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

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

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

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

Travel Measures Must Be Implemented at a Granular Level

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

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

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

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

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

Karen Grepin, University of Hong Kong

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

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

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

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

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

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

Diego Silva, University of Sydney

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

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

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

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

Potential Gap in IHR Compliance and Policy Implementation   

Catherine Worsnop, University of Maryland

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

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

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

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

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

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

 

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

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

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

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

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

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

WHO Regional Director for EMRO Ahmed Al Muntari

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Palestine & Syria Retort – What is New?

Syrian delegate to the WHA

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

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

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

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

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

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

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

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

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

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

Image Credits: www.laprensalatina.com.

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

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

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

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

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

Involve Communities, Improve Trust

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

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

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

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

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

Neglected Diseases and Skewed Funding

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

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

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

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

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

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

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

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

Healthcare workers in Nigeria fight to maintain vaccination services during the COVID-19 pandemic.

 

Key World Health Organization (WHO) member states agreed to postpone a potentially polarising discussion on a ‘pandemic treaty’ until November, according to a World Health Assembly ‘draft decision’ published Tuesday.

The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – specifies that a special WHA session should be “dedicated to considering the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response”.

This special WHA would establish “an intergovernmental process” to draft and negotiate this instrument, “taking into account the report of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies”. 

Previously, the US had advocated for a high-level ministerial meeting to consider the possibility of an international instrument or treaty.

Late Tuesday afternoon, Germany delivered a statement on behalf of 59 countries that now support the  special session of the WHA in November to discuss a possible pandemic treaty.

“In our view, a pandemic treaty under the roof of the WHO is the preferred way forward to strengthen the multilateral health architecture,” said Germany in the statement.

Mike Ryan, WHO Health Emergencies Programme Executive Director, appealed Tuesday for “the highest-level political commitment” to address the organisation’s weaknesses in the face of pandemics. 

Dr Mike Ryan, WHO Executive Director of Health Emergencies Programme.

Reciting a lengthy list of epidemics that had ended with unmet promises to fix global responses, Ryan said, “If I had a dollar for every recommendation made in this space, I would have a completely funded programme.”

“My personal view is that we need a political treaty that makes the highest-level commitment to the principles of global health security — and then we can get on with building the blocks on this foundation,” Ryan told a lunchtime briefing on pandemic preparedness.

Since November the European Union has advocated a pandemic treaty similar to the Framework Convention on Tobacco Control, but has faced opposition from the US, Russia and Brazil. (The tobacco convention provides signatories with evidence-based tobacco control strategies that they are obliged to implement, albeit incrementally.)

Russia’s WHA representative told Tuesday’s plenary that there was no need for additional requirements beyond the International Health Regulations, as these are binding global regulations to prevent the spread of disease.

US public utterances have been vague, although an earlier Health Policy Watch report indicated the US was trying to stall discussions by proposing various diplomatic measures such as a high-level ministerial meeting to consider setting up an “international instrument”.

US Health and Human Services Secretary Xavier Becerra

Addressing Tuesday’s plenary, US Health and Human Services Secretary Xavier Becerra called for “urgent action this year to strengthen health security and pandemic preparedness” by “improving global triggers.” 

Measures should include a “sustainable global health security financing mechanism” and developing “surge capacity” for global manufacturing of personal protective equipment, vaccines, therapeutics and diagnostics, said Becerra.

However, comments from various US officials during the Assembly indicate that the country is concerned about the financial responsibilities attached to any legal framework, which might be difficult to get domestic support for.

EU Upbeat About Pandemic Treaty

Meanwhile, the EU delegations to the United Nations in Geneva were positive about the draft decision.

“Ahead of the World Health Assembly, the EU and a group of countries from across all WHO regions built a large coalition to ensure that WHA74 would pave the way for establishing a process for a Framework Convention on Pandemic Preparedness and Response,” according to a statement from the EU delegations.

“The decision to be adopted today by the Assembly will set up a special session of the WHA in November 2021 to focus on this one issue with a view to starting the formal negotiation process immediately thereafter.”

Also Tuesday, Charles Michel, President of the European Council, reiterated the EU’s call for an international treaty to “foster a comprehensive approach to better predict, prevent and respond to pandemics, strengthen global capacity and resilience to ensure fair access to medical solutions, and bolster international alert systems that are sharing … cutting-edge medical research.”

Three Perspectives on WHO Inadequacies

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

Three key reports – from the Independent Oversight and Advisory Committee (IAOC), the Independent Panel for Pandemic Preparedness and Response (IPPR), and the International Health Regulations Review Committee (IHRC) – have laid bare various WHO failures in the face of COVID-19.

The IPPR presented its report to the WHA on Tuesday. This team was led by former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Sirleaf. Clark told Tuesday’s technical briefing the panel “has recommended the adoption of a pandemic framework convention within six months, using powers under Article 19 of the WHO constitution”. 

“We see the convention as being complementary to the International Health Regulations,” Clark said. “We think its negotiation should be facilitated by the WHO, with involvement at the highest levels of that negotiation of governments, scientific experts and civil society.”

This convention would fill gaps in the current legal framework, clarify the responsibilities of states and international organisations, reinforce states’ pandemic-related measures and support WHO’s empowerment, she said. 

It also would set up principles and mechanisms for financing preparedness and early response, and for the “global public goods of vaccines, therapeutics, diagnostics, and essential supplies and technology transfer.”

More pointedly, Clark noted that “WHO needs to have unfettered access to the sites of an outbreak, and it shouldn’t need to go through a negotiated process to get there.”

IHR review co-chair Lucille Blumberg said her committee also supports a pandemic treaty to address regulatory gaps that “mostly concern detection, assessment, and alert provisions, as well as preparedness for core capacities. … There are other elements required for a comprehensive global architecture for emergency preparedness and response which seem to fall outside of the IHR. 

“This has made us consider there may be benefits in agreeing on a global legal mechanism that would outline such provisions while supporting and complementing IHR implementation — and this could be done through a pandemic treaty,” Blumberg said.

Image Credits: Twitter: @WHOAFRO, WHO.

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

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

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

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

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

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

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

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

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

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

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

Assaults on Health in Conflict Situations

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

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

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

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

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

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

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

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

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

Trends in Violence Against Health Workers for 2021 

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

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

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

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

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

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

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

Actions Needed by States, the UN and WHO

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

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

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

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

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

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

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

Calling for Five Concrete Steps by Global Community

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

German Chancellor Angela Merkel

Push to Vaccinate 10% by September

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

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

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

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

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

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

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

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

Appeal for Travel Restrictions to be Eased

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

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

Dechen Wangmo, Minister of Health of Bhutan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Broad in Scope 

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

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

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

Evergreen, Elastic Vaccine Manufacturing Capacity – Keys to Practical Success

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

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

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

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

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

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

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

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

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

More Transparency Needed

Jamie Love, Director of Knowledge Ecology International

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

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

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

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

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

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

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

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

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

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

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

Scotland’s Fight Against Alcohol Abuse

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

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

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

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

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

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

Stop Incentivising Unhealthy Commodities

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

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

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

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

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

Public Health Policies Save Lives

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

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

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

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

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

Image Credits: rawpixel/unsplash.

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

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

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

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

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

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

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

EU to Propose Third Way at WTO Meeting in June

EC President Ursula von der Leyen

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

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

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

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

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

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

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

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

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

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

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

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

IMF Director-General Kristalina Georgieva

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    

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

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

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

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

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

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