Vaccination rollout in Accra, Ghana

Mayors from three capital cities in the global south have appealed for speedy “technology transfer” to enable them to produce their own COVID-19 vaccines at Friday’s World Health Organization (WHO) bi-weekly COVID-19 media briefing.

The mayors’ appeal comes on the eve of a meeting next week between WHO Director General Dr Tedros Adhanom Ghebreyesus and World Trade Organization (WTO) Director General Dr Ngozi Okonjo-Iweala to discuss “how to overcome the barriers to boost production vaccine equity”, said Tedros.

Adjei Sowah, mayor of Accra in Ghana, said that his city had almost used up all 300,000 vaccine doses it had received recently via COVAX – yet it has a population of five million including a two-million strong transient population which could be spreading the virus to rural areas.

To achieve vaccine equity, Sowah proposed that rich countries “share their surplus doses” and the “acceleration of technology transfer” to enable manufacturing in Ghana and other countries in order to “reach herd immunity as quickly as possible”. 

‘Finish and Fit’ Possible in Bogota

Mayor Claudia Lopez from Bogota in Colombia, with a population of 11 million, said that her city would need to vaccinate six million people to achieve herd immunity – but it lacked the doses to do so.

Bogota had been able to produce vaccines until 2001 but “because we did not have the sufficient investment in research and biotechnology, we lost that capacity”, said Lopez.

She appealed to the WHO to assist her city to get investment to enable vaccine production – starting with “finish and fit”, the assembly of vaccine products once the biological component had been made elsewhere.

“We do face the real risk of a third wave and it is vital that, before May we have vaccinated, everybody over the age of 60 and all healthcare professionals. So that means that we need 2.6 million doses in the next couple of months,” said Lopez.

Mayor Yvonne Aki-Sawyerr of Freetown Sierra Leone

Mayor Yvonne Aki-Sawyerr, representing Freetown in Sierra Leone and one of the poorest countries in the world, said her city’s vaccine rollout had started with week with 296,000 doses of AstraZeneca (two doses needed per person).

At a meeting over the past week with mayors from the C40, a network of 97 of the world’s biggest capital cities’, Aki-Sawyerr said it was “really fascinating” to hear from cities such as Los Angeles “who are able to talk about a mass vaccination rollout, in contrast to some of us”.

While Freetown had only recorded 2,222 COVID-19 cases and 80 deaths ”you’d almost think that COVID had passed us by, but it hasn’t because the economic impact has been significant”, said Aki-Sawyerr of her city of slightly over a million people.

“What we face, and what other countries and cities in emerging economies that don’t have the access to the vaccine in the same way as countries who are ordering five times what they require and holding on to these, is economic exclusion and greater inequality,” said Aki-Sawyerr.

“We face a risk of being in a situation where vaccine passes are needed for travel, and that could certainly have an impact on tourism,” she said. “We are very concerned about how this will move from a disparity in a vaccine rollout to reinforcing inequalities, reinforcing economic exclusion and thereby putting everyone at risk.”

 

Independent Panel Still Seeking Views Ahead of Submission Date

 

If the world’s pandemic preparedness, alert and response system had been working properly, the COVID-19 pandemic would not have had such “catastrophic consequences”, according to Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response.

So far,  the pandemic has cost 2.6 million lives, had a substantial impact on the education of  millions of children and is projected to have cost economies $22 trillion by 2025, according to a media release from the panel on Friday following a two-day meeting.

“If the existing system, from the global to the national levels was good enough, the worst would not have happened,” said Helen Clark, former Prime Minister of New Zealand, co-chair of the panel, at the opening of the meeting. “The status quo isn’t just not good enough; it has actually had catastrophic consequences,” she said. 

The panel is considering a range of recommendations aimed at “resetting the international pandemic preparedness and alert system” as it prepares its final report to be presented to the World Health Organization (WHO) in May.

These include solving the problems of speed and transparency in alert and response; country preparedness; the authority of and support for the WHO and equitable access to diagnostics, therapeutics, and vaccines. It is also still taking submissions to its website.

Eleven Million Girls Have Dropped Out of School

The 13-person panel reflected on the International Monetary Fund’s projection that COVID-19 will cost $22 trillion in projected cumulative output loss over 2020-2025 relative to pre-pandemic projections.  

It also noted the World Bank report that, as a result of the pandemic and school closures, 72 million more primary school-aged children may not be able to read or understand a simple text by the age of 10. Some 11 million girls are estimated to have dropped out of school.

Co-Chair Ellen Johnson Sirleaf, former president of Liberia, stressed that behind those enormous numbers are millions of people who have suffered incalculable setbacks, from which recovery will be difficult.  

“People who are poor, people who are marginalized, and those who have faced structural injustices have been at a great disadvantage during the pandemic. This must not continue through the recovery. We must keep their lives and their voices at the heart of our conclusions and recommendations.” 

The Independent Panel was established by the WHO’s Director-General to review experience gained and lessons learned from the WHO-coordinated international response to COVID-19.    

 

 

Image Credits: Gavi/2021/Jeffrey Atsuson.

Dentists are confronting the fallout from a year of disrupted dental care and treatment.

One of the unquantified side effects (or health impacts) of the pandemic has been in a place few people cared to look very deeply – that is our mouths.

For significant parts of the past year, dentists’ chairs in many offices around the world sat empty – as COVID-19 disrupted routine dental treatments. During the early days of the first lockdowns a year ago, we were able to accept patients for emergency dental treatments only.

Patients’ fear of leaving their homes resulted in delays and cancellations of regular check–ups, while others simply delayed pending treatment. And most of the patients we saw during this period were suffering from severe tooth pain resulting from unfinished or delayed treatment, ultimately culminating in either an extraction or a permanent restoration of the tooth.

On top of that, the dental profession had been called out (falsely) as being one of the most unsafe in terms of pandemic risks.

COVID-19 and Dental Safety

Most dental practices have now been able to re-open (both in and out of lockdowns), by reinforcing our already stringent infection prevention and control protocols as necessary and according to regulations.

We also have updated data showing that the profession has experienced significantly lower infection rates of SARS-CoV-2 than other healthcare professions in the USA, in Europe and beyond.

Preliminary data on the COVID-19 infection rate among dentists and other healthcare workers, suggest that COVID-19 infection in dental practice may be less likely than in other healthcare settings.

Dental practices are proven to be safe. Despite this, an underlying fear in the general public of contracting COVID-19 persists and has resulted in many of our patients delaying regular check-ups and only booking an appointment once they are already in pain or with infections that require complicated treatment. We encourage our higher-risk patients to have a dental check-up every three to six months – many have quite clearly put off a visit for nearly a year, which has led to extractions that could have been avoided.

This is serious cause for alarm, as these initial oral health issues can transform into broader health concerns. High-risk patients – tobacco users, pregnant women, people with diabetes – who are more susceptible to gum disease and tooth decay can also be more vulnerable to other diseases. Poor oral health has been linked to a host of other health conditions including heart disease and stroke, cancers, and respiratory disorders.

