemic. 

That was the key message of former New Zealand Prime Minister Helen Clarke, at a debate Friday, co-hosted by civil advocacy groups Health Action International, Medicines Law & Policy, and Knowledge Ecology International. 

Former New Zealand Prime Minister Helen Clarke, who is also co-chair of The Independent Panel for Pandemic Preparedness and Response

“There has just not been a rapid enough scale up the production of vaccines to meet the urgent need of comprehensive global vaccination,” declared Clarke, co-chair The Independent Panel for Pandemic Preparedness and Response – which issued a crosscutting report this month.

 “And that is why the panel has called on the WHO and WTO to convene urgently a meeting of the major vaccine manufacturing countries and companies to crunch through….. licensing,  knowledge and technology transfer agreements for COVID-19 vaccines. 

“We say – if that can’t be achieved within three months, then a waiver of intellectual property rights under the proxy agreement should come into force, immediately.”

Clark spoke on the same day that 62 WO members submitted a revised proposal on the WTO IP waiver “from certain provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19”, as reported by KEI International. 

While not a major revision, the new draft of the proposal led by South Africa and India narrows the scope of the waiver more explicitly to COVID “health products and technologies”. It also makes it time-bound, calling for the waiver to remain in force “for at least 3 years from the date of this decision” with a review by the WTO General Council after that.

In her proposal, meanwhile, Clark echoed the offer of a ‘deal’ that was also raised Thursday by her Independent Panel co-chair, Ellen Johson Sirleaf – that countries flush with vaccines should share at least 1 billion doses with COVAX by 1 September, and two billion doses by the middle of 2022, to avoid a WTO vote on the waiver proposal. Said Clark: 

 “We’re all aware that the high income countries collectively have ordered far more vaccine doses than they would ever need to cover their populations.  

“So as they’re scaling up their vaccination rollouts, we call on them to provide, by September, at least a billion doses to the 92 low and middle income countries covered by GAVI [ the vaccine alliance]… and 2 billion doses in total by the middle of next year. 

“That redistribution will help cover the highest priority groups in low and middle income countries,” she said. 

With 62 sponsors now for the waiver deal, the possibility of an unprecedented vote on the waiver proposal looms as a real possibility for the WTO’s 164 members. 

Not Only Health Security – Pandemic Treaty Should  Focus On Access & Equity 

So far, an overriding focus of the pandemic treaty debate (see related story) has been the need for a stronger legal instrument to require countries to prepare for, transparently report on, and respond to outbreak risks, along with strengthening WHO’s investigative capacity. 

But any Treaty should also be a statement of equitable access to medicines, treatments and vaccines, proponents said:

“We can no longer afford to rely solely on a model of charitable giving, which proves inadequate in the face of global infectious threats,” said Clarke.

Pandemic Treaty mechanisms also need to go beyond the current donor-driven models of distributing vaccines and medicines to LMICs – to insure more stable global public-sector funded finance for their production and distribution, she and other panelists said.  

Said Anna Marriott, Health Policy Advisor for Oxfam: “long-term sustainable funding will be needed to invest and maintain manufacturing facilities,” especially in the global South where they are dire.

Broad in Scope 

The Pandemic treaty mechanisms must also be broad enough in scope to ensure that not only access to vaccines, but to also treatments and diagnostics, is more assured, said UNITAID’s Executive Director Phillippe Duneton. He described, for example, how the extreme shortages in oxygen supplies seen in South Asia and some Latin America countries is also exacerbating the coronavirus death toll. 

“We need to have all the tools, it’s about access to vaccines, it’s about access to treatments, about access to diagnostics. So, there is not only one [of those] that needs to be considered.”

And if voluntary licensing permissions for COVID treatments are struck with Pharma, those should not be limited to just certain countries or regions of the world – as they have been in the case of other treatments for HIV, hepatitis, and other diseases. Instead they should be available everywhere, including middle-income countries of Latin America and South East Asia, panelists added. 

Evergreen, Elastic Vaccine Manufacturing Capacity – Keys to Practical Success

Martin Friede, WHO’s Coordinator of the Initiative for Vaccine Research

On a more practical level, new regional vaccine manufacturing facilities, as they come into being, need to be build to adapt to changing market conditions – as well as being assured markets for their products in slack times – as well as during pandemic peaks, said WHO’s Martin Friede. 

“This will work if the [Pandemic] Treaty supports sustainable markets between pandemics as well as during pandemics,” he emphasized. 

Friede, a former biotech innovator and high-level pharma official, is leading WHO’s work on a mRNA technology transfer hub – to build regional capacity to produce new mRNA vaccines.

He cited the H1N1 pandemic as an example, where new manufacturing facilities that were created to fill the immediate needs of the pandemic survived only if they could also produce and supply markets for more routine vaccines in non-pandemic periods.  

“If a facility is not producing something that it is selling on a day to day basis, it will not be maintained,” said Friede, explaining that the incentives to maintain production capacity for goods that are rarely needed are weak. 

In addition, financial partners and buyers – from countries to big donor institutions – need to recognise that the medicines and vaccines produced by new, start-up facilities may be more expensive than those of well-established multinationals operating in Asia or the United States.  

So big global agencies as well as national governments need to recognize the long-term benefits of local procurement, and procurement from a healthy mix of suppliers – rather than always chasing after the lowest-priced options from the largest producers thousands of kilometers away, Friede stressed: 

“We are seeing facilities being closed down because the national government says we don’t need influenza vaccines’ or we can buy influenza vaccines on the international market cheaper than we can make them ourselves’.”

More Transparency Needed

Jamie Love, Director of Knowledge Ecology International

Greater transparency from the biopharmaceutical sector will also be needed to support the expansion of manufacturing capacity around the world, said Jamie Love from Knowledge Ecology International.

“It would be helpful if there was just more openness and transparency about what facilities are out there that have some capacity to manufacture,” he said, noting that on average, technology transfer takes about 6 months, based on previous agreements that have been sealed. 

“There are facilities which right now can manufacture without any changes, they’re ready to go. And then there are other facilities that would require some modifications and some changes in addition to whatever knowledge transfers is required…[it would be helpful to know] what facilities are out there, and what would it take in terms of time, money, and know how to get those facilities online.”

