The vaccine developed by Oxford University and AstraZeneca was one of the vaccines included in the study.

Striking through the politicised warnings and potentially hollow gestures, a new study has found that COVID-19 vaccines could remain out of reach until at least 2022 for nearly one- fifth of the global population – despite months of pleas and appeals to ensure their widespread global distribution.

The study, published in The BMJ, is the most systematic yet by researchers assessing publicly announced pre-orders of vaccines ahead of their regulatory approval, and where the doses will go.

On the plus side, in a best case scenario global production next year could create enough vaccines to immunize some 5.96 billion people by December 2021, the paper finds. That’s nearly 80% of the global population

However, current procurement patterns suggest that purchases may be very skewered – with rich countries stockpiling large amounts of vaccines and some poorer countries not receiving any at all, says the study.

The assessment, undertaken by a team of experts from Johns Hopkins Bloomberg School of Public Health, found that more than half of the 7.48 billion doses of the most advanced vaccines, which have already been pre-reserved, would be shipped to high-income countries, whose populations account for just 14% of the world total.

That leaves only about 40% of total doses available for distribution to low- and middle-income countries (LMICs), which comprise more than 85% of the world’s population – if rich countries don’t snap up even more.

Decisions on how equitably the remaining doses are distributed will thus determine whether a significant portion of the global population would be immunized by the end of the next year – other whether some countries still face large immunization gaps.

Peer Reviewed Study on Distribution Issue is a First

Discourse surrounding vaccine nationalism and equitable distribution has so far been delivered in large part through politicised messages or institutional warnings. The appearance of a peer reviewed study – and as the UK and US begin vaccinating their more vulnerable populations – provides a rigorous reminder that the COVID pandemic will linger long past the Global North’s immunisation.

That such a massive portion of the population – realistically, those living in low- and middle-income countries (LMICs) – would be left behind illustrates that the significant steps made this year towards achieving vaccine equity still is not enough.

EU Considers Donating 5% of Its Vaccines to LMICs

In related news, the European Union is considering an initiative whereby LMICs would receive 5% of the COVID vaccines the European Union (EU) has ordered.  However some critics say that the move could also undermine the aims of the WHO-led COVAX Facility to create a global pool of vaccine procurement and exchange, including poor countries.

An internal document drafted up by the French government, and secured by Reuters, set targets for vaccine donations, under the presumpton that EU would wind up with surplus doses – due to its pre-orders with a range of vaccine manufacturers with vaccines that have now been approved or are in advnaced stages of trials.

Donating 5% of the 1.3 billion vaccines the EU has so far secured would mean that up to 65 million vaccine doses could be administered to those living in LMICs.

It is so far unclear, however, whether the EU would donate 5% of its initial 280 million Pfizer/BioNTech and Moderna doses, given its population is nearly double that number – and those vaccines are the first becoming available to the public.

The plan could step on the toes of WHO’s own vaccine procurement program, COVAX, which aims to provide 2 billion shots to countries around the world by the end of 2021.

Dr Tedros Adhanom Ghebreyesus, WHO Director General, urged countries to “honor their pledges” to the COVAX Facility on Friday.

The arm of the COVAX scheme procuring supplies for LMICs, however, is still reliant upon donations in a period where rich countries have also seen big economic setbacks. And despite donation pledges from 64 high-income countries to the facility, which is co-led by Gavi, the Vaccine Alliance, WHO director general Dr Tedros Adhanom Ghebreyesus has said that billions more in support is still needed. At a recent WHO media briefing he urged leading donor nations to turn their pledges of support for the COVAX facility into action.

As one anonymous source working with COVAX told Reuters: “The more governments become active outside the (COVAX) facility, the more the international community as a whole starts to lean towards compromising the basic principles of equitable allocation.”

Image Credits: John Cairns.

Ella Adoo-Kissi-Debrah’s death in February 2013 was initially recorded as being caused by acute respiratory failure. It is now recorded as having been caused by acute respiratory failure, severe asthma and air pollution exposure.

Global health and air pollution advocates have hailed a landmark court case which has recognized air pollution as a factor into the 2013 death of a 9 year-old girl – for the first time in history.

On Wednesday, a Coroner Court in the United Kingdom ruled that air pollution was one of the causes of death of 9-year old Ella Kissi-Debrah, who lived with her mother near a heavily trafficked road in London, the South Circular. Ella has thus become first person in the UK – and potentially in the world – to have air pollution listed as a cause of death.

“Today was a landmark case, a 7 year fight has resulted in air pollution being recognised on Ella’s death certificate,” tweeted the Ella Roberta Family Foundation, that was formed in Ella’s name, and pursued the court battle to win her justice. “ Hopefully this will mean many more children’s lives being saved. Thank you everyone for your continued support.”

https://twitter.com/i/status/1339096906786426880

“Landmark case in UK! Air pollution recognized in Ella’s death certificate. Ella’s light guiding and Rosamund Kissi-Debrah fighting made the miracle. Our heart is full of emotions beating with Ella, Rosamund and the fantastic ‘duo’,” tweeted Maria Neira, WHO Director of Public Health, Environmental and Social Determinants of Health.

Ella Kissi-Debrah with her mother Rosamund in a family photo.