If the call for investing in health systems as part of universal health coverage has largely fallen on deaf ears until now, COVID-19 has certainly forced the issue. This pandemic has severely exacerbated health inequities across the spectrum.

Increasing Burden of Oral Disease

It has never been more apparent that overall health and oral health are absolutely intertwined and cannot exist independently. This World Oral Health Day we need to acknowledge the reality that precedes COVID-19: a picture of an increasing burden of oral disease across the board, matched by inadequate population-level prevention strategies and ineffective care for those in need. We must advocate for oral health professionals (and our profession more broadly) to be actively involved in all efforts to improve health for all and leave no one behind.

Optimal oral health for all is certainly an aspirational goal, but what does it actually stand for? How can we make this goal truly meaningful to oral health professionals, patients and people alike?

Universal Coverage for Oral Health

Any genuine move towards oral health for all first needs to embrace the idea of universal coverage for oral health. This starts with driving better oral health awareness campaigns for public benefit, guaranteeing that by 2030 essential oral health services are integrated into primary healthcare in every country. This shift requires focusing on prevention and early detection of diseases, making oral healthcare available and accessible in both urban and rural areas, and ensuring the affordability of appropriate oral healthcare for all.

It will also be essential to integrate oral health into the general health and development agenda by 2030. This means addressing the shared social, moral, and commercial determinants of health and recognising that untreated oral disease is the most common health condition globally—accounting for a considerable fraction of the overall noncommunicable disease burden.

A Resilient Oral Health Workforce

Finally, by 2030, we need to build a resilient oral health workforce by tackling both the plethora and scarcity of oral health professionals and auxiliaries. This model of an oral health workforce would focus on the prevention of oral diseases; screen for and monitor systemic health conditions; integrate environmentally friendly, innovative, and appropriate technologies to benefit patients; and implement oral health resource and workforce planning in cooperation with governments, educators, and oral health professionals.

Let’s not overlook the obvious: as dentists, we are highly skilled health professionals allied with our medical colleagues. Just look to the role many dentists are playing in delivering the COVID-19 vaccine around the world today. This pandemic has also confirmed that we are veterans in adopting those measures considered to protect against the novel coronavirus: protective gear like masks, gloves, and goggles as well as well as established sterilization and disinfection procedures. Our value should not be underestimated, today and in the future.

Dentists have played an important role in testing for COVID-19 and delivering vaccines around the world.

Oral Health for All

Oral health for all will not happen overnight – it will require ongoing education and awareness around the broader health issues linked with noncommunicable diseases that help to change the narrative and reinforce oral health as an essential health priority. We must focus on evidence-based dentistry and critical thinking, educate and train oral healthcare professionals to advocate for oral health, empower our patients to take responsibility for their own health and well-being, and engage with industry partners around emerging technologies.

The goal of oral heath for all will also require the collective vision and engagement of many stakeholders across the spectrum: industry partners, academics, educators, and researchers.

And let’s not forget policy makers. Governments at all levels must commit to leading the conversation around oral health in their countries and allocate sufficient resources to tackle the oral disease burden.

Perhaps most critically, we need the buy-in of the population at large, who are potentially the most powerful advocates of all to lead the world to optimal oral health.

Dr Gerhard Konrad Seeberger, president of FDI World Dental Federation.

Dr Gerhard Konrad Seeberger is president of FDI World Dental Federation and a private practitioner based in Cagliari, Italy. He is a member of numerous scientific societies (implant dentistry, periodontology). and a regular contributor to Italian and international journals. He was awarded a doctor honoris causa in medicine from Yerevan State University in Armenia and is an honorary member of several national dental associations (Bulgarian Dental Association, Chicago Dental Society, Mexican Dental Association, Romanian Association of Private Practitioners).

Image Credits: FDI World Dental Federation, FDI World Dental Federation, Flickr – Navy Medicine, FDI World Dental Federation.

African countries will be hosting a conference in April to discuss the local production of vaccines.

IBADAN – African countries are hosting a large conference in April to discuss the local production of vaccines, as key players in Africa’s public health sector try to address the continent’s vaccine shortages.

Circumstances surrounding the COVID-19 vaccine production and distribution had necessitated this conversation, William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative, said during a press conference on Thursday. The conference will take place on 12 and 13 April.

Currently, many African countries are getting most of their COVID-19 vaccines through the global distribution platform, COVAX.

“The current COVID-19 pandemic presents a great opportunity to harness the various conversations and proposals into an action-oriented roadmap led by the African Union and the World Health Organization (WHO) in Africa. And this will lead to increased vaccine production that will facilitate immunization of childhood diseases and enable us to control outbreaks of highly infectious pathogens,” he said. 

William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative.

However, he admitted that Africa only has about 10 vaccine manufacturers based in 5 countries – South Africa, Morocco, Tunisia, Egypt and Senegal – and most were only doing packaging, labelling and filling, rather than the actual production of the vaccine. But Africa has about 80 companies with pharmaceutical production capacity and the manufacturing of sterile injectables, which provided a great opportunity, added Ampofo.

“In Africa, we usually use a primary dosage form, so there is the opportunity to really consider vaccine manufacturing as a major activity that will provide substantial financial returns to the various countries in the different economic blocs if the vaccine supply and chain is well structured,” Ampofo said.

African Health Leaders and Scientist Advocating for Local Production of COVID Vaccines

Even though the COVAX Facility has promised African countries and other beneficiaries 20% of their respective COVID-19 vaccine needs, many more doses are required to achieve herd immunity. 

In addition, Africa CDC Director John Nkengasong said citizens may need booster shots if the protection offered by the vaccine wears off. These are among the reasons why Africa’s public health leaders and scientists are advocating for the continent to be able to produce the COVID-19 vaccines. Beyond COVID-19, Africa heavily relies on UNICEF and the global alliance, Gavi, for its yellow fever and other vaccines. But there are problems ahead. The biggest, Ampofo said, is the way the market is structured. Addressing this will require active involvement of organisational blocs such as the AU.

“We need the regional economic blocs to take care of a very strategic view of how the countries are interdependent. So that production would be geared towards supplying not just a country but meeting regional needs and establishing a system which sustains vaccine production on the continent,” he said.

Covering Ground

Matshidiso Moeti, WHO Regional Director for Africa.

While the local vaccination plans and discussions are continuing, Dr Matshidiso Moeti, the WHO Regional Director for Africa said the continent is rapidly gaining back lost grounds due to the late arrival of doses of the vaccines. 

“Compared with countries in other regions that accessed vaccines much earlier, the initial rollout phase in some African countries has reached a far higher number of people,” Moeti said.

She attributed the development to Africa’s vast experience in mass vaccination campaigns and the determination of its leaders and people to effectively curb COVID-19.

According to the WHO, two weeks after receiving COVAX-funded AstraZeneca vaccines, Ghana has administered more than 420,000 doses and covered over 60% of the targeted population in the first phase in the Greater Accra region – the hardest hit by the pandemic. In the first nine days, it is estimated the country delivered doses to around 90% of health workers. 

