Disha Shetty, an Indian climate and health journalist, will be reporting for Health Policy Watch from the Glasgow Climate Conference (COP 26).  She provides a birds-eye view on the conference here:

Climate and health activists fear that the bold action needed at the crucial United Nations climate conference, COP26, which began on Sunday, is unlikely to materialise because rich countries are delaying commitments to cut carbon emissions quickly.

Although the world is already witnessing rising extreme weather events, if high-income countries such as the United States fail to make bold moves on key issues like shifting from fossil fuels to cleaner energy, middle-and low-income countries cannot be expected to take dramatic actions themselves, observers in Asia and elsewhere fear.  

For this year’s COP26 to be successful, there are several issues that have to be addressed – and these are inextricably intertwined with commitments that low- and middle-income countries need to receive:

  • All countries will have to increase their voluntary nationally determined contributions (NDCs) under the Paris Agreement to rein in global temperature rise to no more than 1.5℃. 
  • Developed countries also have to commit to finances to fund adaptation in developing countries reeling under the impacts of climate change, and the Paris rulebook on implementation of the Paris Agreement will have to be finalised. 
  • There is also a growing call from developing countries for developed countries to acknowledge and compensate for the loss and damage that they are enduring due to the historically high carbon emissions of a handful of countries. 

In the run-up to COP26, the delivery of the highly anticipated $100 billion climate finance has once again been delayed. The COP26 presidency said on Monday that “it will not be known until 2022 whether the $100 billion goal has been met in 2020,” adding that the pledges expected from the developed countries were not yet ready to be included. 

Many poor countries for long have described climate talks by the rich ones as bullying or a con as the finance that eventually materialises is given as loans and debts. This is particularly worrisome for LMICs that will depend on such finance to meet their NDC commitments – and it will inevitably curb their ambition to set stakes even higher.

“This finance is not charity. This finance is to make sure that the polluters pay the cost, so that it may ensure that the emerging countries can actually do things differently,” said Sunita Narain of the Centre for Science and Environment.

World on the path to 2.7℃ temperature rise

The current updated NDCs too fall short and will mean global temperatures will rise by 2.7℃ by the turn of this century, as HPW reported on October 25. 

In light of the lack of progress, COP26 President Alok Sharma has already begun to talk about future COPs, saying at a Tuesday press conference that if the commitments this year aren’t enough to keep temperature well below 2℃, then in the next few years, “we may need to come back and reappraise the commitments that have been made”.

Around 148 countries have submitted new or updated NDCs according to Climate Tracker. Of these, 85 countries have promised to reduce their carbon emissions, including developing countries like South Africa, Kenya, Pakistan and Argentina.

Pakistan has promised to reduce its carbon emissions by 50% by 2030, a move that was welcomed by COP26. Countries in the middle east like Jordan and Kuwait, Uganda in Africa, and Japan in Asia have also improved their NDCs. China also updated its NDC on 28 October but its targets are being seen as falling short of what is needed at this point.

At last count, there were still 28 countries, including major annual carbon emitter India and other smaller countries like Ecuador, as well as conflict-ridden Afghanistan and Congo, that are yet to submit their updated NDCs. The hope is that ambitious targets would help keep the global temperature rise around 2℃ and keep the 1.5℃ in sight in the coming years.

Many countries’ longer-term commitments are more robust. Major global oil producer Saudi Arabia has announced the plan to turn net-zero by 2060 as has China, while Australia aims to become carbon neutral by 2050.  

But the problem is that the timeline of many countries postpone emission reductions until a time that is too late to avoid the world lurching well above 2.7℃ by 2100 and is being seen as mere shifting of goalposts to avoid drastic action now. 

India, currently the world’s fourth-highest annual carbon emitter after China, US and the European Union, has made it clear that it wants compensation for the damage caused by rich nations since pre-industrial times, focussing on the need for equity and historical context. 

Although India hasn’t yet submitted an NDC, it is likely to submit it before 31 October and is expected to announce a 450GW renewable energy target, up from its current installed capacity of 100GW. Sharma has already gone on record to say he hopes to see this reflected in India’s updated NDC and that it would be a welcome step. 

Rich countries are struggling to end coal dependance

With the COVID-19 vaccine roll-out leaving out many poor nations, the trust between developed and developing countries is at an all-time low. A major bone of contention in the talks is that rich countries like the US are asking poor ones to reduce their dependence on coal are themselves not sure how they will move away from fossil fuels.

US President Joe Biden has been struggling to get domestic support for his ambitious climate agenda at home, with just one senator from West Virginia committed to striking out a key clause of energy legislation that would penalize those that do not switch to renewable energy. 

UN Secretary-General António Guterres told a recent COP26 media briefing that he was “extremely worried but still hopeful”. 

Guterres will address leaders of the G20 countries – a group of the world’s largest economies – during their meeting on Saturday and is expected to ask them to be more ambitious in their targets. Guterres stressed the need for developed countries to phase out coal by 2030 and developing countries by 2040. 

This does not seem practical to experts who point out that even a rich country like Germany with resources at its disposal is looking at a coal phase-out by 2035. 

Meanwhile Sharma counted commitments from countries to end financing of new coal plants as a step forward.

Danger of moving to renewables too quickly

While climate talks paint renewables as a magic cure, countries that rely on renewables are beginning to see the social fallouts of moving too quickly. Electricity from renewable sources like wind and solar fluctuate seasonally and are thus perceived as unreliable as well as expensive by policymakers.

There is also pushback from leaders from Africa on the social costs of renewables. Developing countries transitioning to renewables quickly have little or no understanding of the social impacts of big new hydroelectric, wind power or solar farms on land rights, waterways and fisheries, upon which indigenous communities often depend the most. 

Climate change is already causing an energy crisis in key BRICS countries, disrupting supply chains, hitting both renewable and non-renewable sources. 

India was recently staring at a coal shortage caused in part due to excess rainfall hindering coal movement. Worsening drought in Brazil has hit water levels in hydropower generating dams and in turn the electricity supply. 

Experts say this indicates that future energy needs need to be met from diverse sources as no one source can provide energy security – a nuance that COP26 negotiations pushing for renewables have to be mindful of.

Poorer regions disproportionately affected

While poor nations are now being asked to contribute proportionately just as much as the rich to reach carbon neutrality, they also stand to lose the most from the world’s failure to clamp down on emissions so far. 