Image Credits: Sinopharm, Health Action International, Health Action International.

South Africa introduced a sugar tax in 2018 in support of a strategic plan for the prevention and control of obesity.

A sugar tax that generated R3-billion in revenue for South Africa in one year and a mandatory minimum unit price for alcohol products that contributed to a 10% decrease in alcohol-related deaths in Scotland are two examples of proven  successful policies governments have adopted for products that negatively impact health and that have helped raise revenue.

Speaking on the sidelines of the 74th World Health Assembly during a Vital Strategies and NCD Alliance virtual ‘VitalTalks’, health advocates called on governments to implement “concrete policies” to help save lives and prevent Non-Communicable Diseases (NCDs), to phase out incentives for unhealthy commodities and invest in social programs to improve lives.

Lynn Moeng-Mahlangu, SA health department’s chief director for health promotion and nutrition, pointed out that measures like a sugar tax are one part of combatting illnesses. She explained how her government introduced the health promotion levy on sugary beverages in support of a strategic plan for the prevention and control of obesity. The objective was to reduce obesity by 10% by 2020 and other non-communicable diseases.

The tax that came into effect in April 2018 was a triumph, but at about 11% is below a World Health Organization-recommended 20% increase. The WHO recommends that taxes on sugary drinks help to reduce consumption and prevent obesity. The global health body previously said that : “Taxation on sugary drinks is an effective intervention to reduce sugar consumption. Evidence shows that a tax on sugary drinks that rises prices by 20% can lead to a reduction in consumption of around 20% thus preventing obesity and diabetes.”

Moeng-Mahlangu however said the sugar tax had proven that fiscal measures contribute to reducing consumption on unhealthy foods and beverages, but said there was a need for more investment in research that will support policy making decisions.

She called for greater awareness programmes on issues that contribute to NCDs. “It’s also important to educate communities so that they can buy into the policy decisions that governments have taken.”

Scotland’s Fight Against Alcohol Abuse

The introduction of a mimum unit price on alcohol resulted ina a 10% drop in alcohol-related deaths in Scotland in 2019, with 1,020 fatalities compared to 1,136 the previous year.

Scotland became the first country to introduce a minimum unit pricing on alcohol after “it literally became cheaper to buy a cider than a bottle of water”,  said Allison Douglas, chief executive of Alcohol Focus Scotland. 

The primary purpose of minimum unit price (MUP) was to save lives and improve health. It was introduced in May 2018 after years of delays from legal challenges and targeted low-cost, high-strength products, seen as a source of problem drinking, by setting a minimum unit price of 50p per unit of alcohol.

The introduction of the public health measure was to save lives, said Douglas, revealing a 10% drop in alcohol-related deaths in Scotland in 2019, with 1,020 fatalities compared to 1,136 the previous year. The amount of alcohol sold in Scotland also dropped by 3% during the first year of introducing minimum pricing.

The COVID-19 pandemic has accentuated the need to act on NCD prevention and Douglas believes that interventions similar to the MUP are needed now “more than ever”.

“Public health prevention works and has never been more badly needed, Every country needs to look at the best ways of  increasing price controlling availability and reducing marketing to improve and save lives.”

Stop Incentivising Unhealthy Commodities

In the context of post COVID-19 recovery, governments should phase out incentives to unhealthy commodities, reinvest in social protection and use fiscal policies to prevent NCDs, said Nandita Murukutla, Vice President, Global Policy and Research, Vital Strategies.

Murukutla said billions of dollars is given to the alcohol industry every year through tax breaks, tax rebates, marketing subsidies and other incentives, particularly in low-and middle-income countries. This despite alcohol being a “a major public health and societal issue responsible for more than 3 million deaths annually”.

“And we know that it costs society. In the US alone,  It’s responsible for nearly $250 billion a year in social and other health costs.”

 A recent report by Vital Strategies, The Sobering Truth: Incentivizing Alcohol Death and Disability examined how the industry interferes in government policies that are aimed at reducing consumption of alcohol products. “As we seek to build resilient health systems, we have to urge governments, policymakers and health advocates to actively monitor the alcohol industry’s interference in policy and to question the cost and benefits of economic incentives, ”  the report states.

“(It) comes at a time when governments are grappling with the fallout of the COVID-19 pandemic, strained budgets, and an increased risk of people under COVID-19 restrictions turning to alcohol in ways that can harm health and increase mortality.”

Public Health Policies Save Lives

Nina Renshaw, NCD Alliance policy and advocacy director, said the COVID-19 pandemic had “accentuated the need to act on NCD prevention” and that the policy examples cited during the webinar proved that legislative tools  vital to save lives and improve people’s health.

A key message from the Vital Talks session, she said, was that important results were delivered for population health where solid measures and policies were implemented.

“And we heard from South Africa that these instruments can raise significant revenue, which can be reinvested into promoting and protecting health and bring further equity gains,’ she said.

Referencing an OECD report published on 19 May that details efforts over the past year to help developing countries create better tax policy measures, maximize revenue collection, and navigate the challenges of the COVID-19 pandemic, Renshaw said governments should implement robust pricing policies for alcohol as “the return on investment is $16 for every dollar spent on alcohol policies”.

Going forward, Renshaw called on governments to better understand NCDs as a vital part of health security and preparedness for health threats. “ A healthy population is the bedrock of resilience.” 

Image Credits: rawpixel/unsplash.

South African President Cyril Ramaphosa, who is also the ACT-Accelerator co-chair.

The G20 Global Health Summit on Friday elicited more promises from wealthy nations to share COVID-19 vaccines, an undertaking by drug companies to make over a billion doses available by year-end – and an indication by the European Union that it would propose an alternative to the TRIPS waiver at the next World Trade Organization (WTO) meeting.

Hosted by Italy and the European Commission (EC), the summit ended with the adoption of the Rome Declaration, a 16-point commitment to improving pandemic preparedness, increasing local manufacturing capacity and investing in worldwide health systems.

Team Europe – primarily France, Italy and Germany – promised to share 100 million vaccine doses with low- and middle-income countries (LMIC) by the end of the year, while Pfizer committed to manufacturing a billion vaccine doses, Johnson & Johnson 200 million and Moderna 100 million – some of which would be supplied “at cost” to poor countries.