In Morocco, WHO said more than 5.6 million vaccinations have taken place in the past seven weeks, while in Angola, vaccines have reached over 49 000 people, including more than 28 000 health workers in the past week. 

“While the rollout is going well, there is an urgent need for more doses as Ghana, Rwanda and other countries are on the brink of running dry,” Moeti said.

Image Credits: Johnson & Johnson, African Vaccine Manufacturing Initiative, Paul Adepoju.

Nurses preparing a diagnostic test for COVID-19 at a drive-through testing center at the University of Washington Northwest Hospital & Medical Center in March 2020.

Previous infection with COVID-19 protects most people against reinfection for over six months, but those over the age of 65 are more likely to get infected again, found a peer reviewed study published in The Lancet. 

In the world’s first large-scale study of COVID-19 reinfections, researchers from Denmark, Sweden and the United Kingdom discovered that protection provided by prior SARS-CoV2 infection dropped from 80% for those under 65 years of age to 47% in those over 65. 

“Our study confirms what a number of others appeared to suggest: reinfection with COVID-19 is rare in younger, healthy people, but the elderly are at greater risk of catching it again,” said Steen Ethelberg, co-author of the study and senior researcher in the epidemiology of zoonotic infections at the Statens Serum Institut in Denmark, in a press release. 

The study used national PCR test data from 2020 in Denmark to compare the infection rates between individuals who tested positive and negative during the first and second surge of the pandemic. 

Between February and December, Denmark’s testing capacity increased rapidly and managed to test approximately 10% of the population each week by the end of 2020. The population-level observational study was conducted in Denmark due to the country’s investment in high intensity testing and its free-of-charge testing strategy. 

Some four million individuals took a PCR test in 2020. During the first surge, from March to May, of the 533,381 people tested, 2.11% tested positive. Among the PCR-positive people from the first wave, 0.65% tested positive again during the second surge, from September to December, compared to 3.27% of those who tested negative during the first surge. 

There were 5.35 positive tests per 100,000 people among those who had previously tested positive, compared to 27.06 positive tests per 100,000 people among those who tested negative. 

Approximately 0.88% of those over 65 years of age who tested positive during the first wave were infected again in the second surge. Among those in this age group who tested negative, 2% tested positive during the second wave. 

The researchers estimated that protection against repeat SARS-CoV2 infection was 80.5%, but the protection among those aged 65 years and older was reduced to 47.1%.

The increased likelihood of testing positive again among older individuals could be due to age-related changes in the immune system, which affect the coordination of immune responses and adaptive immune system, said the authors. This makes individuals over 65 more susceptible to emerging infectious diseases. 

These findings could inform decisions on which groups should be vaccinated and the implementation of public health measures, including physical distancing and mask wearing. 

People wearing face masks to prevent the spread of SARS-CoV2 as they commute inside a metro station amid the COVID-19 pandemic in Colombia.

“Given what is at stake, the results emphasise how important it is that people adhere to measures implemented to keep themselves and others safe, even if they have already had COVID-19,” Ethelberg said. 

“Our insights could also inform policies focused on wider vaccination strategies and the easing of lockdown restrictions,” he added.

These findings, however, could be limited. The number of infected older people included in the study was small. In addition, the researchers only examined diagnostic test results, so it is possible that those who became reinfected were asymptomatic or had mild symptoms and were not tested.

Duration of Protective Immunity

The longevity of the protection against repeat infection is still unknown, but the researchers found no evidence that the protection waned in six months after infection. 

A separate longitudinal study found that 95% of participants retained immunity for up to eight months after infection, but concentrations of antibodies decreased moderately. 

“The closely related coronaviruses SARS and MERS have both been shown to confer immune protection against reinfection lasting up to three years, but ongoing analysis of COVID-19 is needed to understand its long-term effects on patients’ chances of becoming infected again,” said Daniela Michlmayr, co-author and researcher on bacteria and parasites at the Staten Serum Institut. 

The authors of the study concluded that natural protection cannot be relied upon to achieve long term herd immunity.

“These data are all confirmation, if it were needed, that for SARS-CoV2 the hope of protective immunity through natural infections might not be within our reach and a global vaccination programme with high efficacy vaccines is the enduring solution,” said Rosemary J. Boyton and Daniel M. Altmann, professors at Imperial College London, in a comment linked to the study. 

Healthcare professional administering a COVID-19 vaccine in the United States in February.
Protection Against Reinfection with COVID Variants

The study analyzed infection with the original COVID-19 strain, as variants were not yet present in Denmark during the study period. 

More longitudinal studies and molecular surveillance are needed to assess if the protection against repeated infection differs with the COVID-19 variants that have emerged over the past several months, according to the authors. 

Some of the variants of concern are known to be more transmissible and could escape from natural and vaccine-induced immunity. This could complicate protective immunity, potentially pushing immunity below a protective margin.

Image Credits: Flickr – Trinity Care Foundation, University of Washington Northwest Hospital & Medical Center, Flickr: IMF Photo/Joaquin Sarmiento, ABC7 News.

Drive-through COVID-19 testing in Papua New Guinea. Only approximately 50,000 tests have been carried out in a country of almost nine million.

Papua New Guinea (PNG), a country that has largely avoided the SARS-CoV2 virus, is now facing an outbreak that could cause the country’s health system to collapse, while Australia is being chided by a Médecins Sans Frontières (MSF) official for its opposition to a World Trade Organization (WTO) patent waiver that MSF says would have opened up generic vaccine production faster. The disproportionate access of Papua New Guineans, as compared to Australians, to newly-developed COVID vaccines, is evidence of larger worldwide disparities between vaccine haves and have-nots, MSF says. 

Nearly half of the cases recorded in Papua New Guinea since the beginning of the pandemic, 2,351 total cases as of Monday, have been reported in the last two weeks. 

“PNG was relatively quiet last year with its low number of cases being reported, but today it has bypassed countries like Australia by reporting the highest number of confirmed cases in the last 24 hours,” David Manning, Controller of the PNG COVID-19 National Pandemic Response, said in a statement on Monday. 

James Marape, the PNG’s Prime Minister, warned on Monday that the country was approaching an infection rate of one person in three or four, calling the situation “critical.”

“The number is quite staggering, if we don’t do [a] corrective response to this, our health system will be clogged and we won’t be able to sustain it,” Marape told reporters on Monday, announcing the implementation of nationwide restrictions. 

Prime Minister James Marape at a media conference in Port Moresby on Monday, announcing the implementation of nationwide restrictions.

The low rates of testing, in combination with the large gatherings held last month to commemorate the death of the former Prime Minister, Michael Somare, indicates that the number of infections and deaths is likely to rise rapidly in the coming weeks. 

Australia Blocked a World Trade Organization Proposal for an IP Waiver on COVID Tools – Would Open Markets For More Generic Vaccine Production, Charges MSF

The PNG was set to receive 200,000 doses of the AstraZeneca vaccine from Australia and 70,000 from India through the COVAX facility, but was not expected to receive shipments of either until April at the earliest.

Responding to the crisis, Australian Prime Minister Scott Morrison on Wednesday announced that Australia would send 8,000 emergency doses of the COVID-19 vaccine to Papua New Guinea, which has seen cases of the virus increase dramatically in the last month.