The global temperature is already 1.2℃ higher than the pre-industrial times and in 2020 this translated to around 51.6 million people being directly impacted by climate change-related extreme weather events, according to the latest report of Lancet Countdown on health and climate change.

A warmer climate would mean more infectious diseases and 79% losses in labour capacity due to heat waves for those involved in the agricultural sector in low-income countries. The COVID recovery has led to a surge in fossil fuel use instead of decline, making this an additional challenge, as HPW reported on October 21.
This impact on public health and communities that is being felt disproportionately more in the developing world has led to a rise in calls for compensation towards loss and damage due to climate change. 

Climate finance and a push for loss and damage

Ahead of COP26 a lot of the conversation has been around the need for rich countries to deliver $100 billion in climate finance. This figure already reflects a broken promise as the original commitment was to raise $100 billion annually. It has been over a decade since the commitment was first made in Copenhagen in 2009 and then reiterated in Paris in 2015. 

“Twelve years ago, in Copenhagen, developed nations made a promise to channel $100B per year to countries that are developing and vulnerable to climate change impacts,” said Chirag Gajjar who heads subnational climate action in climate programme at WRI India. “In Glasgow, rich nations must provide an implementation plan to deliver on this promise, translating to $500B between 2020 to 2024,” he said.

In an open letter to COP26, Climate Action Network International, a network of over 1,500 civil society organizations wrote, “The projected economic cost of loss and damage by 2030 is estimated to be between $290-580 billion in developing countries alone.”

China, currently the world’s largest annual carbon emitter, is aiming for net-zero by 2060 and the US, which is the world’s largest historical carbon emitter, is aiming to turn net-zero by 2050. 

But if the worst-case scenario of climate change is to be avoided then countries will have to commit to near-term changes instead of long-term ones on a timeline of decades.


Narain said that, according to the IPCC reports, all countries of the world have to turn net-zero by 2050 to limit global temperature rise to 1.5℃. This requires developed countries to turn net-zero earlier so the developing countries have time to transition. 

“If the US is 2050 and China is 2060 then India has to be 2070,” said Narain, who called net-zero “a scam”.

“Let’s get a perspective on this that we all understand the reality and don’t let some new fancy words divert us from the mission of saying: cut now, transform now!”

Disha Shetty is an independent science journalist based in India. She will be reporting from COP26 as a part of the 2021 Climate Change Media Partnership, a journalism fellowship organized by Internews’ Earth Journalism Network and the Stanley Center for Peace and Security. Follow her on Twitter @dishashetty20

–Updated 1 November 2021

Dr Tedros Adhanom Ghebreyesus.

The incumbent Director-General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, is the sole nominee for his position, which will be decided upon at the 75th World Health Assembly in May 2022. 

With the backing of 28 member states, Tedros is likely to be re-appointed unopposed as the deadline to submit nominations was 23 September. 

Tedros, who was the first African to become the chief of the WHO., was nominated by Germany after his home country,  Ethiopia, rejected nominating him for a second term, according to Reuters report. 

A former health and foreign minister of Ethiopia, Tedros has been accused by the Ethiopian Army Chief of supporting rebels in the conflict zone of Tigray in northern Ethiopia. Tedros is from Tigray. This tension is likely to have been the reason why only three African countries backed his re-appointment.  

Since his election in 2017, Tedros has risen to more prominence in 2020 for his response and communication on the Covid-19 Pandemic. As a Director General, he is the chief technical and administrative officer. If re-elected, it will be his last term as the WHO chief since an incumbent Director-General can be re-appointed only once. Each term is for five years and the next term will begin in August 2022. 

Even though Germany called for support for Tedros’s nomination last month, the US, China, and the UK have not endorsed him, as per documents on the WHO website. 

Relations between the US and Tedros soured during former US President Donald Trump’s term, while China’s cold shoulder to Tedros may be traced to July 2020 when he asked China to provide more raw data on the origins of the COVID-19 pandemic and had asked them to be more “transparent and open and to cooperate”. 

“After witnessing up close the world’s response to the pandemic, I have a unique understanding of the dynamics that have brought us to where we are, and a deep commitment to making the global system fit for purpose, with WHO at its centre,” Tedros said in his written statement to the WHO in response to his nomination for re-appointment. 

Simply by promoting cycling, government officials could address a range of problems including non-communicable diseases (NCDs), car crashes, stress and air pollution.

But officials in different sectors seldom factor health into planning transport and urbanisation, said public health experts at a discussion on public health systems hosted this week by Vital Strategies.

“The future of public health demands that we stop looking for single-issue solutions,” said Jordan’s Princess Dina Mired, Vital’s special envoy for NCDs.

“The future of public health also demands that our health ministries be transformed from ministries of diseases to ministries of health. And this can only happen if we think more broadly about the connections that actually make a healthy society,” she added.

“We are asking you to consider how transportation, energy, finance, development and education can be the building blocks to making deep and lasting changes that protect everyone everywhere.”

This “intersectional” approach would see a range of government departments working together on “co-wins”, said speakers.

“What we’re looking for is a policy or a set of interventions that will yield multiple benefits,” said Dr Nandita Murukutla, Vital’s vice-president for global policy and research.

Taxing ultra-processed food

For her, regulating ultra-processed food offers such an opportunity because such foods are linked to NCDs and obesity. They also have a detrimental effect on the environment, as key ingredients such as corn cause biodiversity loss, transporting the goods cause greenhouse gas emissions and their packaging causes wastage.

“A win-win solution would be a reduction in the consumption of ultra-processed products through solutions such as taxes, which would make these products out of the reach of ordinary people, and provide ministries and governments with a source of revenue,” said Murukutla.

The “low-hanging fruit” to address health and get income for post-COVID economic recovery is to raise taxes on tobacco, alcohol and sugary drinks, major risk factors for NCDs, to discourage people from consuming them, said Jeremias Paul, who heads the World Health Organization (WHO) fiscal policies for health unit.

Paul also proposed removing government subsidies on corn, which is a major component of ultra-processed food, and giving small farmers producing healthy food subsidies instead.

Cities that provide the space to enable people to use their bicycles safely was a win-win for Claudia Adriazola-Steil, Director of Health and Road Safety at the WRI Ross Center For Sustainable Cities.