However, the European Union stood firmly against the proposal for a waiver on intellectual property rights on COVID-19 products under the Trade-Related Intellectual Property Rights (TRIPS) agreement during the pandemic – the TRIPS waiver proposal made by India and South Africa to the WTO.

“I’ve been listening very carefully to the developing countries…and they are complaining that it is difficult for them to use the flexibilities of TRIPS within the Doha Declaration,” EC President Ursula von der Leyen told a media briefing after the summit.

The European Union (EU) had thus decided to provide developing countries with “certainty” that they could use the flexibilities contained in the Doha Declaration during the pandemic, added Von der Leyen.

EU to Propose Third Way at WTO Meeting in June

EC President Ursula von der Leyen

The EU intends to propose a “third way” to the WTO meeting in June, based on “trade facilitation and disciplines on export restrictions, support for the expansion of production, and clarifying and simplifying the use of compulsory licences during crisis times”, she added.

“It’s important that the G20 has convened behind the Doha Declaration and the TRIPS agreement, and will work within it, with flexibilities,” she added.

The EU’s entrenched position comes despite growing support for the TRIPS waiver – including an indication by the US that it was willing to move to text-based negotiations on the proposal put forward by South Africa and India.

In addition, on Friday  62 WO members submitted a revised proposal on the WTO IP waiver “from certain provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19”, as reported by KEI International. 

The revised proposal narrows the scope of the waiver to COVID-19 “health products and technologies” and also calls for it to remain in force “for at least three years from the date of this decision” to be reviewed by the WTO General Council after that.

Despite the EU decision, WTO Director-General Ngozi Okonjo-Iweala told the summit that WTO member states should get ready for text-based negotiations on the proposed waiver. 

“We must act now to get all our ambassadors to the table to negotiate a text. This is the only way we can move forward quickly, we can’t move forward with speeches and polemics,” she told the summit.

“I am hopeful that by July we can make progress on a text and by our 12th Ministerial Conference in December, WTO members can agree on a pragmatic framework that offers developing countries near automaticity in access to health technologies, whilst also preserving incentives for research and innovation,” she added.

However, South African President Cyril Ramaphosa, who is also the co-chair of the Access to COVID-19 (ACT) Accelerator – the WHO-led global effort against COVID-19, said that “it cannot be justified that in this 21st century, Africa has only received 20 million vaccine doses, which is apparently 2% of the global supply”.

Describing the fight against the pandemic as a “war”, Ramaphosa said all countries needed weapons to fight the virus which was why his country and India had proposed a temporary TRIPS waiver.

“Such a waiver would enable developing countries, in particular, to expand their pharmaceutical sectors to facilitate technology and skills transfer, and above all, at this point in time, save lives,” said Ramaphosa.

IMF Boosts Global Reserves to Finance ‘Exit from COVID-19 Crisis’

IMF Director-General Kristalina Georgieva

IMF Director-General Kristalina Georgieva warned the summit of the “dangerous divergence of economic fortunes”, as the gap widens between wealthy countries that have access to vaccines in poor countries that do not.

The IMF estimated that $50 billion was needed to address three key issues – vaccinating 60% of the world’s population by 2022; protection against variants, including possible booster shots; and public health measures to manage the pandemic while vaccinations were taking place.

“With the support of our membership, we are working towards making an important contribution to the exit from this crisis by boosting global reserves with $650 billion special drawing rights — particularly important for countries faced with the toughest challenges.  We are stepping up lending where needed, and we are working on debt sustainability,” said Georgieva.

“Pledges today from a handful of countries are welcome, but the world remains in the grip of a devastating global emergency. It demands bold, collective action. Today, global leaders of the G20 missed this critical opportunity,” said Alex Harris, Wellcome Trust’s Director of Government Relations.

“The moment has passed for warm words and piecemeal contributions – we need courageous, united leadership from countries that can most afford to help others. Next month’s G7 Summit is an historic opportunity to do this. It must not be wasted,” he added.

Johnson & Johnson’s single-dose COVID-19 vaccine

Johnson & Johnson will supply COVAX 200 million of its single-dose COVID-19 vaccines by the end of the year, according to a statement on Friday by Gavi, the Vaccine Alliance, announcing the advance purchase agreement.

The vaccine will be available to both COVAX members who buy their own vaccines and the COVAX AMC members. 

“Today’s agreement between Gavi and Johnson & Johnson means the COVAX Facility is able to offer participants yet another safe and effective tool against the pandemic. I welcome Johnson & Johnson’s commitment to equitable access and to expanding global manufacturing through external partnerships, which is something that will provide long-lasting benefits even after this pandemic is over,” said Dr Seth Berkley, CEO of Gavi.

Gavi and Johnson & Johnson are also discussing the possible supply of 300 million doses for COVAX in 2022. 

“As a one-dose vaccine, the J&J vaccine has particular relevance for places with difficult infrastructure, making it a very important addition to the portfolio.” 

“Our partnership with Gavi is the single greatest step we have taken to ensure our single-shot vaccine is accessible to everyone, everywhere. Our commitment today offers the potential to protect up to 500 million people from COVID-19,” said Paul Stoffels, Chief Scientific Officer at Johnson & Johnson

“COVAX now has agreements for eight vaccines and vaccine candidates – AstraZeneca/Oxford, Pfizer, Moderna, Novavax, Johnson & Johnson, Serum Institute of India (SII)’s Covishield, SII’s Covavax, and Sanofi/GSK – with the aim to expand to 10-12 vaccines in total, providing participants access to a diverse range of vaccines suitable for use in varied contexts and settings.,” said Gavi.

Gavi is also trying to raise at least an additional US$1.6 billion for the COVAX AMC to enable the supply of up to 1.8 billion doses of vaccine for 92 lower-income economies. 

Japan will be hosting the upcoming Gavi COVAX AMC Summit, bringing together world leaders, the private sector, civil society and key technical partners in a virtual event on June 2nd.

In addition to doses secured via agreements with manufacturers, Gavi and its COVAX partners the Coalition for Epidemic Preparedness Innovations (CEPI), the World Health Organization and UNICEF also call on the international community to share doses with COVAX immediately to help those countries that have been worst hit by current global supply constraints and urgently need to protect their most at-risk populations.