Ruling from coroner Philip Barlow stated an early 2014 court finding that had only attributed her death to respiratory failure, should be overturned, as Barlow said, “Ella died of asthma contributed to by exposure to excessive air pollution.”

“So, for the medical record cause of death, I intended to record 1A acute respiratory failure. 1B, severe asthma. 1C air pollution exposure. That is an agreement with the autopsy findings, and also the evidence of Sir Steven Holgate,” announced the Southwark Coroner’s court on Wednesday, reporting that Ella was exposed to nitrogen dioxide and particulate matter (PM) pollution in excess of WHO guidelines.

The initial 2014 inquest into the girl’s death in February 2013 had been recorded as acute respiratory failure, without taking into account any reference to environmental factors that caused the fatal collapse of the girl, who suffered from chronic asthma.

Her mother, Rosamund Kissi-Debrah knew nothing about the health impacts of air pollution, notably from particulate matter and nitrogen dioxide, closely associated with increased severity from asthma, while her daughter was still alive.

It was only when she launched a charity in her daughter’s name, The Ella Roberta Family Foundation,  to improve the lives of children with asthma in south-east London, that she began to stumble across the linkages.

The case was taken up by human rights lawyer Jocelyn Cockburn. Professor Sir Stephen Holgate, an immunopharmacologist and consultant respiratory physician of the University of Southampton and Southampton general hospital, heavily researched the case and produced a report linking air pollution levels to Ella’s death, also testifying in the repeated court hearings.

This Inquiry Played Out Differently Than the One in 2014

In 2019, the United Kingdom’s High Court granted a request from the family for a new inquest over the girl’s death, in light of the new evidence and research that had been gathered – sending the case back to London’s Southwark Coroner’s Court for another round of hearings.

In the 2019 hearing where the new inquest was granted, Judge Mark Lucraft said: “In our judgement, the discovery of new evidence makes it necessary in the interests of justice that a fresh inquest be held.”

The past two weeks in the Coroner’s Court played out a very different inquiry over what took the 9 year-old’s life. Government departments, officials from the local authority, and even Sadiq Khan, the Mayor of London were questioned about what they did – or did not do – to reduce illegal air pollution levels in the area where Ella lived, where levels of nitrogen dioxide air pollution from traffic constantly exceeded annual limits of 40 µg/m3 between 2006 and 2010.

The mayor said the coroner’s conclusion was a “landmark moment” and called pollution a “public health crisis.”

“Today must be a turning point so that other families do not have to suffer the same heartbreak as Ella’s family. Toxic air pollution is a public health crisis, especially for our children, and the inquest underlined yet again the importance of pushing ahead with bold policies such as expanding the ultra low emission zone to inner London.”

According to the WHO, air pollution kills an estimated seven million people worldwide every year, including 4.2 million deaths from outdoor air pollution generated by industry, road traffic, energy production and building heating, among other sources.

The most health-hazardous pollution components include PM 2.5, these fine particles measure 2.5 microns in diameter, meaning that 400 particles can be fit into a single millimetre. These tiny particles can not only enter the lungs but also penetrate into the bloodstream. Excessive levels of nitrogen dioxide, also emitted by vehicles, are closely associated with higher risks of chronic respiratory infections, including asthma.

UK scientists estimate that air pollution shortens British lives by an average of six months. The combined effects of outdoor and household air pollution cause about seven million premature deaths every year – with increased mortality from stroke, heart disease, chronic obstructive pulmonary disease, lung cancer, and acute respiratory infections. Evidence is also growing that it can limit the growth of children’s lungs.

Rosamund Kissi-Debrah told the coroner that had she known the air her daughter was breathing was killing her, she would have moved them away immediately. “We were desperate for anything to help her. I would have moved straight away, I would have found another hospital for her and moved. I cannot say it enough. I was desperate, she was desperate,” she said.

News of the Court Ruling Echos Globally

News of the court judgement echoed quickly around the world, sparking hopes that the landmark ruling may create a precedent that could prevent other children in Ella’s situation from suffering as she did. Advocacy groups for air pollution are already working on ensuring that children are saved from this ‘silent killer.”

Rosamund Kissi-Debrah appearing on television following the ruling.

The NCD Alliance said: “Heartfelt thanks for your tireless work to gain this landmark recognition. You and your family are heroes to so many of us now and to future generations.”

Professor Clare Horwell, an air pollution expert at the UK’s Durham University said: “This is a very important result. I want to say congratulations but that doesn’t feel right. Your enormous dedication has paid off. Ella can never be replaced but her legacy will be remarkable.”

“We celebrate this judgment with a heavy heart. But also huge admiration for a mum who just wouldn’t give up,” tweeted the Indian air pollution advocacy group Care for Air, based in Delhi, which suffers from some of the highest air pollution levels in the world.

Indian groups are already looking at  ways to pursue court claims over health damage wrought by air pollution. One India environmental activist told Health Policy Watch. “We are trying to do something around personal compensation,  and this would be a great precedent,” she said. “Our research is at a very vey early stage and we hope others will beat us to it. Yes, with strong advocates, we could use Indian courts … although with the current dispensation of the government, and compromised judges I am not sure it wouldn’t be dismissed.”

Let Me Breathe, another New Delhi-based platform tweeted:  “Ella died because of air pollution. Thank you [Rosamund Kissi-Debrah] for fighting this fight. It is a step to save many more children.”