“If we can get people to cycle to work safely, this will bring down traffic crashes. Then we will see the levels of physical activity increasing and this means that we will have less chronic diseases – less heart disease, diabetes, obesity,” said Adriazola-Steil.

She added that while there was a clamour for electric cars, these were not going to be introduced fast enough to keep the world from warming up over 1.5 degrees Celsius.

Referring to research done by Oxford University’s Christian Brand, who found emissions from cycling 30 times lower per trip than driving a fossil fuel car, and about ten times lower than driving an electric one, she appealed to people to switch to bicycles and hybrid e-bikes.

“So if you personally want to make a contribution to climate change, you can chip but of course, we’re not going to ask people to take a bike when it’s unsafe. And we really need to make that cheap,” said Adriazola-Steil, who commended the Heart Association for providing funding to encourage cycling.

Factoring health into climate change

“I think a lot about the public health co-benefits of climate change. And of course, the starting point is the public health consequences of climate change, which are enormous,” said Dan Kass, Vital’s vice-president of environmental health.

Public health has not been considered when governments have made decisions about electrification and industrialisation, such as fuel subsidies for the fossil fuel industry, said Kass.

While converting to renewable energy will cost money, Kass said that the potential savings “in terms of lives, saved, hospitalisations averted, children who thrive from avoidance of stunting or low birth weight”  -– even if only applied to the air pollution aspect of climate emissions – would more than pay for the cost of the interventions necessary to green the economy.

With the international climate change conference, COP26, beginning over the weekend, Kass says an agreement on reducing carbon emissions would be a win for health.

“Countries have still yet to ratify what’s called Article Six, which is a pricing scheme for carbon,” says Kass. 

“Economists globally have near consensus that the most equitable, least regressive way to reduce consumption and emissions is to properly price carbon, and factor in all of the social consequences of business as usual and climate scenarios,” said Kass.

The pricing would be distributed throughout the economic system, paid for by producers as well as consumers – and the effect would be to “incentivize investment in alternate technologies”.

“We need to act like the earth is burning, because it is,” said Kass.

But he warned that there isn’t yet a level of popular support for the urgency necessary to address climate change.

“We need to make the benefits known to people in the near term,” said Kass. “Your air quality is going to be better, your water quality is going to be better, you’re going to have greater access to energy. Those things will drive public support for the hard decisions that have to be made.”

Image Credits: Heybike/ Unsplash.

Only five African countries are likely to reach a WHO global goal of vaccinating 40% of their populations by the end of the year, and the continent’s roll-outs may be slowed further by a global shortage of the syringes need to administer vaccines.

UNICEF has reported an imminent shortfall of up to 2.2 billion syringes for COVID-19 vaccination and routine immunization in the coming year, according to the World Health Organization’s (WHO) Africa region.

This includes special 0.3ml syringes needed for the Pfizer-BioNTech COVID-19 doses, for which there is no global stockpile.  

“Early next year COVID-19 vaccines will start pouring into Africa, but a scarcity of syringes could paralyse progress,” WHO Africa Director Dr Matshidiso Moeti told a press briefing on Thursday.

“Drastic measures must be taken to boost syringe production, fast. Countless African lives depend on it.” 

COVAX is trying to secure deals with syringe manufacturers, and through better planning to avoid deliveries outpacing the supply of syringes, the WHO reported.

Only 6% of Africans – 77 million people – are fully vaccinated, while over 70% of high-income countries have already vaccinated more than 40% of their people.

Three African countries – Seychelles, Mauritius and Morocco – have already vaccinated over 40% of their people, while only Tunisia and Cabo Verde are on track to reach this global WHO target by year-end. 

While COVAX has delivered around 50 million vaccines to Africa, the continent still faces a 275 million dose shortfall in order to vaccinate 40% of all Africans.

Wave after wave

Dr John Nkengasong, Director of the Africa Centers for Disease Control and Prevention (CDC), told an earlier media briefing that 82% of the continent had experienced a third wave of COVID, while seven countries had already had a fourth wave.

“We are going to go from wave to wave unless we address the question of vaccinations,” said Nkengasong.

While cases in most of Africa are going down, cases are rising in countries in the Central African countries of Gabon, Congo, Cameroon, as well as Egypt. 

COVID deaths in Nigeria increased by 66% and by 36% in Egypt, added Nkengasong.

Meanwhile, the WHO urged countries to improve their vaccine roll-out readiness. Some 42% of countries have not yet completed district-level plans for their campaigns, while nearly 40% have not yet undertaken “intra-action reviews” which are key to refining and improving their vaccination campaigns,” according to the WHO

The WHO is conducting emergency support missions to five African countries to help support, speed up and improve their COVID-19 vaccine rollouts, with plans for missions to another 10 countries this year.

Image Credits: Wuestenigel/Flickr.

Merck laboratory that developed the new oral COVID treatment, molnupiravir

A potentially game-changing antiviral treatment for COVID-19 that can be administered orally early on, and potentially head off much more serious cases, is set to be licensed for generic production in most low- and middle-income countries (LMICs), in an unprecedented breakthrough in access to a new COVID treatment.  

The historic deal, reached between the pharma company Merck Sharp & Dohme (Merck) and the Medicines Patent Pool paves the way for MPP to sign contracts with generic drug manufacturers to produce and sell the treatment, molnupiravir  at discounted prices to more than105 countries worldwide, once the drug has been approved by the US Food and Drug Administration and the World Health Organization. 

The agreement is the first time in the pandemic that a major pharma company has agreed to such an open-ended license for generic production of a newly developed drug. The drug,  currently awaiting US FDA emergency review, reduced risks of hospitalization or death by about 50% among patients with mild or moderate COVID, according to the company reports of the results of its Phase III trial.  

The deal also represents a major coup for the Geneva-based MPP, a non-profit organization with a long track record of negotiating with big pharma innovators for broader generic production of costly new drugs for treating hepatitis, HIV, and other diseases. 

Until now, however, MPP had not been able to enter fully into the COVID medicines access fray – with pharma producers reluctant to negotiate with the non-profit over broad-based licenses for the generic production of COVID vaccines and drugs.  Other new COVID drug treatments, such as the newly-approved monoclonal antibody cocktail REGEN-COV, remain expensive and hard to access in most LMICs. They are also more difficult to use  – as they need to be administered intravenously.