COVID-19 Deaths Could be 2-3 Times Higher than Officially Reported

Meanwhile, a new WHO estimate suggests that deaths from COVID-19 since the pandemic began may be 2-3 times higher than the 3.2 million deaths officially reported until 1 May 2021.

The estimates were contained in a new World Health Organization (WHO) World Health Statistics Report, released on Friday – which tracks a wide range of health statistics on disease, risks and other health indicators, across all 194 member states.  According to the report, while 1.8 milion deaths from COVID were officially reported in 2020, the real death toll last year was likely 1.2 million more than that, based on overall excess mortality rates for 2020, as compared to previous years. 

That leaves preliminary WHO estimates to suggest the total global excess deaths attributable to COVID-19, both directly and indirectly, amounted to around 3 million in the year 2020,  the report states.

And based on the data from 2020, the excess deaths recorded until now, may be 2-3 times higher than the 3.2 million deaths recorded until now – that is more than 6 million deaths, the report suggests.  The reason for the under-estimates lay in the fact that deaths from many people with pre-existing health conditions that make them more vulnerable to COVID diasese, may be recorded as dying from diabetes, heart, respiratory disease, or other such conditions – even if it was COVID that actually triggered their deterioration and death.

    

Cumulative confirmed COVID-19 deaths as of 1 May 2021, by region: a) in thousands; b) per 100 000 population; and c) by location

Cases Shifting From Wealthy to Low- and Middle-Income Countries 

In addition, while almost half (48%) of all reported COVID-19 deaths have occurred in the Americas, and one third (34%) in Europe, a shift in cases and deaths from higher- to lower-resource settings is now becoming evident, according to the report.

“ While high income countries (HICs) accounted for about 64% and 59% of the global monthly new cases and deaths, respectively, in January 2021, the shares dropped to 31% and 27%, respectively, in April 2021,” the report states.

In contrast, low- and medium income countries’ (LMIC) share of new global monthly cases rose from 8% in January 2021 to 37% in April 2021, and the share for new deaths from 8% to 22% between January and April 2021.

Meanwhile, of the 23.1 million cases reported in the South-East Asia Region to date, over 86% are attributed to India.  Until now, the WHO Region of the Americas and the European Region accounted for over three quarters of cases of the 150 million cases reported so far, with case rates per 100 000 population of 5999 and 5455 respectively. 

 

A patient getting tested for COVID-19 at the Paris Charles de Gaulle Airport in January 2021.

Though the COVID-19 pandemic has largely been a story of failure, strong preparedness of public health systems coupled with decisive responses have shown that it is possible to prevent and prepare for future disease threats, according to a new report.  

The report, conducted by Resolve to Save Lives, an initiative of Vital Strategies, highlights eight case studies that show the success of epidemics that didn’t happen, or whose impact was lessened, because of careful planning and strategic action. 

“No response is perfect and there’s no one size fits all approach, but taken together, these studies demonstrate that in moments of crisis, communicating clearly and effectively while working collaboratively with partners and communities can prevent epidemics, [guiding] our conversation on the future of global health security,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives on Thursday.

The report reviews how the trajectory of an epidemic can be altered when a country invests in and prioritizes preparedness for infectious diseases outbreaks, such as Uganda and Brazil. 

Uganda’s Rapid Response and Mobilization Against Ebola Outbreak

Surveillance for Ebola Virus at the border between Democratic Republic of Congo and Uganda.

Within days of the Ebola outbreak being declared in the Democratic Republic of the Congo (DRC) in August 2018, Uganda was able to rapidly mobilize its response teams to prevent further infection. 

Within weeks, Uganda opened multiple Ebola Treatment Centers and rapid testing laboratories near the DRC border, where border screenings were conducted for all people entering the country. 

By November 2018, the Ugandan government had vaccinated nearly 5,000 health care workers and response staff.

This was all done before any cases had been identified in Uganda. 

Ugandan Minister of Health Dr Jane Ruth Aceng attributes the country’s strong outbreak response to collaboration and partnerships across sectors.

“Strong partnerships for support, both financially and also technically, as well as stakeholder engagements are critical in responding to any public health emergencies,” said Aceng.

Brazil: Mass Vaccination Against Yellow Fever 

Brazil’s successful response to containing yellow fever in 2019 produced dramatic results, with only 85 yellow fever cases and 15 deaths reported.

Brazil’s successful response to its 2016 – 2018 yellow fever outbreak was due to its scientific expertise on the disease and its role as one of the largest producers of the yellow fever vaccine – making the country well-positioned to address its yellow fever outbreak. 

However, at the time of the outbreak, vaccine supplies were low. 

To manage a large number of vaccinations needed amid a vaccine shortage, health officials requested additional supplies from an international stockpile, and stretched supply further by using partial doses of the vaccine.

Studies have shown that one-fifth of a standard dose can provide up to a year of immunity, and can be beneficial for containing outbreaks. 

Health officials also prioritized surveillance of yellow fever outbreaks among animals, which would provide advance warning of where human cases would later appear. 

By the end of the 2019 yellow fever season, these measures had produced dramatic results, with only 85 yellow fever cases and 15 deaths reported. 

Highlighting Brazil’s successful response to containing yellow fever, Dr Sylvain Aldighieri advocated for increased investments in healthcare workers – a critical issue, he said, should be stressed in the upcoming G-7 and G-20 Global Health Summits.  

“We have this population of healthcare workers dealing with a day-by-day battle for more than 16 months.”

Investment in healthcare workers includes Personal Protective Equipment, vaccinations, training, and adequate ratio of staff-to-patients.  

Aldighieri pointed out that integrated and strong primary health care was also what aided Brazil during its outbreak.

“If you have a strong primary health care system it avoids a lot of trouble in the following steps of response.”  

Seven-One-Seven Approach to Pandemic Preparedness

From these case studies, and from existing recommendations, Resolve to Save Lives has proposed a goal of seven-one-seven – identifying any suspected outbreak within seven days of its emergence, responding rapidly through investigation and reporting within one day, and establishing an effective response within seven days. 