Long Journey Though the Court Process

While the journey often seemed quixotic, Ella’s mother did not give up.  And along the way the determination of Rosamund snowballed, gathering her support from not only the world’s most famous air pollution and health experts, but also celebrity figures.

On Tuesday, just before the court case ruling was issued, former California Governor Arnold Schwarzenegger sent her a letter, saying:

“My thoughts are with you and your family tonight, ahead of the release of the coroner’s invest into Ella’s tragic death. I know this is the culmination of years of hard work on your part to have pollution’s terrible impact on your daughter acknowledged.  As a father, I cannot think of anything worse than what you have been through… You are a hero.”

In a statement issued just ahead of the court ruling, Rosamund said: “Professor Stephen Holgate who described the nine-year-old girl’s condition as ‘a canary in a coal mine’. It seems it was always going to end in a disaster no matter how hard we tried to maintain her. When your triggers are spikes in air pollution, I guess it was always going to end in heartbreak.”

“The past six years of not knowing why my beautiful, bright and bubbly daughter died has been difficult for me and my family, but I hope the new inquest will answer whether air pollution took her away from us,” she said in 2019, just after the new court hearing was granted.

“If it is proved that pollution killed Ella then the government will be forced to sit up and take notice that this hidden but deadly killer is cutting short our children’s lives.”

Now that proof has become a reality.

Image Credits: @rosamund_ElsFdn.

Rialto Bridge, Venice, deserted in lockdown – scene from the suppressed WHO report, “An Unprecedented Challenge.”

Second in a series: In the wake of the expanding media attention to a suppressed WHO report evaluating the early days of Italy’s COVID-19 pandemic response, WHO has begun circulating guidelines to staff for responding to the media over questions that have remarked about recommendations for Q&A

The internal WHO memo obtained by Health Policy Watch  instructs staff to tell the media that the report An unprecedented challenge was recalled after WHO “found some factual inaccuracies related to the timeline of the pandemic – and that the data had not been properly verified.”

The detailed guidance – entitled “Reactive Q&A in case of media questions” and red-marked “Internal- do not share”  provides no details about what “factual inaccuracies” were in fact unearthed in the report – which had undergone multiple layers of formal WHO review and approval before its publication on 13 May – and subsequent removal. 

Framed as a Mock Q&A 
WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 1

Framed as a  mock Q &A, the WHO guidance  poses questions that the media may ask about the report in forthcoming days – and provides explicit instructions for how WHO staff should respond.  

More than corporate guidance, however, the tone and detail of the mock responses build a corporate narrative that clearly supports the moves made in May by WHO Assistant Director General Ranieri Guerra, a political appointee handpicked by WHO Director General Tedros –  to bury the report – against the views of the career professionals that developed it.    

The WHO recommended media “answers” shape a public narrative supporting Guerra’s attempts to change or remove key report sections that were critical of the Italian government’s preparedness efforts – over the objections of professional staff that said this amounted to political censorship.   

The report, compiled by a large WHO team, under the direction of Francesco Zambon, WHO’s coordinator of  the WHO European Office for Investment for Health and Development, Venice, had undergone multiple layers of scientific review and publications approval prior to being published.

Street vendor in Italy – Scene from the suppressed WHO Report, “An Unprecedented Challenge”

It was withdrawn by WHO just a day later – in what critics say amounted to a worrisome act of political censorship – led by ADG Guerra who had a vested political interest in seeing to the report’s suppression.   

Guerra, a former senior official in Italy’s Health Ministry, was in charge of the country’s prevention activities during his 2014-2017 term in the government. It was a period when a national pandemic plan dating from 2006 was supposed to have been updated according to an 2013 European Commission request. But the plan was not updated.   

WHO Assistant Director General, Ranieri Guerra

Guerra  reportedly sought to blur the WHO record over that omission by ordering Zambon to amend language in the WHO report to state the opposite – that Italy’s pandemic plan had been “updated” in 2016.  

Zambon refused, according to a lengthy series of Health Policy Watch interviews with Italian and WHO insiders. Those were supported by a series of leaked email exchanges between Guerra and Zambon over the censorship issues, first published several weeks ago in Italy’s highly-regarded RAI Report TV series. 

Francesco Zambon,  WHO European Office for Investment for Health and Development

Yet another new email, detailing Zambon’s subsequent protests to his boss, Hans Kluge, head of WHO’s Regional Office for Europe, over the pressures that Guerra had applied, was disclosed in a story Tuesday by Health Policy Watch. 

In the  27 May email to Kluge, Zambon described the pressures Guerra had applied – and warned of the impacts to WHO’s credibility and independence that could occur as a result of political censorship moves.  

Zambon attributed the pressures to Guerra’s own fears of political embarrassment – due to his own failure to update the 2006 pandemic plan.   

WHO Soundbites Deflect Charges that Censorship Was Inappropriate  
WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 2

Over the past weeks, the Italian media obsession with  “An unprecedented challenge” – the report’s origins and suppression – has spread internationally.  Observers also see it as a bellwether for how WHO may also handle other, even more contentious investigations ongoing now into the global pandemic response and the origins of the SARS-CoV2 virus that first emerged in Wuhan, China. 

Critics wonder if those forthcoming WHO reports also be reviewed in light of their politically correctness – and cleansed of language critical of any government in the world or any former national government official with political influence in WHO?  