However, Médecins Sans Frontières (MSF) Australia said Morrison’s gesture is far from being enough – charging that Australia should reverse its opposition to an intellectual property waiver on COVID-19 vaccines, being debated by the WTO, so poorer Pacific Island countries could get doses faster. 

“There’s no doubt [if] the intellectual property waiver had been hastened and scaled at an earlier time there was a higher probability that Papua New Guinea would have been able to get vaccines [by now],” Jennifer Tierney, Executive Director of Médecins Sans Frontières (MSF) Australia, told The Guardian.

“The intellectual property waiver proposal was first made to the WTO by India and South Africa in October last year. Australia was one of the countries opposing this from the start,” said Tierney.

“Add to that the fact that wealthy countries, including Australia, representing only 13% of the global population, had already locked up at least half of the world’s leading potential COVID-19 vaccines, through pre-purchase deals with pharmaceutical companies,” she added.

Australia’s objections to the patent waiver under debate in the WTO – which would temporarily waive intellectual property rights on COVID-19 medicines and vaccines came alongside those of Brazil, Canada, the EU, Japan, Norway, Switzerland, the United Kingdom and the United States. 

Australia to Send Vaccines and PPE to Assist with “Uncontrolled” Outbreak in PNG 

Marape has reportedly asked Australian officials for assistance expediting vaccines for healthcare workers. This call has been echoed by aid groups, urging Australia to act immediately. 

“I put to [Australia] if possibly a smaller supply of vaccines could come in at the very earliest so that the health workers are given the defence in the first instance,” said Marape. 

In response Morrison said that 8,000 doses of the AstraZeneca vaccine would be sent immediately, along with personal protective equipment (PPE) and a team of health specialists to provide technical advice and help with emergency management of the outbreak. 

“We’ve known that [the] challenge was always going to be too great for Papua New Guinea, as time went on, and that indeed is proving to be the case now,” said Morrison at a  Wednesday press conference. 

Scott Morrison, Australia’s Prime Minister, at a press conference on Wednesday.

He also announced that Australia had requested the European Union to permit the immediate export to Australia of one million doses, for which the country had already contracted. Australia has purchased 53.8 million doses from AstraZeneca, 3.8 million of which are to be imported from overseas. 

“We’ve contracted them. We’ve paid for them. And we want to see those vaccines come here so we can support our nearest neighbour, PNG, to deal with their urgent needs in our region,” Morrison said. 

This call comes shortly after Italy blocked a shipment of 250,000 vaccines to Australia in early March due to its own domestic vaccine shortages; the Italian move was the only export order that a European Union member state has refused to implement – out of over 300 requests. 

An answer is expected from the EU within days.

Brazil’s Health System in Crisis as New Record in Deaths is Hit

Meanwhile, Brazil recorded 2,841 deaths on Tuesday, a record high for the country since the beginning of the pandemic, surpassing the US in the 7 day average of COVID-19 deaths, as the health service is experiencing a historic collapse. 

The COVID-19 units in 25 of Brazil’s 27 states are at or above 80% capacity. The health system is being overwhelmed by cases and the situation is “extremely critical across the country,” the Fundação Oswaldo Cruz (Fiocruz), a biomedical centre manufacturing the AstraZeneca vaccine in Brazil, said in a statement.

“The situation in Brazil is a cautionary tale that keeping this virus under control requires continuous attention by public health authorities and leaders to protect people and health systems alike from the devastating impact of this virus,” said Carissa F. Etienne, Director of the Pan American Health Organization, at a press briefing on Wednesday.

Brazil has the second highest number of infections and deaths in the world, with over 11.6 million cases and 282,127 deaths, and only 4.6% of the population have received at least one dose of a COVID-19 vaccine. 

The health authorities are rolling out the Oxford/AstraZeneca and Sinovac vaccines and have purchased doses of the Pfizer/BioNTech, Johnson & Johnson, and Sputnik V vaccines. The vaccination campaign, however, is slow and only a fifth of the expected doses produced in Brazil will be delivered by the end of March. 

Fiocruz researchers urged the government to adopt strict prevention and control measures, including restricting non-essential activities, expanding physical distancing measures, enforcing the use of masks on a large scale, and accelerating the rollout of vaccines. 

New Health Minister Continues With Bolsonaro’s Controversial COVID Policies

Brazil’s fourth health minister since the start of the pandemic was officially appointed on Wednesday. It is doubtful, however, that he will represent a change in the policies of President Jair Bolsonaro, who has consistently downplayed the severity of the virus and has received widespread criticism for his handling of the pandemic. 

Marcelo Queiroga, the new health minister, stopped short of endorsing social distancing measures or a lockdown to curb the spread of the virus at a press conference on Tuesday. Instead he asked the population to wear masks and wash their hands.

Marcelo Queiroga, Brazil’s new health minister, speaking to reporters on Tuesday.

“These are simple measures but they are important, because people can with these measures avoid having to shut down the country’s economy,” Queiroga said. 

He stressed that the country’s health policy is set by the president and the minister is responsible for implementing it.

Disapproval of President Bolsonaro’s handling of the pandemic has reached a record high, with 54% of respondents to a new Datafolha poll considering his actions bad or very bad. This has risen since late January, when 48% of respondents were disapproving.

Image Credits: ABC News Australia, Facebook – Papua New Guinea National Department of Health, ABC News Australia, Reuters.

tb
In just one year COVID-19 has undone 12 years or progess in the fight against tuberculosis.

In just one year, COVID-19 has undone more than a decade’s progress in the fight against tuberculosis (TB), health experts said on Thursday.

While COVID-19 fatality numbers are decreasing worldwide, TB-related deaths remain steady at 4000 cases a day – an occurrence experts partly attribute to limited access to TB treatment services during COVID lockdown periods and TB funds being diverted to fight the virus.

“Twelve years of impressive gains in the fight against TB, including in reducing the number of people who were missing from TB care, have been tragically reversed by another virulent respiratory infection,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership. 

The STOP TB Partnership shared new data on Thursday showing that nine of the countries with the most TB cases – representing 60% of the global TB burden – saw a drastic decline in in diagnosis and treatment of TB infections in 2020, ranging from 16 – 41% (with an average of 23%). The drop brought the overall number of people diagnosed and treated for TB in those countries to 2008 levels. 

Annual percentage change in TB diagnosis and enrollment for nine high-TB burden countries

There are many similarities between TB and COVID-19. Both are airborne infections transmitted through breathing, affecting primarily the respiratory tract, and causing similar symptoms such as cough, fever, and breathlessness. 

Responses to COVID-19 and TB are also similar, including testing, tracing, masking, isolation, and airborne infection control in health care and other settings. 

When the COVID-19 pandemic started in high burden countries, TB program expertise and resources were used to respond to virus.But, as a result of lockdowns, TB diagnostic and treatment services became inaccessible, greatly impacting the amount of people reached and treated. 