This type of goal, said Frieden, will provide impetus and accountability to make substantial and sustained financial, technical, and political investments needed to improve global health and our capacity to find, stop, and prevent future pandemics.” 

“The COVID-19 pandemic has reinforced the need to work together. We’re all connected. And it’s on all of us to prevent epidemics.” 

Effective Global Health Governance and Collective Investment in Preparedness Needed 

Recommendations for addressing future pandemics and looking beyond COVID-19 through more effective global health governance were also considered, in light of the recently released Independent Panel Report, 

“We need a strong World Health Organisation (WHO), but we [also] need a more independent WHO that could operate independently and actually make decisions faster, said Dr John-Arne Rottingen, Ambassador for Global Health at the Norweigian Ministry of Foreign Affairs.

He emphasizes that though achieving this type of leadership is a ‘tricky balance’, it demonstrates the need for strong public health capacities not just in the WHO, but across the globe.

This is important in developing countries, which have limited resources to prepare for disease outbreaks. Though countries would ideally like to focus on themselves and their key priorities, the ‘collective investing’ in the health systems of low-and-middle-income countries would be a ‘public good’, not just at the national level but also at an international level, added Rottingen. 

“It’s good for everyone. We can avoid infectious disease threats and it’s a collective investment,” he said, noting all countries should contribute, from high-income to low-income countries, investing both domestically and to collective finance mechanisms. 

As seen with the vaccine nationalism of the current COVID-19 pandemic, countries primarily focus on the needs of their people before considering the ripple effects of disease outbreak in other countries. 

Investment towards countries with ‘lower purchasing power’ would contribute to pandemic preparedness. 

“We need to demonstrate that we can deliver equitable access in this pandemic; if not we will not be trusted in the future.” 

Image Credits: Flickr – International Monetary Fund, WHO Afro, Matt Taylor, WHO.

Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, at a press conference on Thursday.

The hostilities between Israel and Hamas over the past 10 days have caused significant damage to the health system in Gaza, putting the Palestinian population at risk of increased spread of COVID-19 – after six weeks in which new cases had been in sharp decline.

The health system in Gaza is now facing severe shortages of essential medicines and supplies and it’s only COVID test facility was destroyed. The closure of border crossings has restricted the entry of medical supplies – although Israel said late Thursday night that it would begin opening the borders to humanitarian aid if a cease-fire with Gaza’s Hamas authorities, due to take effect at 2 a.m. local time, holds. 

“WHO calls for the urgent facilitation of humanitarian access to the Gaza Strip to allow entry of essential medical supplies, referral of patients to facilities outside the Gaza Strip, and passage of medical teams and humanitarian personnel,” said Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, at a press conference on Thursday that came just ahead of the Egyptian-brokered cease-fire agreement with Israel. Hamas began a missile assault on Israeli cities 10 May, in reprisal for Israeli moves to evict several Palestinian families from homes in East Jerusalem and Israeli police clashes with Palestinians around the city’s Al-Aqsa Mosque, Islam’s third holiest site.  Israel responded with heavy aircraft raids over Gaza, targeting offices and high-rise buildings of strategic importance, and damaging a vast labyrinth of underground tunnels, which Israel says were used by Hamas fighters hide from Israeli attack.  

Over 245 deaths and 6,700 injuries have been reported in the Gaza Strip and West Bank during the violence, according to WHO, while in Israel, 12 people including two children have been killed.

What’s more, however, the aerial bombing of Gaza damaged or destroyed 19 health facilities, a desalination plant that supplies clean water to 250,000 people, and Gaza’s main COVID-19 testing laboratory. 

Gaza, which has been under an Israeli blockade since the Islamist Hamas Party took control of the enclave in 2007, has seen intermittent flareups with Israel that have grown in intensity as Hamas gained more missile power to hit deeper into Israeli territory. Neither Hamas nor the Israeli government recognize each other as legitimate authorities.

More than 90 attacks on health care workers have been recorded in the West Bank and Gaza Strip, with 21 recorded in the Gaza Strip and 70 in the West Bank, Mandhari said, adding that, “WHO also calls for the immediate cessation of hostilities and an end to attacks that either directly or indirectly impact health care in the occupied Palestinian territory.” 

In the Israeli-occupied West Bank, the Palestinian Authority, which is recognized by Israel, has limited self-rule, under the terms of the 2003 Oslo Accords. However, the past two weeks also saw a wave of West Bank Palestinian demonstrations and clashes with Israeli troops in support of the Hamas as well – creating barriers to access of health facilities, particularly in East Jerusalem, which is under Israeli control.

The WHO situation overview of casualities and damage caused since 7 May in the occupied Palestinian territories.

Damage to Health and Water Facilities – Interrupts Essential Health Services and COVID Testing and Vaccinations

In Gaza, the only functioning COVID-19 testing lab, housed in the Al-Rimal health clinic in Gaza city, was damaged on Monday by an airstrike. It processed over 2,500 tests per day, as well as administering COVID vaccinations and providing other essential health services. 

The damage to water desalination plants and water sanitation hygiene (WASH) infrastructure increases the risk of waterborne diseases and impacts hygiene, which is a central component of COVID-19 public health measures, said WHO officials.

Along with that, 46% of essential drugs and 33% of essential medical supplies also are out of stock in Gaza. And heavy damage to roads, including the main road to Shifa Hospital, one of Gaza’s largest hospitals, is obstructing ambulance access.

The health impacts of the escalation in violence in the occupied Palestinian terriories.

WHO has procured and delivered US$200,000 worth of essential medicines to hospitals in East Jerusalem, and has a convoy ready with US$500,000 worth of rapid diagnostic tests, equipment, and medical supplies destined for the Gaza Strip. 

“The fighting must stop immediately. Until a ceasefire is reached, all parties to the conflict must agree to humanitarian pause to ensure access into and out of Gaza for humanitarian staff and critical goods…to allow for safe movement, and for the delivery of assistance,” said Dr Rik Peeperkorn, WHO Head of the Regional Office for the West Bank and Gaza Strip.

“We need a ceasefire, we need a humanitarian pause,” said Dr Richard Brennan, WHO Regional Emergency Director for the Eastern Mediterranean. “We need the humanitarian access. We want all the crossings to be opened to let the aid in and let the sick and injured out.”