In the case of the Italian report, the internal WHO media guidance, sets a standard for that – deflecting complaints over Guerra’s attempts to alter the report  – and justifying his attempts to censor unflattering phrases. 

Has WHO been covering up for Italy? 

This is one of the key questions in the mock series that the WHO guidance poses. 

WHO response: No, WHO engages in frank and forthright communications with governments on an ongoing basis. The organization undertakes all activities impartially and without fear of retribution or expectation of favor. 

However, there are emails from WHO staff saying that they were doing that. WHat can you say about this?

WHO response: Those messages refer to avoiding unnecessary criticism of Italy at the most difficult time in the response. This had nothing to do with covering up information.  A pandemic response should focus on saving lives. We have a mechanism for counties to evaluate their respective response and offering guidance for effective response.

The media statements also pin the blame onto Zambon for not involving the Italian government directly in the redaction of what was supposed to be an independent review of Italy’s pandemic response – and one in which Guerra was the named liaison. 

WHO Refuses Italy’s Request to let Staff Testify in Investigation Over Pandemic Response 
WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 3

The WHO memo further states that WHO will refuse Italy’s recent requests to allow Zambon testify in an ongoing Italian investigation into the management of the pandemic’s early days  – in the northern region of Val Seriana – which was particularly hard hit.  

Italy’s Ministry of Foreign Affairs sent the request to WHO’s Director General Dr. Tedros Adhanom Ghebreyesus requesting permission for  Zambon to be interviewed by the legal team investigating the slow and faulty government response to the pandemic in the region.  This is after Guerra did already provide testimony to the prosecutors. 

WHO’s mock response to questions about the legal case states: 

“WHO staff are international civil servants. The organization and its employees undertake all activities impartially and without fear of retribution, expectation of favour. To preserve its objective and independence, the organization does not become involved in any political administrative or legal matters at the national level.”

[If pressed] the guidelines state that WHO staff should add:  “Rainieri  Guerra spoke with the Bergamo authorities in his personal capacity, WHO did not authorize him to speak to the prosecutor.”

With regards to Zambon specifically, the WHO memo instructs staff to state: 

“If Dr Zambon testifies in his personal capacity, he cannot speak about any matters related to WHO, his work or function with WHO, other WHO officials, or disclose or refer to any documents or information owned by WHO, including correspondence or verbal exchanges,” states the guidance from WHO about how to respond to media inquiries about the legal investigation, adding. 

“WHO has requested information from the Prosecutor and the Ministry of Foreign Affairs of Italy and has offered to reply to written technical questions in writing. No reply to these questions has been received.” 

Page 4
WHO Confirms  – Using Guideline Soundbites Word For Word

Asked Tuesday night by Health Policy Watch about the pending Italian request for Zambon to testify, a WHO European Office spokesperson replied, using the memo’s guideline language, almost word for word.  It stated: 

“WHO has requested information from the Ministry of Foreign Affairs of Italy (from the prosecutor) and has offered to reply to written technical questions in writing. No reply has been received.

“WHO staff are international civil servants. The organization and its employees undertake all activities impartially and without fear of retribution or expectation of favour. 

“To preserve its objectivity and independence, the organization does not become involved in any political, administrative or legal matters at the national level. 

“Ranieri Guerra spoke with the Bergamo authorities in his personal capacity. WHO did not authorize him to speak to the prosecutor. If Dr Zambon decides to testify in his personal capacity, he cannot speak about any matters related to WHO, his work or function with WHO, other WHO officials or disclose or refer to any documents or information owned by WHO, including correspondence or verbal exchanges.”

WHO Narrative Justifies Guerra’s Attempts to Suppress Report’s Critical Phrases 

Among the other key points covered in the WHO narrative of the doomed report as it is to be presented to the media, are the following:   

Censorship: “Did Ranieri Guerra censor the report?  “No, that was an internal WHO decision taken at the level of the Regional Office. The document was removed because it contained some factual inaccuracies related to the timeline of the pandemic,” states the memo. 

Official status of document: Although the report, had gone through all the layers of official WHO approval and bore a WHO copyright and logo, the WHO memo instructs staff to say that it “was not an official WHO document” and was “never sent to the [Italian] Ministry of Health, which therefore has never assessed or commented on it” according to the memo. … . 

Deletion of embarrassing phrases: The WHO memo defends Guera’s attempts to remove a report reference to the initial hospital response as “improvised, chaotic and creative?”. 

Pandemic plan update: In a mock question that asks:  “Is it true that Italy’s pandemic plan had not been updated since 2006, and the initial response from hospitals was “improvised, chaotic and creative?” WHO replies stating: “The COVID-19 pandemic has been unprecedented and many countries have faced huge challenges, including Italy. Italy was the first country in the European Region to be hard-hit, with the situation escalating in a matter of days. The initial response was particularly complex.  However, words like ‘improvised, chaotic and creative’ do not do justice to the tremendous efforts of the Government and the regions.”   

Cover-up:  While denying that WHO has been “covering up for Italy,” the memo effectively defends Guerra’s attempts to squash or alter key statements in the report on the basis that they would be embarrassing to the Italian government. If reporters asked about the “leaked emails from the Regional Director appearing to keep the report under wraps” WHO officers should reply as follows: “The message referred to the importance of engaging with the national counterpart, which is a normal practice to check data and facts.. However the Minister of Health of Italy was apparently not informed in an appropriate way and in due time”. 