Charles Gore, MPP Executive Director, said of the breakthrough, “This transparent, public health-driven agreement is MPP’s first voluntary licence for a COVID-19 medical technology, and we hope that MSD’s agreement with MPP will be a strong encouragement to others.”

The MPP is all the more meaningful as the new drug will be the first major COVID medication that can be administered orally to non-hospitalized patients, said WHO in a statement.

‘Best agreement any company has made’    

The announcement was roundly hailed by WHO and other UN-affiliated agencies managing the UN-supported ACT-Accelerator initiative to broaden access to vaccines and drugs.  A number of medicines access advocates who have bitterly criticized pharma for failing to issue more voluntary license deals for for other cutting edge vaccines and treatments, issued particularly warm statements about the Merck deal. 

Said Jamie Love, of Knowledge Ecology International, “The license between the MPP and Merck for the manufacture and sale of molnupiravir is the best agreement any company has made for licensing its intellectual property during the COVID-19 pandemic.

“The 69-page license agreement is fully transparent, unlike the agreements with CEPI, COVAX, Operation Warp Speed, the Gates Foundation, the Wellcome Trust, other companies or most governments,” added Love referring to the other international and UN-supported initiatives on COVID drug and vaccine access.

“The license makes it possible for any generic manufacture located anywhere the world to supply molnupiravir in the licensed territory, and provides a pathway for supplying to countries outside the licensed territory, when patents are not in place or subject to compulsory licenses.

“The licensed area is large enough (more than half the world’s population) to induce efficient generic entry and economies of scale,” he added – while noting that the 18% population coverage in LAC is weakest – although a separate Merck deal with Brazil is reportedly underway. 

Concluded Love: “Given the objectives of scaling up production of molnupiravir at the lowest prices for the lowest income countries, the agreement is an impressive achievement for the Medicines Patent Pool and Merck deserves credit for being the first company to make a deal with the Medicines Patent Pool.”

MSF calls out shortcomings of contract 

Even so, some civil society stakeholders, and notably Médecins Sans Frontières (MSF) said that the licensing arrangement “does not go far enough” expressing “disappointment with the limitations of this license, as its territory excludes nearly half of the world population and important upper-middle-income countries (UMICs) with robust manufacturing capacity, such as in Brazil and China.” 

Yuanqiong Hu, Senior Legal and Policy Advisor, MSF Access Campaign added that: “After more than a year of secrecy of companies’ bilateral deals in a pandemic, it is a welcomed step forward to have the first fully published voluntary license from MPP covering COVID19 medical tool. 

“However, a closer look reveals its limitations for increasing access to one of the first promising antiviral drugs for COVID-19. It’s disappointing…. Middle-income countries excluded from the license had 30 million COVID-19 infections in the first half of 2021, 50% of all infections in low- and middle-income countries.

Medicines, Law and Policy, while generally positive, also called out a clause that would allow MPP terminate a sublicence agreement with a manufacturer of the new drug, in the case of a patent challenge – a clause reportedly included at the request of the drugs initial developers at DRIVE, a subsidiary of Emory University and Ridgeback Pharmaceuticals.

Emory University has in fact waved royalties on the sale of the drug in low- and middle-income countries for as long as the WHO-declared international public health emergency continues.

However the termination of sublicence clause also has provoked protests by students, who say that it could restrict or undermine the flexibility of the generic licensing agreement.

Merith Basey, Executive Director for Universities Allied for Essential Medicines, a student-led movement that aims to change universities’ licensing practices told us: “Emory University has betrayed its mission to serve humanity by stifling global access to a potentially life-saving COVID treatment. Molnupiravir was developed on Emory’s campus with massive amounts of tax-payer funding, yet this license includes a stipulation demanding a no-patent challenge. We call on the institution to remove the clause and favor people over profit in the midst of a global pandemic that has killed over 5 million people so far.”

Image Credits: Merck , Merck .

October is Liver Cancer Awareness month, and Europe has a liver cancer problem. Over the past two decades, there has been a 70% increase in liver cancer-related mortality in the region. 

In 2020, 87,000 Europeans were diagnosed with liver cancer while 78,000 died from the disease in the same year.

Late diagnosis is a serious problem. About half of patients are only diagnosed in an advanced stage of cancer and have less than a year to live.

Liver cancer is the sixth most common cancer and the third biggest cause of cancer-related deaths globally. 

In the US, the rate of deaths from liver cancer increased by 40% from 1990 to 2004 while the overall rate of non-liver cancer deaths declined by 18%.

Projections for the US estimate that in 2030, liver cancer will be the third-leading cause of cancer-related deaths, surpassing breast, colorectal, and prostate cancers.

There are many risk factors for developing liver cancer, and chronic liver diseases caused by viral hepatitis, alcohol, or fatty liver disease are the most important.

Diabetes and obesity 

Non-alcohol fatty liver disease (NAFLD), which is often a consequence of obesity and diabetes, is the leading cause of death among 35 to 49-year-olds in the UK, making NAFLD a health threat that should not be underestimated. (The more severe form of NAFLD is called nonalcoholic steatohepatitis, or NASH).

Outside of COVID-19, NAFLD is also about the fastest growing disease globally. It occurs in about one in four people around the world and has emerged as the most prominent cause of chronic liver disease. 

Experts predict that, over the next decade, NAFLD will become the leading cause of end-stage liver disease and liver transplantation. It is already the fastest-growing cause of hepatocellular carcinoma (HCC), the most common form of liver cancer worldwide.

Faced with a ticking public health time bomb in Europe, we are clearly in a race against time to both prevent and treat this disease before the epidemic worsens and overwhelms health systems.

Better treatment access

Treatment of chronic liver diseases to avoid their progression to precancerous states like cirrhosis significantly reduces the risk of liver cancer, and this has been convincingly demonstrated. 

Improved and equal access to state-of-the-art management of these diseases is a core element in the fight against liver cancer.

Although liver cancer remains one of the few cancers with increasing incidence and mortality, public awareness of liver cancer is much lower than for other cancers. 

As a consequence, patients who have liver cancer and patients who are at increased risk for liver cancer often face stigma in their social lives, and also in the medical settings.

Treatment options for liver cancer have significantly improved over the recent years, which makes early diagnosis the most critical point. Case-finding strategies need to be implemented, at least in at-risk patients, as strongly recommended by clinical guidelines.