As the number of people vaccinated against COVID-19 grows, the number of COVID-19 deaths decrease while TB will continue to kill roughly 4000 people every day, the new data shows.

“In the process, we put the lives and livelihoods of millions of people in jeopardy. I hope that in 2021 we buckle up and we smartly address, at the same time, TB and COVID-19 as two airborne diseases with similar symptoms,”  Said Ditiu.

Dr Lucica Ditiu, Executive Director of the Stop TB Partnership
Investment in TB ‘Drastically Different’ From COVID-19 

In addition to the worldwide drop in TB diagnosis and treatment, data emerging from India and South Africa shows that people coinfected with TB and COVID-19 have three times higher mortality than those infected with TB alone. This makes contact tracing, case finding, and bi-direction TB and COVID-19 testing essential.

“Why is it that TB, which was not too long ago, a global pandemic killing people all over the world in very large numbers?” asked Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria, during a press briefing.

Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria

COVID-19 claimed 1.8 million lives in 2020 and said Sands pointed out that the numbers of people who died from TB in 2020 may have been around 1.7 million, 90% of the number of COVID deaths.. 

But the investment in TB is not as substantial as the investment in COVID-19 – 2% of what is spent on COVID-19 is the amount invested in TB, which Sands called “drastically different in terms of resource commitment.” 

“Why is it that we have left people behind? We haven’t finished the fight against TB, as an older pandemic. Should we not use the forced rethinking of our approaches to global health that COVID has catalyzed?” 

“Let’s really step up our fight against TB, and get rid of it. If we don’t, we are again creating another future risk for humanity in the form of multidrug resistant (MDR) TB.” 

India’s Integrated TB and COVID-19 Response 
The TB programs of several high TB burden countries have made efforts to recover. Some have been more successful than others, such as India.

India was one one of the first countries with a high TB burden that have made vast efforts to recover, developing a rapid response plan by August 2020, after the national government’s TB notification system, “Nikshay,” reported a 70% drop between the 10th and 15th weeks of 2020.

“TB didn’t go anywhere when the COVID-19 pandemic hit,” said Dr. Harsh Vardhan, Minister of Health and Family Welfare, India. “People just got distracted, health workers were redirected, and health systems became overwhelmed. Recovery efforts succeed with political leadership and substantial resources, along with an insistence that COVID-19 outreach and prevention efforts include TB work, instead of replacing it.”

progress
Honorable Harsh Vardhan, Minister of Science and Technology, Minister of Health and Family Welfare, India

The primary goal of the response plan was to integrate TB into all COVID-19 programming, taking advantage of how both infections attack people’s respiratory systems. 

Boosted by public commitment from India’s Prime Minister, efforts to locate TB and COVID-19 cases in all health care facilities intensified, and rapid molecular testing for TB expanded. 

Bi-direction screening of TB and COVID-19 took place for people displaying influenza-like illnesses and severe acute respiratory infections. Contact tracing systems and testing for TB linked to COVID-19 contact tracing were set up, and private care TB facilities were opened. 

India’s response to the simultaneous burden of both TB and COVID-19 has shown that it is possible to integrate approaches to tackle airborne pandemics. “If a nation like India can dream of this, the rest of the world has to think beyond this. We have to admit that the current pandemic has demonstrated the vulnerability of humankind to exigencies, recognizing that we have to strive to add speed and predictability,” said Vardhan.

Investing in TB Creates a ‘Defense System’ Against Respiratory Diseases 

The shift of TB resources to COVID-19 has disproportionately impacted people in low and middle-income countries, which means that more resources and investment towards TB can greatly reduce the double burden of both diseases. 

“We can rein in COVID, and we can protect against new airborne risks in the TB response service platforms to fight current and future airborne diseases, but to succeed, we will need to put equity and human rights at the center of the approach,” said Dr Joanna Carter, Vice-Chair of the Stop TB Partnership Board and Executive Director, RESULTS.

The theme for World TB Day, observed on 24 March, is ‘The Clock is Ticking’, which conveys the sense that the world is running out of time to act on the commitments to end TB made by global leaders.  

The theme for World TB Day 2021 is ‘The Clock is Ticking’

Carter Concluded: “This kind of level of annual investment could have a transformative impact on TB efforts globally, and help build the infrastructure that protectings communities in the world against all kinds of airborne diseases. We can’t force a false choice between fighting COVID or fighting TB. Communities, individuals, and health systems are facing both of these challenges, and they have to have the financial and human resources to respond.” 

“If we act ambitiously now, we can make huge progress against TB and COVID, [creating] a defense system against future infectious respiratory disease threats, [protecting] everyone.” 

Image Credits: STOP TB partnership , STOP TB partnership , WHO.

disaster
Nearly 1 million Somalians were affected during the 2020 flooding. The World Disaster Report found that COVID-19 has presented new risks to the African continents already limited in their financial resources.

COVID-19 has presented new risks to the African continent, with already limited financial resources needed to respond to climate hazards and natural disasters now being diverted to fight the pandemic.

The pandemic has made it all the more challenging to ensure there is adequate disaster financing on the continent, and this now needs urgent attention, said Kai Gatkuoth, the technical coordinator for disaster risk reduction at the Directorate of Rural Economy and Agriculture of the African Union Commission, following the launch of the International Federaton of the Red Cross and Red Crescent Societies (IFRC) 2020 World Disaster Report in the Africa Region.

Released under the theme The World Disaster Report 2020: Come Heat or High Water: Tackling the Humanitarian Impacts of Climate Change Crisis, the global report is based on inputs from a number of Red Cross Red Crescent National Societies around the world.  But there is a special focus on the African continent, one of the most vulnerable regions, particularly in terms of climate change-related disasters, which also have knock-on effects in terms food security, conflict – and of course disease.

“Now the confluence between the Covid-19 and climate hazards makes vulnerability even worse for different communities,” observed Gatkuoth.

He cited recent flooding in parts of east, central and west Africa that led to mass movement of people as an example of a natural disaster worsening the Covid-19 situation. “What we need to do now is address the disaster risk within the context of Covid-19,” he urged.

A Covid-19 disaster recovery framework is now under development that will help AU member states respond to the pandemic in the context of disaster reduction. “We are also developing multi-hazard warning systems that will ensure that there is a clear linkage between natural hazards and pandemics as well as pests, diseases and conflicts,” Gatkuoth said.

One of the major challenges for tackling natural disasters on the continent is the disconnect between disaster risk reduction and climate change adaptation approaches. At the moment about 30 national disaster risk reduction strategies exist in Africa and are growing.

“The report highlights the importance of having linkages between the two,” said Amjad Abbashar of the United Nations Office for Disaster Risk Reduction. One of the reasons why this is the case is that a lot of governments do not have climate change and disaster risk reduction actors working together, he added, calling for increased dialogue between the sectors. 

More Financing Needed for Disaster Risk Reduction

But with climate related droughts, flooding, locust waves and other events becoming more intense and frequent, preparedness has never been more urgent. But higher levels of preparedness can only be achieved if disaster risk reduction financing is available and adequate, to help African countries better cope with natural calamities, the report stresses. 