WHO internal guidelines for responding to journalists’ queries about the suppression of the WHO report “An unprecedented challenge” on Italy’s pandemic response – Page 5
Zambon – Italian Ministry Of Health Could Not Co-Author Independent Report    

The independent review of Italy’s response had passed through all of the usual WHO publications approvals – before Guerra noticed language that he found politically sensitive, and demanded changes in specific texts in a series of emails to Zambon around 11 May.  

In his 27 May email to WHO’s European Regional Director, Hans Kluge, disclosed by Health Policy Watch in a previous story, Zambon had stressed that Guerra was the person who had been tasked with conveying an outline of the report to the Minister of Health Robert Speranza in April.  

And Guerra also was interviewed by one of the report’s co-authors, so he was therefore “fully informed.” If he did not convey the outline to them, “he is directly responsible for the incident with the Minister/President ISS   [Italy’s National Health Institute  (Istituto Superiore di Sanità, ISS)], that he not only created, but ignited,” recounted Zambon.   

However, in order to preserve the independent nature of the WHO review, Zambon said, the report was never intended to be directly co-authored with Italy’s Ministry of Health. At stake, is: “WHO independence – This is an independent review.  I cannot see how this could be written together, nor reviewed by the involved parties such as the MOH, ISS as suggested.” 

Zambon also warned Kluge about the damaging precedent the censorship move could set in light of the recent World Health Assembly mandate to WHO to carry out other politically charged  investigations into the global pandemic response and the origins of the SARS-CoV2 virus – which have already encountered political resistance from China. 

WHO Response to Health Policy Watch  – ‘We Won’t Discuss Factual Inaccuracies’ 

Asked in a follow-up email from Health Policy Watch Tuesday evening to detail what were the factual inaccuracies that led to the withdrawal of the report, a WHO spokesperson declined to say:

Q. Health Policy Watch: What specifically are the errors in the report?  Since the report is online and circulating widely, please be specific with an actual date, number or other factual information that you found, post-publication, to be so incorrect that the report had to be withdrawn – rather than merely corrected?

WHO:  We are not going to discuss factual inaccuracies. 

 

 

The new initiative is intended to support young people who will join a workplace changed by the COVID-19 pandemic, including the 1 billion children worldwide who have missed out on education.

As the dust began to settle in June 2009 in the aftermath of the global recession, 81 million young people found themselves out of work, as the youth unemployment rate rose to 13%.

But unemployment as a result of the COVID-19 pandemic – with 1 in 6 young people worldwide having already lost their job – is expected to far exceed that figure if there is no policy intervention. Even among those still in work, working hours (and subsequently wages) plummeted, with the Americas and Central Asia seeing an 18% and 14% drop respectively.

And for those yet to enter the workforce, 2020’s economic fallout could very likely leave a deeper scar lasting for years to come: more than 1 billion children and young people have been kept out of education this year, as schools and universities closed around the world.

It was up against this backdrop that the World Health Organisation (WHO) and the UN Foundation launched its new initiative to invest in youth-led solutions to the pandemic, in collaboration with the world’s largest youth movements.

Speaking at a press briefing on Monday, WHO director general Dr Tedros Adhanom Ghebreyesus, confirmed the Organization would be providing US$5 million to support the Global Youth Mobilization for Generation Disrupted scheme.

“We hope that it will become a platform for supporting progress towards other health goals, including universal health coverage (UHC),” he said, adding that the youth voice is crucial in creating effective supportive policies.

In January 2021, the initiative will issue a call for proposals from youth groups to determine youth-led COVID solutions, ahead of a Global Youth Summit in April 2021.

The scheme is supported by the Big 6 Youth Organisations, consisting of: YMCA and YWCA, the World Organization of the Scout Movement, the World Association of Girl Guides and Girl Scouts, the International Federation of Red Cross and Red Crescent Societies, IFRC, and The Duke of Edinburgh’s International Award.

The full announcement can be read here.

Image Credits: Source: Allison Shelley/The Verbatim Agency for American Education.

Although world leaders have tested positive for the virus over the past year, Dlamini’s death – within weeks of a positive test – is a first.

Ibadan, Nigeria. Ambrose Dlamini, eSwatini’s Prime Minister, has become the first world leader to die after testing positive for COVID-19. His death sends a clear and chilling message across Africa: the worst days of the pandemic are not behind us.

Dlamini passed away on Sunday 13 December in South Africa, where he was receiving treatment after his condition worsened two weeks ago. This followed a positive test for coronavirus in mid-November. The government’s official statement on its Prime Minister’s death did not state a cause.

The late Prime Minister, who will be buried in a state funeral, had held office since October 2018.

Although many world leaders have tested positive for the virus over the past year, including US President Donald Trump and Brazil’s Jair Bolsonaro, Dlamini’s death – within weeks of a positive test – is a first.

eSwatini, formerly Swaziland, is to the northeast of South Africa.
HIV Response Has ‘Lost a Champion’: eSwatini Was First African Country To Meet 2030 HIV Targets

Under his leadership, eSwatini, a small landlocked country adjoining South Africa, became the first on the country to meet UNAIDS’ 95-95-95 targets to end the HIV/AIDS epidemic by 2030.