Hepatitis B vaccinations

Finally, we must directly tackle the key environmental factors that cause liver diseases and liver cancer. In addition, successful Hepatitis B vaccination programmes need to be continued and expanded as the core element of primary liver cancer prevention as it has the potential to prevent roughly twice as many cancer cases as HPV vaccination.

Earlier this year the European Commission launched its Beating Cancer Plan in response to the fact that the EU region is home to a quarter of the world’s cancer cases and is facing an annual economic impact of €100 billion if urgent action is not taken. 

This plan is precisely what is needed to bring scientific societies, experts and patient groups together to move forward measures that can go a long way towards stopping liver cancer in its tracks.

But these measures need to be coordinated across the region, led by the European Commission, and implemented by EU Member States.

A starting point has to be the setting of standards for awareness, prevention, and management of liver cancer across the region. It is pivotal that we educate and raise awareness amongst everyone: healthcare professionals, patients and families, risk groups, policymakers and the general public.

Liver cancer usually occurs as a consequence of underlying chronic liver disease and cirrhosis. Thus, the EU and Member States should implement preventive measures that include evidence-based strategies to reduce the burden of liver disease, focusing on reducing alcohol consumption and obesity, and on early detection and treatment of chronic liver disease.

Early detection is critical for those patients with liver diseases associated with a high risk of liver cancer such viral hepatis B and C, alcohol-related and non-alcoholic fatty liver disease. The EU and Member States should add liver cancer to their screening list, at least for patients with underlying risk factors. In addition, existing programs providing the opportunity of early case finding of liver diseases should be leveraged where possible. The salivary screening for Hepatitis C using point of care testing is a good example and complements the WHO HCV program aiming at fighting HCC as well.

Inter-disciplinary disease management

But we also need improved access to better disease management for patients with liver cancer across all member states of the EU. This means a more structured pathway for the diagnosis and treatment of patients when they are receiving care in hospital, as an outpatient and then at home. 

That will require better inter-disciplinary cooperation between hepatology, oncology and other relevant disciplines and ideally collaborative clinical guidelines that are driven by comprehensive scientific evidence.

Basic research continues to be a critical element for improving patient outcomes in liver cancer. There is still further knowledge needed about aetiology, rare liver cancer entities, markers and diagnostics which might facilitate early detection even in primary care. 

The EU and Member States should support such research projects and cross-country collaboration by setting up EU-wide platforms with the aim of sharing data and closing the gap between medical knowledge and clinical practice.

The high standard of care in the EU is based on high-level science and research. In order to maintain these standards furthermore and drive improvements, it is essential to collect data collaboratively across all member states. The EU and Member States should support the setting up of specific patient registries for liver cancer. 

The collation of this data would facilitate surveillance, research and the overall management of patients with liver cancer.

Care must be patient-centric. People living with liver cancer and their families should have unrestricted access to information, medical treatment, and measures to improve their quality of life, regardless of their life situation and ethnic origin. All patients with liver cancer should benefit from the same high standards of care wherever they are in Europe.

Thomas Berg is the Secretary-General of the European Association for the Study of the Liver (EASL) and Head of the Division of Hepatology at Leipzig University Medical Center in Germany.

 Maria Buti is the EASL EU Policy Councillor and Professor of Medicine and Chief of Internal Medicine and Hepatology at the Hospital General Universitari Valle Hebron in Barcelona, Spain.

 

 

Strive Masiyiwa, head of the African Vaccine Acquisition Trust (AVAT)

The US government has enabled Africa to get access to 50 million Moderna COVID-19 vaccines by giving the continent its place in the vaccine queue, Strive Masiyiwa, head of the African Vaccine Acquisition Trust (AVAT) said on Tuesday.

“This is a time swap arrangement whereby the United States government basically stood aside for the next quarter so that we could access vaccines and purchase them ourselves,” Masiyiwa told a media briefing of the Africa Centers for Disease Control (CDC).

AVAT will get 15 million Moderna doses in December and a further 35 million between January and March. It also has an option to buy 60 million more, delivered at 20 million doses per month, between April and June.

“These doses are being purchased by AVAT courtesy of the United States government, which has been phenomenal in its support,” he added.

South Africa’s President Cyril Ramaphosa and Kenya’s President Uhuru Kenyatta negotiated the deal directed with US President Joe Biden, said Masiyiwa.

Other than a deal with Johnson and Johnson (J&J) for 400 million vaccines over 13 months from August, “none of the vaccine suppliers had any doses for us this year,” said Masiyiwa.

 

The Africa Union has been able to get the J&J vaccines largely because they are being assembled by Aspen in South Africa – but even ensuring that these doses remained on the continent required reaching an agreement with the European Union, which initially planned to import the African-assembled vaccines.

Jessye Lapenn, the US Ambassador to the African Union, praised AVAT’s leadership and expressed her country’s support for the continent’s vaccination efforts.

The White House confirmed that it would defer the delivery of about 33 million Moderna vaccines to enable the African Union to buy the doses.

Masiyiwa said the African Union’s long-term vision was for Moderna to reach a  fit-and-fill agreement with an African manufacturer.

The company recently announced that it wants to build a $500 million mRNA vaccine manufacturing facility in Africa.

“We recognize that access to COVID-19 vaccines continues to be a challenge in many parts of the world and we remain committed to helping to protect as many people as possible around the globe, said Moderna CEO Stéphane Bancel.

Moderna said that it was “working on plans to allow it to fill doses of its COVID-19 vaccine in Africa as early as 2023, in parallel to building an mRNA vaccine manufacturing facility in Africa”. 

Moderna, which received millions of dollars in R&D support from the US government, has been under pressure from the Biden administration to supply low and middle income countries with vaccines.

AVAT is currently supplying 39 African countries and 15 Caribbean countries, but only 8,7% of Africans have had at least one vaccine dose.

Meanwhile, COVAX revealed on Monday that less than 10% of vaccine donations pledged to it by wealthy countries had been delivered.

Of the 1.3 billion COVID-19 vaccine dose donations promised to COVAX by wealthy countries, only 150 million doses have actually arrived – around 9% – Gavi CEO Dr Seth Berkley told the World Health Summit.