“If we are speaking about the current political and security situation in the region and in the occupied Palestinian territory in particular, there is no health without peace,” said Mandhari.

Some 75,000 people have been displaced by the violence, with 47,000 seeking shelter at 58 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East. The overcrowding at these shelters could facilitate the spread of the SARS-CoV2 virus, WHO officials said. 

COVID Figures Likely Don’t Reflect Local Situation 

Both the West Bank and Gaza were just coming out of a third COVID wave when the violence escalated. The damage to health infrastructure, testing capacity, and water sanitation facilities will likely cause the pandemic to worsen, officials said. 

Even before the hostilities started on 10 May, cases were sharply declining from a peak of 2,500 new cases in April, to less than 600 as of May 10. And that trend has continued over the past week. However, officials are concerned that recent data is misleading, due to the current absence of testing and tracking procedures, particularly in Gaza. 

About 5.4% of Palestinians in Gaza and the Occupied West Bank have received at least one dose of a COVID-19 vaccine – doses obtained through the WHO co-sponsored COVAX initiative or from donations.   

This is in stark contrast to Israel’s national vaccination campaign, which has immunized 62.8% of the population with at least one dose. 

WHO currently has a convoy of 10,000 more Sinopharm COVID-19 vaccines waiting to enter Gaza as soon as possible to provide jabs to more of the population, said officials.

“Overall there is still a huge shortage of vaccines in the occupied Palestinian territories and the coverage is still way too low,” said Peeperkorn.

Dr Rik Peeperkorn, WHO Head of the Regional Office for the West Bank and Gaza Strip.

WHO announced that US$7 million will be needed for the health response in the occupied Palestinian territories over the next six months. 

The plan is to first provide assistance to Gaza for acute health needs and then focus on rebuilding the health infrastructure and strengthening the health system to ensure a functional primary health care system is established once again, said Peeperkorn.

In the midst of the ongoing conflict, a heated political debate is expected to take place in the upcoming World Health Assembly (24 May -1 June) on a draft resolution on the health conditions of and assistance to provide the Palestinian population.  Israel has long complained that setting the resolution as a separate agenda item for the WHA represents disproportionate and politicized treatment of the Palestinian issue – as compared to the many other humanitarian flash points around the world – which do not get the same prioritization at the WHA forum.

Image Credits: WHO.

pandemic

Conquering the COVID-19 pandemic will inevitably be the main topic for discussion at the impending 74th session of the World Health Assembly, which begins Monday, 24 May. Global health experts weighed in this week at a series of briefings on what to expect from at the upcoming event. Geneva Solution’s Pokuaa Oduro Bonsrah reports:

The annual World Health Assembly will open online on Monday, with ministers of health from the World Health Organization’s 194 member states tasked with wading through a heavy agenda dominated by how to fix the COVID-ridden global health system and step up global response to future crises. 

“It is time to elevate the threat of pandemics at the level of other existential threats such as nuclear accidents,” Dr Joanne Liu, former International president of Médecins Sans Frontières (MSF) and a member of the Independent Panel for Pandemic and Preparedness Response (IPPR), said in an interview with Geneva Solutions. 

“This is why we call it a “Chernobyl moment in the 21st century”. If we want to move fast and in a sustainable way this scale up is necessary.” The findings of the independent review panel, set up by the WHO to examine the international COVID-19 response and published last week, will be at centre of discussions next week. 

What is the WHA and Why is it Important?

WHO Director-General Dr Tedros Adhanom Ghebreyesus delivers the closing speech for the World Health Assembly, 2019

As the decision-making body of the World Health Organization (WHO), the annual WHA meet-up gives member states the opportunity to chime in on WHO’s policy direction, governance, budget spending and health priorities.

The eight-day assembly, while officially hosted in Geneva, will take place online for the second year in a row, with over 2,750 people already registered to the event including civil society organisations. While COVID-focused, the Assembly will also tackle a range of health issues from antimicrobial resistance to non-communicable diseases. Exhibiting the largest agenda ever, with over 72 items, global health experts shed light on areas that they expect will dominate this 74th session.

Pushing for Legally Binding Instruments to Fight Pandemics

Charles Michel, President of the European Council

Hot on the agenda are talks for a “pandemic treaty” or convention to better prevent, prepare and respond to infectious disease outbreaks. First floated by the European Council’s president Charles Michel in November, the idea has so far been backed by 25 countries, including the WHO. However some of the world’s major powers, including the US and China, have yet to commit. 

The organisation’s treaty-making powers have only been used once in its history to create the Framework Convention on Tobacco Control (FCTC); it is one of three decision-making tools the WHA has at its disposal, including its recommendation powers used the majority of the time, and its regulation tool that formed the basis of the International Health Regulations.

Speaking at a press briefing on Wednesday, Steven Solomon, principal legal officer at the WHO said: “What’s so interesting about this upcoming World Health Assembly is that all three tools will be considered for possible needs in response to the pandemic,” Solomon noted.

Antoine Flahault, director of the Institute of Global Health at the University of Geneva

Although the intricacies of the treaty are yet to be discussed, Dr Antoine Flahault, director of the University of Geneva’s Institute for global health, said a pandemic treaty should guarantee the power of investigation from an early stage.

“With COVID, it would have been useful to have a pandemic preparedness treaty to allow full, independent, rapid investigation into the inception of the pandemic. As we have seen in the China example and the investigation in Wuhan, we missed the chance to scrutinise the origins of the pandemic early on, which has potentially devastating effects” said Flahault, also speaking at the briefing.

Bearing this in mind, when convening a Public Health Emergency of International Concern (PHEIC), the formal declaration by WHO of “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease”, the pandemic should be treated in a similar way to the treaty on the non-proliferation of nuclear weapons or World Trade Organizations directives, “giving it the same level of power and impact, so that when violated sanctions are imposed,” he added.

In Liu’s opinion this should go beyond agreeing on rules, and would instead like to see more “action and accountability.”

Cementing the Power of the WHO to Fight Off Future Health Crises and Eradicate the Current Pandemic

The Independent Panel Team

At a more informal level, countries have been working amongst themselves to agree on how to strengthen WHO preparedness and response to health emergencies, and it is hoped recommendations emerging out of these discussions will be made at the WHA, according to Solomon.