This is particularly the case, given that weather-related disasters have risen in intensity, per decade, by nearly 35% since the 1990s. Therefore, increasing disaster risk reduction financing remains a big priority to building resilience across the continent.

The report comes at a time when the “entire humanity is facing complex risks”, noted Ambassador Josefa Sacko, the high commissioner for Agriculture Rural Development Blue Economy and Sustainable Environment at the African Union. She added that the report provided important lessons for narrowing the divide between climate change and disaster risk reduction.

However, Abbashar  said “there needs to be disaster risk financing attached …because you are not going to implement the strategies if they are not budgeted. 

“So, more financial commitment is needed by governments, to ensure that disaster risk reductions strategies are not only coherent, integrated [and] complement climate change adaptation strategies – but that they are also adequately funded,” he observed.

When Abbashar took over as the Africa Region director at the IFRC in September 2020, 11 African countries were appealing for support to cope with floods.

“Is the level preparedness and readiness enough? The clear answer is no,” said the IFRC’s Mohammed Mukier, IFRC’s African Regional Director, referencing the technical capacity and financial resources needed to deal with emergencies.

However, Mukier was also quick to point out that with improved climate modeling, the ability to project and predict trends has improved significantly For example projections of impending drought, floods and even population movements for 2022 is now possible. “With all this predictability why are not investing in terms of building local preparedness and readiness?” Mukier said. 

Despite all the challenges, the mindset across African governments is also changing, Abbashar added, saying that in the wake of the devestation seen by COVID as well as from climate related events, “There is political buy-in as illustrated by such strategies as the African Union Strategy for Disaster Risk Reduction, that is critical at the regional level.” 

 

Tanzanian president John Magufuli died on Wednesday following a three week absence from public view.

JOHANNESBURG –The death of Tanzanian President and COVID-19 skeptic John Magufuli has drawn decidedly mixed emotions  – as tributes poured in from both average Tanzanians, as well as other African heads of state and world leaders. But Tanzanian opposition forces said that the president’s mysterious death was a chance for a reboot on both Tanzania’s pandemic response as well as  other vital reform issues.

The responses followed Wednesday’s announcement of Magufuli’s death by the country’s Vice President Samia Suluhu Hassan, set to take over as Tanzania’s first female president, while saying that Magufuli’s death was due to heart failure.

Magufuli, a prominent skeptic of the coronavirus,  died at Mzena Hospital in Dar es Salaam where he was receiving treatment for heart complications he had been suffering from for a decade, according to Hassan.

But his fiercest critic and opposition and main opposition leader Tundu Lissu on Thursday claimed that Magufuli, 61,  had in fact died of the coronavirus, calling his death “poetic justice” following Magufuli downplaying the severity of the COVID-19.  Since last May, Tanzania had steadily suppressed reports of any COVID cases to the World Health Organization – pressuring medical doctors to cite causes other than COVID in hospital records and on death certificates. 

Lissu charged that the Tanzanian government was not being honest about the cause of Maguguli’s death, saying they were “lying even now that he is dead”.

“Magufuli died of corona,” said Lissu, speaking from Belgium in an interview broadcast on Kenyan network KTN News, citing personal sources.  “My message to Tanzania is that this is an opportunity to open a new chapter….This is a rare opportunity for us to step back from disaster and go back to sanity,” the opposition leader added.

 

Magufuli Downplayed COVID-19

Magufuli had scoffed at the coronavirus, championing alternative medicines and calling for prayer instead of face masks. Then three weeks ago, shortly after two senior officials in his government died of COVID-19, Magufuli disappeared from public view.  His disappearance immediately fuelled rumours that he had contracted COVID-19, but his illness remained unconfirmed, and its precise nature, was not disclosed. 

 “President Magufuli did not wear a face mask. He actually denigrated anyone who wore face masks. He did not believe in vaccines, he did not believe in science,” said Lissu.

“He placed his faith in faith healers and herbal concoctions of dubious medical value. And what has happened, happened. He went down with corona.” 

Magaguli downplayed the pandemic and denounced vaccines as a Western conspiracy against Africans.  Magufuli claimed prayer had beaten the virus.

Tanzania has not updated its COVID-19 cases or deaths since May, 2020 when the country had recorded a total of 509 cases and 16 deaths, but a doctor in Dar es Salaam told the BBC that there has been a significant increase in the last two months in admissions of patients exhibiting respiratory symptoms consistent with COVID-19. 

Hassan said Magufuli was admitted on 6 March to Jakaya Kikwete Cardiac Institute for heart problems and discharged the next day. A week later he felt bad and was rushed to Mzena Hospital where he was getting treatment under the supervision of doctors from the cardiac institute. Hassan said burial arrangements were underway and announced 14 days of mourning and the flying of flags at half-staff.  

Vice President Hassan Set To Become Tanzania’s First Female President
Tanzania’s Vice President Samia Suluhu Hassan should assume the Presidency following the death of President John Magufuli.

Despite his reputation as a COVID-skeptic, fellow African leaders heaped praise on Magufuli’s leadership, with Kenyan President Uhuru Kenyatta announcing that flags in Kenya and all Kenyan diplomatic missions abroad will be flown at half-mast from Thursday 18, until Magufuli’s burial.

“In testimony of the high esteem in which the People of Kenya hold President John Pombe Magufuli, the Republic of Kenya will observe a period of seven days of national mourning,” Uhuru Kenyatta said. “As a symbol of Kenya’s enduring respect for Magufuli, as well as Kenya’s solemn solidarity with the Nation and People of the United Republic of Tanzania,” flags in Kenya and its diplomatic missions will be flown at half-mast, he added. Kenyatta termed Magufuli as a champion of pan-African ideals.

South African president Cyril Ramaphosa said: “South Africa is united in grief with the government and people of Tanzania as they go through this difficult moment.”

According to Tanzania’s Constitution, Vice President Samia Hassan will assume the presidency for the remainder of the five-year term that Magufuli began serving last year after winning a second term. She is the East African nation’s first female president. 

 

 

 

 

 

 

 

EMA Executive Director Emer Cooke

The European Medicines Agency’s safety committee (PRAC) on Thursday gave a resounding endorsement of the Oxford/AstraZeneca vaccine against COVID-19, concluding that the vaccine’s benefits vaccine “far outweigh” any risks  –  despite a possible link between some vaccinations and rare cases of blood clotting associated with low levels of blood platelets. The EMA statement followed two weeks of mounting concerns over reports of such rare events – leading to 17 countries to suspend the vaccine rollout, at least temporarily. 

In a press briefing Thursday evening, an EMA panel stressed that the AstraZeneca vaccine “is not associated” with an increase in the overall risk of blood clots. Nor is there evidence of problems related to specific batches of the vaccine or to particular manufacturing sites. 

However, the EMA safety review did find that the vaccine may be associated with very rare cases of blood clots associated with thrombocytopenia, i.e. low levels of blood platelets (clotting elements in the blood), and also including rare cases of clots in the vessels draining blood from the brain (CVST).