Joining the Africa CDC press briefing on Tuesday, Berkley said that COVAX had supplied 40% of Africa’s vaccine doses but the facility had experienced a major slowdown after India banned the export of AstraZeneca vaccines made it its country although COVAX had already paid for the vaccines.

A session of the 2020 World Health Assembly.

Some civil society organisations (CSO) are sceptical about whether a ‘pandemic treaty’ is the best way to address future global health crises, while treaty supporters say it will provide a legal framework binding countries and global health bodies to more agile and rapid responses to future outbreaks. 

A session Monday sponsored by the Geneva Global Health Hub (G2H2) brought leading CSOs, diplomats, academics and even WHO’s chief legal counsel face to face to air those views, in the context of a research initiative on the treaty being undertaken by the hub. 

The debate comes just weeks ahead of a planned special session of the World Health Assembly which is to determine whether the global body will indeed move forward on a Treaty, as a key measure for improving pandemic response. 

The treaty initiative has been supported most visibly by European countries, led by European Commission President, Charles Michel, who in a separate session at the World Health Summit in Berlin that the treaty would guarantee “access to information, financing, vaccines and countermeasures. It would increase capacity and resilience – at all levels.” 

Diversion or game changer?

25 heads of government and international agencies have come together in support of the new pandemic treaty

Some of the civil society organisations that have expressed disquiet about the treaty proposal perceive it as a potential distraction or diversion by wealthy countries from the so-called TRIPS waiver proposal, currently under consideration by thee World Trade Organization. The proposal by South Africa and India for a broad-based intellectual property waiver on COVID vaccines and treatments, now being debated by the WTO’s TRIPS Council , is perceived by civil society as a game changer that would help open the doors to despearately needed COVID vaccine and medicines manufacturing in Africa and the global South. 

Many of the European countries that have been among the most staunch opponents of the TRIPS waiver are also key pandemic treaty supporters, noted journalist Priti Patnaik, who is researching stakeholders’ views on the pandemic treaty for G2H2 -giving rise to the CSO suspicions.

And yet at the same time, some developing countries have supported a pandemic treaty because they believe it would “rein in the influence of non-state actors, including powerful foundations, and get some binding obligations to apply to industry to avoid vaccine inequities in the future,” she added. 

‘Switch-and-bait’ tactic

Unni Karunakara, senior fellow at Yale’s Global Health Justice Partnership, said that the major focus should be on deploying available tools and medicines to every corner of the world, rather than negotiations over a new treaty: “Shouldn’t global vaccination coverage be an overwhelming priority now?” he asked.

“We do have frameworks and tools. They’re not perfect, but there are enough tools for us to overcome this crisis together,” said Karunakara, a former president of Medecins sans Frontieres.

“What is lacking, however, is the political will to share essential resources and tools, even with all of the treaties in place.”

His comments reflecting the cynicism of other civil society activists who see “a big overlap between the countries that are blocking the TRIPS waiver, and the countries that are supporting the pandemic treaty.

“So there’s a perception of a ‘switch-and-bait’ tactic that reeks of bad faith,” he added.

And while transparency measures – such as the mandatory sharing of genetic materials by countries where outbreaks are suspected – have been discussed as key treaty features, similar mandates for transparency or sharing of vaccines and medicines technologies have been fiercely opposed by the EU, he pointed out.

“TRIPS waiver-blocking countries have made the case for voluntary actions by pharma to ensure access to essential COVID-19 medical tools, so they treat Big Pharma with kid gloves,” Karunakara observered.

“Interestingly, they take a very different tone and approach to the global south in the treaty, insisting on enforceability in the sharing of information and materials with WHO and other governments to allow for independent verification.” 

“The assumption here is that global south is the problem, that diseases originated in poor country, and pose national security risks to rich countries.”

If you are against the treaty – what is your multilateral alternative?

Björn Kümmel, at the WHO Executive Board’s January 2021 meeting.

Björn Kümmel, deputy head of the global health unit in the German Federal Ministry of Health, disputed that there is any direct political link between the treaty and the TRIPS waiver – or the kinds of hidden agendas that civil society groups fear.

“I doubt that it’s, from a logical point of view, right to say that even though a country has it stands on the TRIPS waiver, you can’t tackle other equity issues,” he told the G2H2 session.

“That’s one angle to look at, the TRIPS waiver, but there are many more angles to be looked at. So to say that that is the only magic bullet, I think that would be fully wrong, I wouldn’t limit it to this.

“I think that equity goes far beyond, and certainly, if a treaty was negotiated, it’s quite clear that this [TRIPS waive] will be put on the table, and that all governments will have to look at the different interests that are on the table and negotiate them with an open outcome.”

He noted that the treaty was first proposed formally by Chile, not the European Commission, and has the support of a wide array of countries, including South Africa, Kenya, and Tunisia, as well as Thailand and Indonesia.  

Anything better than ‘Chaos’ we see now

Describing the current global health situation as “dysfunctional”, Kümmel asked the G2H2 session: “If you are against the treaty, tell us what is your multilateral alternative to it, to be realistically implemented, lets say in the next five years?”  

“What the countries who are proposing a treaty are trying to say is:  anything is better, than compared to the chaos that we’re seeing currently.

“Legal clarity is needed, and it will be …a painful exercise for many of us, and most likely a difficult one for many governments, including mine, most likely also others. But in the end, it’s this is multilateralism.”

Uniquely in the global health landscape – and unlike environment, trade or finance – there is a dearth of global treaty instruments. In fact, among the dozens of international treaties in force today, the only two binding instruments in global health today are the IHR and and the Framework Convention on Tobacco Control (FCTC), he pointed out.

Pandemic is a ‘window of opportunity’ for bigger changes

In light of the outstanding questions, however, the working group of countries that are preparing for the WHA special session had devised a “three-step approach” to their deliberations on a way forward.

They are considering in parallel: WHO internal reform measures; revisions in the existing International Health Regulations that currently govern global emergency response; and finally, the Pandemic Treaty alternative. 

In terms of WHO reform,  the conclusion has been that such measures would “not be sufficient in order to overcome the next pandemic,” Kümmel said. 

Amendments to the International Health Regulations (IHR) also would take time to negotiate.  And a key question here is: “would they be a game changer for the next pandemic to come? Certainly not,” he added, noting that there is “no compliance mechanism that currently is foreseen in the IHR.”