In the recent report by The Independent Panel, co-chaired by the former prime minister of New Zealand, Helen Clark, and president of Liberia, Ellen Johnson Sirleaf,  weak links were found in both preparedness and response – including a broken global emergency alert system, a hesistant WHO and patchy country responses.  Lessons from previous pandemics were not incorporated either, the panel found, citing, for example, the 2009 H1N1 influenza response. 

Along with supporting a Pandemic Treaty, as a way to make pandemic response a higher political priority back by an stronger legal mandate, the Independent Panel also urged that WHA member states push for the creation of a Global Health Threats Council, with plans to put the idea forward at the United Nations General Assembly (UNGA) in September.

“By having this at the highest level it gives it the attention it deserves. We want it at the UNGA after discussion at the WHA, giving heads of states and governments the opportunity to take up ownership it needs,” said Liu.

WHO’s Political Independence

Current WHO Director General Dr Tedros Adhanom Ghebreyusus

In order for the WHO to flourish and have the appropriate means to address the current and future pandemics, the global health experts also believe the political independence of the WHO also needs to be frankly  discussed as  a top priority at the WHA.

This includes a recommendation by the Independent Panel that member states limit the WHO director general’s tenure to just one term of no more than seven years – as compared to the system today, whereby he can hold office for up to two, five year terms. 

The hope is this would shield the WHO chief from political pressures during his tenure – and from pressures to collude  with certain member states in order to secure re-election for a second term.

Instead of a seven-year non-renewable-term, Flahault, however, advocates for a five-year non-renewable term. Still, the main message of independence and autonomy  remains the same.

Governance and Funding Without Strings Attached

Bill Gates, chair of the Bill and Melinda Gates Foundation

When it comes to coughing up cash, member states have stalled on increasing their contributions. Philanthropic actors such as the Bill and Melinda Gates Foundation have filled the void by becoming major funders of global health and the WHO; but this has in turn been met with criticism from civil society as well as some member states for giving external actors too much influence over the organization.

Both Flahault and Liu say the blame should be shifted from philanthropies – to that of countries that are not playing their role. “The total WHO budget for example is hardly above the budget of most teaching hospitals in high income countries, such as University of Geneva Hospital,” explained Flahault.

Read also: Bill Gates is ready to spend more on global health – governments should too, says foundation official

The WHO should be robust and agile enough to anticipate, and respond to, health crises. As such the question of reform, including of its governance structures, also is a looming issue at WHA meetings.   

But for Flahault institutional reform can suck up a lot of energy and time – without yielding enough results. Instead, he says that the focus should be on giving the WHO the mandate to coordinate and lead on health matters.

The Question of Vaccine Equity

Civil society groups demonstrate outside embassies of the United States, United Kingdom, Australia, Canada, Brazil, and other countries which oppose a temporary WTO patent waiver on COVID-19 health products.

“One of the priorities of the WHA to be discussed with urgency is the production of vaccines, technology transfer and patent waivers”  Flahault also said.

While the final decisions around a proposed intellectual property waiver on Covid vaccines and other health products will be made in the World Trade Organization, WHA statements and discussions will also have an influence. 

The WHA debate will also come on the heels of a critical Global Health Summit of the Group of 20 (G-20). Outcomes of Friday’s G-20 meeting, hosted by the Italian government and the European Commission, will also set the texture of high-income country positions in the WHA proceedings.  

A draft G-20 “Rome Declaration” seen by Health Policy Watch,  makes no mention of the proposed IP waiver – referring only to the potential for “voluntary… technology transfer and licensing partnerships.”  And although the leaders of the G20 will also affirm their support for the WHO and Gavi co-sponsored ACT Accelerator initiative, which aims to hasten the distribution of Covid-19 vaccines, drugs and tests across the world, they fall short of clearly committing desperately needed new funding to it. 

A weak G-20 commitment would be a blow to the WHO-backed scheme, Flauhault said, adding that if there was sufficient political will, the US and its allies could potentially vaccinate the whole planet.

“It would cost about 27 billions of dollars to immunize the world population, which is affordable. A country like the US, which I am not saying should vaccinate the world, could however do so if it wanted to. If not high income countries should invest in doing so as soon as possible,” Flahault said.  

At the same time, this year’s WHA will see solid support from the United States, following the change in the administration – and Washington is expected to be a big player in the proceedings. 

Read also: Fauci signals new chapter in US relations with the WHO

“The US body-language is quite important because they have recently been a big defender for multilateralism,” said Liu.

“These are good signals for global health and particularly during the pandemic.  They are pushing back on the waivers of patents, and should also really consider funding the Covax equitable vaccine sharing scheme,”  Flahault added. 

COVID Will Become a Pandemic of the Poor if Neglected Now

The pandemic may become a disease of the poor if nothing is done; coronavirus lockdown in a Roma community in Romania. Makeshift barracks leaves it difficult to follow social distancing and basic hygiene rules.

In the absence of strong action by wealthy donor countries at the G-20 and the WHA, the trajectory of COVID risks the disease becoming a “pandemic of the poor”, Liu warns.

For Liu, if the opportunity is not seized at this year’s WHA to adequately address the WHA, by taking bold decisions and committing to actions then she believes COVID will become an endemic disease, mostly but will be limited to low and middle income countries, whilst high income countries leave the rest of the world behind.  

 “My biggest worry is that high income countries will pull themselves out of the grip of COVID-19 because they will vaccinate the population, and have herd immunity. Low and middle income countries will then be stuck, just like what happened with  HIV and Tuberculosis,” she said. 

The Question of Taiwan

Former Taiwan Vice President Chen Chien-jen in an interview in 2017 discussing the absence of an invitation for Taiwan to attend the World Health Assembly.

In 2008, Taiwan was invited every year to the WHA as an “observer” but since 2016, this invitation – issued at the discretion of the WHO Director General – ceased. This was after Taiwanese elections brought a new government into power with a more hard-line stance toward China – leading Beijing to oppose the seat for Taiwan in the Assembly – even as an observer.  