UNAIDS’ Winnie Byanyima said: “The HIV response has lost a champion.”

95% of people living with HIV in eSwatini know their status, 95% of people who know they are HIV-positive have accessed treatment, and 95% of people on treatment have suppressed viral load. eSwatini and Switzerland became the first in the world to meet these targets, back in September.

At the time, he urged the population not to rest on its success, nor to be discouraged by setbacks. “We must ensure that no one is left behind. We must close the gaps,” he added. “We are aiming for 100–100–100.”

In September, Dlamini told Health Policy Watch that, while his country is not fully equipped to deal with pandemics, it had successfully leveraged its HIV/AIDS response to expand capacity to treat members of the population with COVID-19.

“We’ve developed some capacity that we are going to leverage going forward,” he said. “We are going to use the national response framework which has really done well, providing us with capacity over the years. We want to develop it so the country to deal with future pandemics.”

Speaking about his death, UNAIDS Executive Director Winnie Byanyima said: “The HIV response has lost a champion.

“He was a friend of UNAIDS and helped to steer his country to great successes in the HIV response. We will miss him.”

eSwatini’s Rising COVID Case Rate is a Warning for the African Continent

But despite all of this, eSwatini has struggled to keep COVID cases from rising. The country has the 6th highest infection rates of SARS-CoV-2 on the continent, with 5,855 confirmed cases per million population. The continent’s average is 1,765: three times less.

And although Africa has repeatedly dashed expectations during the pandemic, faring much better than most developed countries, that infection rate in eSwatini is growing aggressively: a trend found in its neighbouring countries.

According to eSwatini’s health ministry, among its population of 1.1 million, the country has recorded 6,768 cases and 127 deaths, leaving a case fatality ratio (CFR) of 1.9%, only slightly lower than the global CFR at 2.2%.

Lizzie Nkosi, the country’s Minister of Health, confirmed reports of recent increases in the number of COVID-linked deaths, flagging that the rise was particularly significant among people with co-existing medical conditions like diabetes, hypertension, cardiac disease and asthma.

“We therefore urge the public to ensure that they do medical check-ups regularly, at least once a year and those diagnosed with a chronic illness should adhere to the treatment as advised by the health workers,” the ministry stated.

This warning came 11 days before the Nigeria Center for Disease Control (NCDC) announced it had recorded “a sharp increase” in the number of COVID-19 cases across the country between 30 November and 6 December, sparking fears of an imminent second wave.

NCDC added that the proportion of people who were COVID-positive among those tested had increased from under 4% to 6% compared to the previous week – still lower than the continental average of 10.7%.

Elsewhere, in Tunisia, more than 1 in 5 COVID tests returned positive results, marking the highest positive test rate in Africa.

Despite the Surge, African Health Leaders Fear They May Not Get Vaccines Until Mid-2021

This all comes as the continent watches countries in the Global North begin their COVID-19 vaccination campaigns. Africa is not expected to have access to vaccines until mid-2021. And as the holidays fast approach, Africa’s national and regional health authorities are concerned that citizens also are ignoring recommended guidelines.

Earlier in December, Dr. John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) told Health Policy Watch that the gains made on the continent regarding the control of the pandemic are being threatened.

To compensate, African leaders need to be more vocal in encouraging citizens to embrace and adhere to guidelines: “My greatest concern and fear is that the gains we’ve worked so hard to achieve may be eroded significantly if we relent [in] our public health and social measures. We need to go back to the basics – washing hands, keeping our distance, and most importantly, wearing masks.”

The daily confirmed COVID-19 cases per millions people, in Nigeria, Tunisia and across the continent.

But the key messages shared by Nkengasong and other public health officials aren’t attracting much attention. Among other political and business leaders and the general public, the widespread feeling is that stricter measures and adherence, as proposed, would extort a significant toll on mental and physical health, and on national economies: as is the case around the world.

In African countries like Nigeria, as well, many people have yet to come to terms with the fact that the pandemic threat is real.  In July, Health Policy Watch reported that the city’s leadership and a significant proportion of the general public do not consider the threat of COVID-19 to be strong enough to halt education or put families out of work.

Despite the surge in cases seen in Nigeria, outdoor events are already returning, with indoor events also potentially on the horizon. On the other side of the continent, elections in Uganda have caused considerable mass gatherings for political rallies, with subsequent infection surges. And this is not deterring Ghanaians, who are now massing for their own election events. Even though regulators are advising against travel, citizens are doing so regardless.

The laissez faire attitude has been attributed by public health experts as a result of the continent’s comparative success in handling the pandemic earlier in the year, as developed countries collapsed under the strain.

Perhaps the news of Dlamini’s death could convince populations across Africa that the sky is yet to fall on the continent. It could be that this visualises the human cost of the pandemic in a way that data can’t. Regardless of the outcome, it is clear that for Africa the worst days are not yet behind it.

Image Credits: World Economic Forum, Johns Hopkins University & Medicine, World Economic Forum.


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UK Health Secretary Matt Hancock.

Sixty different local authorities in England have reported around 1,000 infections caused by a new COVID-19 variant.

The variant is not thought to have an impact on disease severity or mortality, or on the efficacy of a vaccine. It has been reported to WHO.