So against the other options, “an international binding agreement is interesting,” he said. “And why are many colleagues pushing for this to happen now? Well, it’s the reality that after Ebola and past pandemics the global community was unable to implement the lessons learned,” he said.

And if negotiations don’t begin now, in the heat of the ongoing crisis, they will never happen at all.

“Many of the international independent panels have called for bold recommendations to be implemented,” Kümmel reminded the group. “One of them is the treaty. But many of those recommendations have never reached successful implementation, because the window of opportunity for real structural changes normally vanishes with the next crisis to come after the pandemic.”

The treaty would also retain WHO’s centrality as the nerve center of the global health architecture – amidst a plethora of new health initiatives emerging in Europe  and elsewhere:

“There are a multitude of ideas and recommendations, and the treaty is a legal framework into which most of the other recommendations would fit,” he said, in reference to recent proposals such as one by the Pan European Commission on Health and Sustainable Development to create a new global health board under G-20 auspices. Others have talked about a new global health finance board in association with the World Bank and/or a new UN-level Global Health Threats Council, under the auspices of the UN General Assembly.

So the Pandemic Treaty is “also a mechanism to provide WHO with legitimacy after this crisis,” he stressed. “Obviously there are voices out there who could see alternative approaches.  However, I think the ones who are in favour of this treaty have clearly articulated that WHO is the right forum because its the truly multilateral forum for global health.”

WHO precedents for equitable access to vaccines?

Germany is not the only actor that sees the treaty as a means of keeping WHO as the world’s main global health meeting place.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus has himself come out in support for the pandemic treaty measure – breaking ranks with previous agency heads who usually remained aloof of controversial measures under consideration by member states.

WHO is therefore keenly interested in how civil society groups may help lead or shape views on the treaty negotiations – and this interest was reflected in a cameo appearance at the G2H2 event by Stephen Solomon, WHO’s principal legal officer.

Solomon said it was “really helpful” to understand some of the “scepticism” around the pandemic treaty initiatives. 

“Understanding the the concern about an agenda driven issue here is very important for the [WHO]  Secretariat,” Solomon told the group.

At the same time, beyond the immediate COVID crisis, other WHO emergency response frameworks already in place also could perhaps benefit from the stronger legal backpone that a pandemic treaty might provide, he pointed out.

One example is the Pandemic Influenza Preparedness (PIP) framework, which mandates that 10% of global flu pandemic vaccine production supply goes to WHO for direct distribution, based upon public health needs. Another is WHO’s Global Action Plan for influenza vaccines.

These “are meant to address equity issues in a number of epidemics, not necessarily pandemics,” Solomon said. 

“I would be very interested in reactions to particular frameworks meant to address inequities, like the pandemic influenza preparedness (PIP) framework, not legally binding. Or like the WHO Global Action Plan (GAP) for influenza vaccines, also not legally binding. 

“But both are interesting and potentially of important reference to pandemic preparedness and response. PIP basically says 10% of global pandemic vaccine production supply goes to WHO for distribution on the declaration of an influenza pandemic for distribution based on public health needs, and we have legally binding contracts for that 10%,” said Solomon.

“Could that be a reference point for responding to future pandemics?

“If so, would it be useful to put that in more of a legal framework because of weaknesses within that structure –  particularly the idea of countries not allowing export for vaccines already under contract?” Solomon asked.

Similarly, the Global Action Plan for influenza vaccines was a 10-year, non-binding arrangement that aimed to better distribute capacity for flu vaccine production, including among low- and middle-income member states, he pointed out, asking:

“Could that also benefit, or not, from a normatively binding architecture?”

The final research report will be launched by G2H2 on 24 November.

–Elaine Ruth Fletcher contributed to the writing of this story.

Image Credits: WHO / Antoine Tardy, EU Council, C Black, WHO.

Climate change: Scientists have long predicted climate disruption will lead to more extreme weather, such as heatwaves, droughts and floods

The latest climate commitments from 165 of the 192 countries that are signatories to the 2015 Paris Climate Agreement would still lead to a global temperature rise of 2.7°C by the end of the century, according to an updated United Nations analysis of climate commitments and their impacts.

Major emitters including China and India, remain among those 27 countries to have not yet submitted any updated commitments at all in advance of the decisive days of the Glasgow Climate Conference (COP26), which begins on Sunday.

UN Secretary-General Antonio Guterres on Monday called on China to present an “ambitious” contribution at COP 26.

Guterres also said the UN also fully supports the Chinese presidency of the COP15 Biodiversity Conference, happening in Kunming 25 April-8 May of next year. For him, “ambition on biodiversity and climate are mutually reinforcing.”

“Both in Glasgow and Kunming, we must do our part to make peace with nature and safeguard our planet for future generations”, he added.

The analysis of all “Nationally Determined Commitments” to have been received so far by the UN Framework Convention on Climate Change (UNFCCC) found that global greenhouse gas (GHG) emissions would still increase by about 16% by 2030, as compared to 2010 – even if all of the commitments were met.

“Comparison to the latest findings by the Intergovernmental Panel on Climate Change (IPCC) shows that such an increase, unless changed quickly, may lead to a temperature rise of about 2.7°C by the end of the century,” said a UNFCCC press statement.

The updated analysis was published ahead of the COP26 to ensure that countries have the latest information at hand on the impact political commitments so far would make to climate trends, UNFCCC said.

Countries far from reaching targets to keep emissions under 1.5°C warming mark

climate commitments
Nationally determined commitments (NDCs) are still not enough to prevent the rise of global temperatures by 1.5 Celsius

But it dramatically underlines how far away countries remain from meeting the goal to keep global emissions under the 1.5°C warming mark that scientists say is needed to prevent a spiral of increasingly and destabilizing changes, as well as to the ecosystems of forests, glaciers and oceans, as well as freshwater access and food production.   

“This latest report from the UNFCCC makes clear, to protect the world from the most devastating impacts of climate change, countries must take more ambitious action on emissions, and they must act now,” said Alok Sharma, COP26 President, saying that the report underlines why countries need to show ambitious climate action at COP26.

 “If countries deliver on their 2030 NDCs and net zero commitments which have been announced by mid-October, we will be heading towards average global temperature rises of just above 2°C,” he noted. 

That’s an improvement over the commitments made in 2015, which would have led to a temperature rise of just under 4 °C – “So there has been progress, but not enough,” Sharma said.