“The EMA Committee has come to a clear scientific conclusion. This is a safe and effective vaccine. Its benefits in protecting people from COVID-19, with the associated risks of death and hospitalisation, outweigh possible risks,” said EMA Executive Director Emer Cooke at the press briefing, adding that overall, “The committee also concluded that the vaccine is not associated with an increase in overall risk of thromboembolic events or blood clots.” 

At the same time, she said, in the Agency’s Pharmacovigilence Risk Assessment Committee (PRAC) investigation and review, a “small number of cases of rare and unusual, but very serious disorders” were detected, that triggered a more focused review.  “And we still cannot rule out definitively a link between these cases and the vaccine,” said Cooke. 

As a result, she said that the agency would be adding a warning about rare events to the vaccine label and patient information – as well as launching more follow up studies. 

“If it were me, I would want to be vaccinated tomorrow,” Cooke stated, when asked by reporters if she would take the AstraZeneca vaccine herself – or wait for another product. ”But I would want to know if anything happens to me after vaccination, what I should do about it, and that’s what we’re saying today.  

“I want to reiterate that our scientific position is that this vaccine is a safe and effective option to protect citizens against COVID-19. It demonstrated that at least 60% efficacy in clinical trials and preventing coronavirus disease, and in fact the real world evidence suggests that the effectiveness could be even higher than that.”

Blood Clots – Still Very Rare Events 
Sabine Straus, chair EMA pharmacovigilence Risk Assessment Committee (PRAC)

Cooke stressed that the instances of thrombocytopenia-associated blood clotting remained very rare events. And rare adverse events are common with almost any vaccine or medication:

“About seven million people have now been vaccinated in the EU with the AstraZeneca vaccine, and 11 million have been vaccines in the UK…When you vaccinate millions of people it’s inevitable that you have rare or serious incidents,” she said.

“But I want to reiterate that our scientific position is that this vaccine is a safe and effective option to protect citizens against COVID-19.” 

According to the latest EMA data, of an estimated 20 million people in the United Kingdom and Europe that have so far received the vaccine as of March 16, the EMA had reviewed only 7 cases of blood clots in multiple blood vessels (disseminated intravascular coagulation, DIC) and 18 cases of CVST (cerebral events).

”A causal link with the vaccine is not proven, but is possible and deserves further analysis,” stated an EMA news release issued simultaneously with the press briefing. 

Greater Proportion of Very Rare Cases Observed in Young Women 
astrazeneca
EMA Panel announces results of its review of the safety of the Oxford/AstraZeneca COVID-19 vaccine.

A greater proportion of these very rare cases, however, have been observed in young women, the committee members acknowledged. This may also explain why more are being seen on the European continent than in the United Kingdom, where the AstraZeneca rollout focused first on older groups. 

The EMA experts did not rule out, either, a possible link between such rare events and contraceptive pill use, which can increase the overall risk of blood clots for young women: 

“Yes, it is always a distinct possibility,’’ said Sabine Straus, EMA Safety Committee head, in referring to those risk factors that might contribute to such a rare event among those being vaccinated. “One of the risk factors that is highlighted for the [thrombosis] disease or the syndrome, as such, is also oral contraceptives. The committee also is investigating if the risk of such events might be higher among recovered COVID patients who are vaccinated.” 

A past COVID infection might also add to the risks of such, she said. “COVID is an important risk factor for thrombosis and also a post-COVID syndrome. So that might have played a role.” 

She added that smoking was also a general risk factor for thrombosis anyway, but cautioned, “I am not sure it’s a risk factor for these specific cases, but it’s something that we are also looking into.” 

United Kingdom versus Europe Differences 

There have also been proportionately fewer reports of the rare events in the United Kingdom – just three cases – as compared to elsewhere on the European continent, including seven cases in Germany, three in Italy, one in Spain and two in India, the panel stated. 

Said Peter Arlett, head of EMA analytics, “we know that the AZ vaccine in the UK, was given predominantly to older patients, compared to the totality of European member states. And therefore, if blood clot cases are more common in younger women, for example, then it would suggest that you get more cases in Europe than you would in the UK.”

In some European countries, health workers, including young women, have been a first priority in vaccine campaigns.

The panel also said that they would be investigating other reports of other rare adverse events seen in any of the vaccines that have so far been EMA approved. Those have also included reports in the United States of sudden decreases in blood platelet clotting elements, called “immune thrombocytopenia” (ITP), shortly after vaccination with the Pfizer and Moderna vaccines.  The syndrome can cause excessive bruising and bleeding. 

Said Straus, “A separate investigation has been started for ITP, and that is a signal that is ongoing for the moment.” 

Image Credits: HPW .

air
Smog over Delhi, India

The unexpected – and unexplained – dissolution of India’s brand-new Commission on Air Quality Management (CAQM), established by Prime Minister Narendra Modi at the peak of North India’s air pollution crisis five months ago has taken air pollution scientists and clean air advocates by surprise. Members of the commission were also taken aback, learning of the news through weekend media reports, sources familiar with the issue said.

The Commission, disbanded after the Modi government failed to see through a parliamentary law to back up the executive decree issued in October, prompted immediate protests  by opposition politicians, with Atishi Marlena from Delhi’s ruling Aam Aadmi Party charging the national government with yet another failure in pollution policies.   

“Who will take action on Haryana, Punjab, UP (Uttar Pradesh), Rajasthan due to burning of stubble?,” Marlena asked, referring to the rural regions around Delhi which flood the city with air pollution during the late fall and early winter. “With the CAQM gone, who will now take action against errant polluters,” she asked, speaking to a Hindi language media outlet. 

Government – Rattled by Farm Protests, Doesn’t Want to Penalise Stubble Burning
air
Farmers in India protesting new agricultural laws passed by the Modi government.  While the new laws focus on crop price policies – the government may be fearful of any step that could alienate farmers further, some observers believe.

While Modi and his ministers offered no comment, sources told Health Policy Watch that his government was nervous about the powers that had been granted to the new commission – which had been empowered to prosecute polluters, including farmers burning crop stubble, and impose stringent penalties. 

“Farmers protests have become a very sensitive topic,” the source said, noting that the government is rattled by the media attention the protests have gained both domestically and internationally. “It wants no more trouble in this sector in the current scenario.”  

For over 100 days, tens of thousands of farmers have been camped around Delhi’s periphery to protest against a series of agricultural laws passed by the Modi government in September 2020.  Billed as modernization measures, the laws would leave farmers to negotiate produce prices on the open market – something farmers say  will put at the mercy of large agro-businesses, and threaten their livelihoods. Even after multiple rounds of talks between the government and farmers, the protests show no sign of ending. 

Lack of any official communication on the Commission’s sudden dissolution has, however, led to confusion and conjecture. That, after Commision members had reportedly been appointed for a period of three years. 

The confusion continued this week, as some government sources said they still expected the CAQM to be “up and running in a few weeks,” but without saying how that could happen since there is no legal framework for the body to operate – after the time frame for transforming an executive decree into a parliamentary act elapsed. 

One news report even quoted Environment Secretary R.P Gupta saying cryptically “ It’s not that the commission will not come back, but not now. The commission will be coming back slightly late.” 