Health Secretary Matt Hancock said in Parliament today: “We have identified a new variant of coronavirus which may be associated with the faster spread in the South East of England. Initial analysis suggests that this variant is growing faster than the existing variants.”

“WHO [is] working together with scientists around the world, evaluating each of the variants that are being identified,” said Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead, in a press briefing on Monday.

She added that studies designed to understand the “virus’ behaviour, its ability to transmit or its ability to cause different forms of disease” are “underway in the UK”.

The UK is currently experiencing a sharp rise in cases, notably in London, the South East and South Wales.

“Above all, this is a reminder that there is still so much to learn about COVID-19 … The speed at which this has been picked up on is also testament to this phenomenal research effort,” said Dr Jeremy Farrar, Director of Wellcome. “However, there is no room for complacency. We have to remain humble and be prepared to adapt and respond to new and continued challenges as we move into 2021.”

He added that there will be surprises in how the virus “evolves and [in] the trajectory of the pandemic in the coming year.”

The full statement delivered by Matt Hancock is available here.

In the world’s 47 least-developed countries, 50% of healthcare facilities lack basic water services and 60% lack sanitation services. The former is the first line of defence against any infectious disease.

One out of every four health facilities worldwide lacks even the most basic access to water supplies. And in the world’s 47 least developed countries, one in every two facilities lacks such access, according to a new WHO report, co-authored with UNICEF, on access to water, sanitation and hygiene (WASH) in health care facilities.

The report also found that one out of every 10 health facilities, including hospitals, lack sanitation services, and one out of three lack facilities basic waste management services to dispose of health care waste – waste that has exploded during the pandemic with the expanded use of personal protective equipment, SARS-CoV2 testing materials alongside the large amounts of disposable waste that is routinely generated.

The dearth of safe water and sanitation facilities is most dire in the world’s 47 least-developed countries (LDCs), where three in five health facilities lack basic sanitation services, and seven out of 10 facilities fail to segregate and manage infectious healthcare waste management adequately.

The net result is that nearly 2 billion people who rely on those health services, as well as the healthcare workers employed in them, are at heightened risk of infections, including from COVID-19, in the midst of the current pandemic.

The new report Fundamentals first: Universal water, sanitation, and hygiene services in health care facilities for safe, quality care, published on Monday, comes only days after Universal Health Coverage Day was observed.

WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“Working in a healthcare facility without water, sanitation and hygiene is akin to sending nurses and doctors to work without personal protective equipment” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General on Monday.

“Water supply, sanitation and hygiene in health care facilities are fundamental to stopping COVID-19. But there are still major gaps to overcome, particularly in least developed countries.”

The report follows an initial baseline analysis last year of WASH in healthcare. The new report is far more comprehensive than last year’s analysis, providing a more robust profile of the situation around the world, Tom Slaymaker, Senior Statistics & Monitoring Specialist at UNICEF, told Health Policy Watch.

Specifically, this year’s report includes data from 165 countries and 794,000 facilities, compared to last year’s data from 125 countries and 560,000 healthcare facilities.

But large gaps in data remain, he stressed, in global estimates for sanitation, hygiene and environmental services coverage.

Countries Are Off Track When it Comes to Universal Access

Despite some pockets of progress, the report warns that countries are “significantly” off track to achieve universal access to basic WASH services within a decade.

While 85% of the 47 least developed countries surveyed undertook situational analyses on access to WASH services, less than a third have costed out new national strategies to improve the situation. And only 10% have integrated WASH indicators into monitoring of national health systems. This includes just 5 countries: Benin, Serbia, Lebanon, Thailand and Nigeria.

Every dollar invested in hand hygiene alone in health care facilities can generate a return of US$15, OECD found in 2018.

“During these unprecedented times, it’s even more clear how fundamental WASH is for prevention of infections and improving health outcomes,” said the World Bank’s Global Director of Health, Nutrition and Population, Muhammad Pate. “We must work even closer together to ensure that WASH is included in all interventions and at scale.”

Funding WASH in healthcare facilities is among the most cost-effective investments that governments can make, emphasized Jennifer Sara, Global Director for Water at the World Bank Group. Every dollar invested in hand hygiene alone in health care facilities can generate a return of US$15, the Organisation for Economic Co-operation and Development (OECD) found in 2018.

“For millions of healthcare workers across the world, water is PPE,” she said. “It is essential that financing keeps flowing to bring water and sanitation services to those battling the COVID crisis on the front lines.”

WASH is Fundamental to Sustainable Development Goals & COVID-19 Response

As populations around the world anticipate a COVID-19 jab, access to WASH services in healthcare facilities has become more critical than ever before. For healthcare workers – who have borne about 15% of the global COVID-19 case toll, even though they account for only 3% of the world’s population – this is especially pressing

“Many [healthcare workers] have fainted after wearing PPE for a long time,” one nursing officer in India was quoted as saying in the report. “We are dehydrated and not drinking enough water. Nurses are being diagnosed with urinary tract infections – it starts leaking and you want to talk about dignity!”

healthcare workers constitute about 3% of the world’s population but have borne about 15% of the global COVID-19 case toll.

Inadequate WASH services can also fuel neglected tropical diseases, which affect 1 in 5 people worldwide, mostly in low- and middle-income countries (LMICs). They also account for 11 million sepsis deaths a year, a preventable life-threatening condition, predominantly affecting newborn children, pregnant or recently pregnant women, as well as those living in LMICs.