In the wake of the pandemic, which saw allegations of a Chinese cover-up of the SARS-CoV2 virus origins, as well as a refusal then and now to share critical data around the outbreak’s early days,  there have  been growing  calls to renew the invitation to Taipei – beginning already last year.  

For this year’s 74th WHA, some 13 WHO member states have called for Taiwan to be allowed to participate, with the issue set to be discussed on Monday.  This includes the G-7 (Group of Seven most industrialized countries), which have formally  endorsed Taiwan’s attendance. 

The participation of Taiwan is critical for scientific reasons,  says Flahault. “In global health and security terms, there is absolutely no doubt that Taiwan should be one of the full members of the WHA. The way the country has managed the pandemic offers great tools and lessons which will be important knowledge to share at the WHA and it is a pity if we do not get this,” he said. 

From Taiwan to vaccine equity, the challenge throughout all of the WHA debates will be for individual member states to rise above their own narrow set of national or geopolitical interests – recognising that the pandemic is a threat to all.  

“What I expect from the WHA is that member states show exemplary leadership. This year has to be a game changer in terms of response and preparedness to pandemic,” said Liu.

Republished from Geneva Solutions. Health Policy Watch Watch is collaborating with Geneva Solutions, a new non-profit Geneva platform for constructive journalism covering International Geneva

Image Credits: WHO / Antoine Tardy, Antoine Flahault, IPPR, UNGA, Tadeau Andre/MSF , Thomas Hackl/Flickr, Flickr – Taiwan Presidential Office.

ip
A network analysis of COVID-19 mRNA vaccine patents

Governments and pharmaceutical companies alike must work together in combating the ‘virus of intellectual property (IP) monopolies over COVID-19 vaccines – which  further exacerbates inequality and lack of access to vaccines for vulnerable groups. 

That was the uptake of a group of experts speaking at a webinar Wednesday on “The Virus of IP Monopoly Capitalism”’ hosted by the Society for International Development (SID). 

“What we need is collective intelligence, not the segmentation of different actors, allowing each person possible to participate in the production process,” said Ugo Pagano of the Italy-based Siena University, during a webinar 

The symposium discussed current global tensions between proponents of the proposed World Trade Organization (WTO) TRIPS waiver to accelerate access to COVID-19 vaccines – and its pharma industry opponents who support a system that they say stimulates innovation – even if the benefits may be unevenly distributed.  

Intangibles Controlling Global Economy

The smiling curve of intangibles – Investor state dispute settlements shift power to private actors and increases value of intangibles

IP, or ‘intangibles’, are “‘considered a lion’s share of powers concentrated in the global economy”, said Susan Sell of the Australian National University.

Intangibles are IP trademarks and patents that play an outsized role in the global economy, with the political and economic powers that own those goods controlling the value of oft-essential products and services. 

In terms of the COVID-19 pandemic, that can include patents governing tests, Personal Protective Equipment (PPE), vaccines, and medicines. 

“It’s a winner-takes-most system right now – and those who own the intangibles are the winners in this system,” said Sell. 

This means that developed countries and pharmaceutical companies are the “winners” of this system, said Sell, with developing countries and vulnerable groups struggling to access essential equipment and treatment, worsening inequality and poverty, and leading to many unnecessary COVID deaths. 

IP Regulation is Not Sustainable 

IP

Experts argued that protecting IP so as to stimulate innovation is not a sustainable model. The COVID crisis has forced the world to rethink issues around the efficiency and efficacy of IP regulation moving forward.

“[It is now the time] to start raising some questions about the sustainability of [IP regulations],” said Mohammed El Said, of the University of Central Lancashire, United Kingdom.

“The COVID-19 pandemic is not the first pandemic and it won’t be the last. However, our ability in dealing with and actually having the correct and right mechanisms in limiting its impact will, [in turn] impact how we’re actually going to deal with future occurrences of this nature.” 

Although more and more of the world’s population are now able to access COVID vaccines, which El Said called a ‘turning point in the fight against the pandemic’, sufficient supplies have yet to reach developing countries. 

Vaccine nationalism is ‘counterproductive’ to the vaccine supply problem, because while most developed countries have access to vaccines, the pandemic will still persist in other countries and regions that are now labeled hotspots, such as India and Latin America and the Caribbean, prompting all the hard work in fighting the vaccine to be undone. 

Future of Global Economy – Innovation Towards Delivering Global Public Goods 

Susan Sell, School of Regulation and Global Governance, Australian National University

The future of the global health economy must shift towards a model where innovation, which is now left to the markets, would instead be the basis for a model that can deliver global public goods.  

There’s a ‘reduced commitment to social policy in the face of imperatives of finance capitalism’, said Sell.  “It’s really about profits, it’s really about shareholder value.”

This, according to her, causes economic powers to block social and reform initiatives if they have the potential to threaten either profits or shareholder value. 

Evidence of this can be seen in the resistance by countries with large pharma interests, such as Germany, to waiving patent protections. German officials believe that the United States’ support of the TRIPS waiver would create ‘severe complications’ for the production of vaccines, a German government spokeswoman told Bloomberg recently. 

The spokeswoman argued that the limiting factor for the production of vaccines is manufacturing capacities and high quality standards, not the patents, countering the point made by experts during the webinar to shift  market innovation towards increased accessibility of global public goods.

Monopoly on Knowledge Impacts Vaccine Production and Supply

Els Torreele, Institute for Innovation and Public Purpose; University College London

However, Els Torreele of the University College London asserted at the webinar that the protection of IP through monopolies, also impacts production capabilities and technologies, leading to vaccine hoarding and the buying up of available stock. 

“[These monopolies] have led us to the situation that we’re in,” said Torreele, noting that the public ends up on the ‘losing end’ of this situation. 

“We’re confronted with this highly unequal and inequitable situation”, she added.

As a way forward, Torreele cited the recommendations contained in the recent report of The Independent Panel to transform the Access to COVID-19 Tools Accelerator (ACT-Accelerator) into a truly global end-to-end platform for development and rollout of vaccines, diagnostics, therapeutics, and essential supplies. 

“We need to make sure all our efforts result in equitable access.” 

Image Credits: Nature Biotechnology, OECD, Open Source/Flickr.