Commission set up during October Crisis – Initially Offered Hopes Of Change 

The Commission had been hurriedly set up on October 28, 2020 when north India’s air quality was at its worst. The appointed chairman, a retired head of the country’s petroleum and natural gas, took charge on a day in November when official monitors reported PM2.5 levels at almost 100 times more  than WHO’s guidelines for 24-hour average levels of fine particulate matter. 

air
Air Quality Index of India – real time air quality data as of 17 March, based on a scale of 0 to 500 (Good to Hazardous). Every city in India observed air quality improvements compared to 2018 and earlier,  However, India continues to feature prominently at the top of the most polluted cities ranking with 22 of the top 30 most polluted cities globally.

It is estimated that 1.7 million people die every year in India from air pollution – with Delhi consistently ranking as one of the most polluted cities in the world. The city was estimated to have seen 54,000 deaths due to PM2.5 air pollution in 2020 – or one death per 500 people, according to the most recent Greenpeace-IQAir study, reported by Health Policy Watch.

When it was established last fall, the Commission was billed as a replacement for a bureaucratically awkward, and largely ineffective, Environment Pollution (Prevention and Control) Authority (EPCA), which had set up 22 years ago by India’s Supreme Court. The Commission, reporting directly to the Modi’s government, was presented as a body that could act more effectively on the thorny air quality issue. 

Although air quality experts and advocates at the time had questioned its mode of creation – by executive decree at a time when India’s parliament was in recess – they also expressed hopes that the Commission could be a step forward – consolidating the functions of the EPCA and multiple other task forces into a single body with more significant powers, and membership including representatives from the central and state governments.  

Defunct Commission Had Innovative Features – Welcomed By Air Quality Campaigners  

The executive decree, or “ordinance”, that established the now-defunct Commission also included some other innovations that were welcomed at the time by air quality campaigners. These included treating the Delhi national capital region as an airshed; involving some well-respected clean air non-profits; and working from the ground up with a fully-funded secretariat. 

And in some ways, the Commission’s creation also represented the most explicit action yet by Prime Minister Modi to address the threat of India’s air pollution to public health – even though the Prime Minister continues to consistently avoid the issue in his public statements.

“While the process of creating the CAQM was problematic, the agency itself represented a significant milestone. The CAQM had an airshed-level mandate, dedicated funds and staff, and would have assumed accountability for air quality outcomes in the region. The lapsing of the ordinance definitely leaves an institutional vacuum, and is a deeply worrying development,” says Santosh Harish, Fellow at the Centre of Policy Research who specialises in energy and environment policy and air quality governance. 

‘Set Up To Fail’ – Clean Air Community Angry and Aghast  
Real time air pollution indicators globally, as of 17 March, from World Air Quality Index – with pollution indicatrors ranging from Good (0 to 50) to Hazardous (301 to 500).

Now, the commission’s dissolution just five months after its formation has left the clean air community wondering if the body was, in fact, created to fail. 

Throughout its five-month tenure, the commission was publicly invisible – with no official or even social media channels of communication, although sources unofficially spoke about data collection that was underway to better identify local emission sources, exposure levels and pollution levels.

“This one was set up to fail – and it did so gloriously. Without periodic reporting on what the CAQM did, it is unclear what they delivered, so what are we lamenting about?,’ says Karthik Ganesan, a fellow with the non-profit Council on Energy, Environment and Water. 

“In theory, these centrally constituted bodies are effectively replicating the Central Pollution Control Board in its coordination role. Strengthening institutions that actually are vested with the task of addressing AQ at various levels – starting with the CPCB and giving it the autonomy to constitute committees to coordinate action in regional air sheds, would make this a more productive effort,” he added. 

In a scathing piece, environmental lawyer Ritwick Dutta echoed the message saying: “It was clear from the beginning that the CAQM was designed to fail. In the five months of its existence, its single major failing was that almost nobody even knew it existed. It had no office, email address, website or even a phone number through which people could contact its offices.” 

Dutta added: “The government gave the CAQM the power to hear grievances of the people affected by air pollution, but the main grievance of the people was finding the commission itself.”

Added Bhavreen Kandhari, a member of activist group WarriorMoms called it a shocking lapse:  “The lapse of the CAQM Ordinance has been very disappointing and shocking. This clearly shows how serious the government is about the critical issue of air pollution.”

Campaigners Call For Intervention of Courts Once More 

Now that the Commission has effectively dissolved, air quality advocates are calling for the courts to intervene once more. Traditionally, India’s Supreme Court has been the leading arbitrator of air quality issues – in the absence of strong government policies. 

In fact, shortly before the CAQM was created, the Supreme Court ordered the creation of a new single-judge committee to lead the charge on the air pollution issue, headed by a retired Supreme Court  judge, Madan Lokur.  

Then, just after that appointment was announced, Modi’s government announced that it was forming the new Commission – making judicial intervention irrelevant at the time. 

Some critics now suspect that the Commission’s creation was merely a ploy to head off intervention by the courts at the peak of India’s annual air quality crisis – a crisis that builds up every winter in the dry season, which coincides with autumn crop burning and household heating, and then ebbs again with springtime weather and monsoon rains.  

“Clearly it wasn’t the honest and genuine political will of the government to set up this commission,” said Vimlendu Jha, founder of environment and sustainability non-profit Swechha.

“The dissolution of the commission is just one more flag up in the air displaying arrogance and ignorance of our political class. This episode is a joke on all of us who felt we had arrived at the regional and airshed approach to clean air,” he added. 

Kandhari said that clean air advocates would now file a new legal appeal to the Supreme Court to reinstate it’s committee.  She  said that  the application will be made on behalf of a 17-year old student Aditya Dubey – who suffers the respiratory effects of air pollution – borrowing on a successful legal strategy used last year in the United Kingdom to get the courts there recognize the health effects of air pollution on children. 

“We need immediate intervention by the honourable court to protect our right to breathe,” she said. 

Aam Aadmi Party criticises the dissolution of CAQM, federal govt

Speaking in the  Hindi language  media outlet, opposition legislator Marlena  urged the city’s government to protest the Commission’s dissolution.  In addition to crop burning, she added, other deliberate development policies are contributing to Delhi’s longtime pollution stew, she stressed.

Those, she added, include the federal government’s allowance of “5,000 polluting  brick kilns, 13 thermal power plants and several polluting industries” to flourish within a 300 km radius of Delhi; some 60%  of Delhi’s pollution comes from outside the city. 

CPR’s Harish sounded a more upbeat note saying: “I hope that a new bill to replace the ordinance may yet get tabled, discussed, and passed in the Parliament, and that the CAQM is only temporarily suspended.” 

Depending on the outrage the dissolution generates, that may yet happen. 

Jyoti Pande Lavakare is a journalist and author whose non-fiction memoir about the human cost of air pollution, ‘Breathing Here is Injurious to Your Health’, was published by Hachette in November 2020.

Image Credits: toiplus/India, Jean-Etienne Minh-Duy Poirrier/Flickr, World Air Quality Index.