“That is why we especially need the biggest emitters, the G20 nations, to come forward with stronger commitments if we are to keep 1.5 °C in reach over this critical decade. Glasgow must launch a decade of ever-increasing ambition. At COP26 we must come together for ourselves, future generations and our planet,” he said.

GHG emissions would begin to decline around 2025 

Total emission levels by 2030 would only be about 9% below 2010 levels.

On the more positive side, the updated report also confirms that emissions reduction efforts could be more effective over time.  For the group of 143 Parties that submitted new or updated NDCs, total GHG emissions are estimated to be about 9% below the 2010 level by 2030. 

Further, within that group, some 71 Parties communicated a carbon neutrality goal around mid-century. The report finds that these Parties’ total GHG emission level could be 83–88% lower in 2050 than in 2019.

Monday’s report updates an earlier UNFCCC report, published last month, which had compiled only 86 country commitments.

Patricia Espinosa, Executive Secretary of the UNFCCC, said: “I thank and congratulate all Parties that have submitted a new or updated NDC since the publication of the full report in September. These NDCs clearly represent a commitment to acting on climate change.”  

“At the same time, the message from this update is loud and clear: Parties must urgently redouble their climate efforts if they are to prevent global temperature increases beyond the Paris Agreement’s goal of well below 2°C – ideally 1.5°C – by the end of the century.

Overshooting the temperature goals will lead to a destabilised world and endless suffering, especially among those who have contributed the least to the GHG emissions in the atmosphere. This updated report unfortunately confirms the trend already indicated in the full Synthesis Report, which is that we are nowhere near where science says we should be,” she cautioned.

The IPCC has estimated that limiting global average temperature increases to 1.5C requires a reduction of CO2 emissions of 45% in 2030 or a 25% reduction by 2030 to limit warming to 2°C. If emissions are not reduced by 2030, they will need to be substantially reduced thereafter to compensate for the slow start on the path to net zero emissions, but likely at a higher cost.

 

Image Credits: Commons Wikimedia, UNFCCC.

Panelists address the vaccine equity panel at the World Health Summit in Berlin, including Seth Berkley (top right) and Ethopian health minister Lia Tadesse (bottom left).

Of the 1.3 billion COVID-19 vaccine dose donations promised to COVAX by wealthy countries, only 150 million doses have actually arrived – around 9% – Gavi CEO Dr Seth Berkley told the World Health Summit in Berlin on Monday.

Ensuring that countries delivered their promised doses “now” was COVAX’s “core ask”, said Berkley, who added that the global vaccine facility was also pushing vaccine manufacturers for greater transparency about deliveries. 

“Our perception is that delays often occur in [COVAX], whereas manufacturers provide vaccines through their bilateral mechanisms,” he added.

Germany’s Dr Lars-Hendrik Röller, Director-General for Economic and Financial Policy in the Federal Chancellery, said that it was very important that the G7 countries delivered on their dose-sharing commitments.

The G20 countries meet in Rome over the weekend, and Röller said he was heading to the city on Tuesday to start pre-meeting negotiations on both vaccine equity and climate financing.

‘Stop-start’ vaccine delivery compounds hesitancy

Ethiopia, Africa’s second-most populous country with a population of over 115 million people, has only been able to administer 4.2 million vaccines due to vaccine shortages, Health minister told the summit.

“When you get very few doses, the demand is high but it is hard to keep the momentum,” said Tadesse, adding that the stop-start supply from COVAX has compounded vaccine hesitancy.

“We initially launched with two million doses of AstraZeneca, which we rolled out but then we could get the second dose on time,” she said, adding that it was very challenging for a country as big as Ethiopia to schedule deliveries for vaccines that arrived “every now and then”.

Ethiopia aims to vaccinate 20% of its citizens by the end of the year – only half the World Health Organization’s (WHO) global target – but even that will be difficult because of delivery challenges, said Tadesse.

Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), said that he believed COVAX was finally on the right track to deliver vaccines to all as there were “sufficient supplies”

“We will exceed 9.3 billion doses manufactured by the end of October, more than 12 billion by the end of the year and probably 24 billion next year,” said Cueni.

COVAX hopes to get one billion of these doses by the end of the year, to add to the 400 million doses it has delivered so far.

Predictability of delivery

Acknowledging Berkley’s call, Cueni agreed that manufacturers “really need to find ways and means to improve to transparency on the predictability of the deliveries”.

“Be it from COVAX contracts, or be it actually sitting down with countries willing to share doses to address all the complexities, be they logistically or be they legal, to make sure that these doses can be shipped before the shelf life expires,” said Cueni.

Other short-term priorities to get vaccines where they are needed, include optimising production, eliminating trade barriers, including on special syringes needed for the Pfizer-BioNtech vaccine, and ensuring country readiness, said Cueni.

Elhadi As Sy, Chairperson of the board of the Kofi Annan Foundation

Röller, who is also co-chair of the COVAX Vaccine Manufacturing Working Group, said that the group would table a number of proposals at the G20 meeting, based on short, medium and long-run workstreams.

Immediate priorities focused on vaccine delivery, including “swaps and more transparency in the contracts”, and less restrictive trade and custom rules in the area of trade and customs. 

“Boosters, we discussed for a long time and the working group made a pretty sensible suggestion that [they] should be based on clinical evidence,” said Röller.

“And the final one is the long run, which is the localised production,” he added. “There are several models you can think about localising production and in particular we have an mRNA hub in South Africa, which is the first one, but there’ll be others to follow,” said Röller, adding that German companies were exploring joint venture options in Senegal and Ghana.

Elhadi As Sy, Chairperson of the board of the Kofi Annan Foundation, warned of the erosion to trust caused by vaccine inequity, saying that the world was “crying out for strong leadership”.

“The data suggests that 90% of doses have gone to 10% of countries. So this says that the place where you live becomes the biggest determinant of your health status, and also determines your access to commodities, and mostly determines if you survive,” said As Sy.

“A truly global response has to be in an inclusive response. What civil organisations are feeling is that they’ve been betrayed in many ways. So many promises have been made, and so many promises have been broken without any consequences. Leaders can meet in UN General Assembly special sessions and make commitments. Very few deliver. And then so what? The consequence of that is your trust is being eroded, and there will be no inclusion, no real partnership, without trust between leaders and citizens.”