In Malawi, where maternal mortality is 30 times higher than in high-income countries, a midwife said in the report: “I remember vividly [when] we had to take women who had just given birth to a nearby river to wash. It would take 45 minutes. Some would collapse along the way. I felt sad for them. But there was no running water at the health facility.”

Apart from infection control and prevention, access to WASH services can also curb antimicrobial resistance, improve quality care, and bolster health system resilience.

Image Credits: UN Water, UNECE, Government ZA.

The WHO Director General said that COVAX is “in danger of becoming no more than a noble gesture” if funding is not secured.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus on Friday issued yet another plea to leaders of rich countries to “honor their pledges” to fund COVID-19 vaccines sufficient to immunize the highest risk groups across the world.

He spoke a day after South African officials raised the spectre that the world was heading towards a state of “vaccine apartheid” whereby rich countries would be able to immunize large sections of their population with vaccines now coming on the market – to which poor countries would not get rapid and widespread access.”

“Our political leaders have pledged to make vaccines a global public good, but that pledge has to be translated into action,” said Dr Tedros, speaking at a Friday WHO press conference.

“I call on world leaders to honor their pledges,” he added. “Sharing the vaccine and having the inoculation everywhere means faster recovery and it’s in the interest of each and every country in the world, lives and livelihoods will get back to normal.”

Speaking earlier in the week at a UN high level meeting, the WHO DG said that COVAX is “in danger of becoming no more than a noble gesture”.

Soumya Swaminathan, WHO Chief Scientist.

Countries also need to ensure that they have logical distribution plans at the domestic level – so that people most at risk of dying from COVID-19 will get the vaccines first, said WHO’s Chief Scientist Soumya Swaminathan, also speaking at the WHO Friday briefing.

“The fact is we are going to have limited doses all over the world, and we need to prioritize those at highest risk of getting the infection and dying from the infection – those are the front line health care workers and the elderly. The rest of us have to be more patient, and rely on the [masking and social distancing] measures we have already been using,” said Swaminathan.

WTO Member States Fail To Agree On “Waiver” For COVID-19 Vaccines & Medicines

WHO has tried to persuade rich countries to come up with some US$ 4.3 billion immediately and US$ 28 billion over the next year, to adequately fund vaccines, medicines and tests through its massive ACT Accelerator Initiative.

Arguing that philanthropy is no longer the solution to the gaping disparities in access to COVID health products that is emerging, South Africa and India have been leading a countermeasure – a World Trade Organization initiative for a broad intellectual property (IP) waiver on any COVID health products.

The proposed waiver would cover patents, copyrights, trade secrets and industrial designs – a measure that the sponsors say would allow low- and middle-income countries to legally acquire and use proprietary technologies more easily than is possible under the current exceptions available for health emergencies under the WTO TRIPS Agreement (Trade-Related Aspects of Intellectual Property Rights).

However the measure was shelved for the time being after Thursday’s WTO meeting, where developed countries, including the United States and members of the European Union blocked advancement of the waiver proposal.  The measure had won the support of a large bloc of low- and middle-income countries in Africa, Latin America and Asia – although other big powers such as China and Russia have also straddled the fence.

South Africa, in its remarks at the meeting, charged that the opponents would be “reinforcing vaccine apartheid” by their inaction.

The proposal, originally submitted to the WTO on 2 October asks that the Organization allows countries to suspend the protection of certain kinds of IP related to the prevention, containment and treatment of COVID-19. Under the proposal, the wiaver would last until widespread COVID-19 vaccination is in place globally, and when the world’s population has developed immunity to the virus.

Despite support from countries including Kenya, Jamaica and Argentina, objection from larger members has meant that the proposal has been shelved until the next meeting in March.

Negotiators have argued that countries in the global South lack an “enabling” environment to develop vaccine industries. “Manufacturers should be able to go ahead and produce without being sued for infringing intellectual property rules,” one expert was reported as saying after yesterday’s negotiations.

Patents, IP and other legal barriers severely hinder a country’s ability to access tools like vaccines and treatments in a timely manner, the South African delegation argued.

“Those delegations opposing the waiver proposal have repeatedly suggested that voluntary approaches offer the best solution,” stated South Africa in its closing arguments Thursday. “As would have been emphasized, the TRIPS waiver proposal is supportive of any voluntary licenses issued by companies, however the terms of such licenses are often such that they may restrict access or reserve supply only for wealthy nations.

“Similarly, for vaccines, bilateral deals are being signed by pharmaceutical companies with specific governments but the details of these deals are mostly unknown. Usually these agreements are for manufacturing of limited amounts and solely supplying a country’s territory or a limited subset of countries.”

The delegation also pressed for information on the European Commission’s IP action plan, which calls for the “voluntary pooling and licensing of intellectual property related to COVID-19 therapeutics and vaccines … to promote equitable global access as well as a fair return on investment”.

In its address, South Africa also questioned how the EU intends to act on its “lofty rhetoric”, citing that there has been limited transparency or explanation as to the mechanisms it proposes that would enable the pooling of IP.

Among the opponents, Canada was among the high-income countries that appeared to be seeking a mediating role. It urged WTO members to continue discussions based on “mutual understandings and consensual solutions” – although its statement also suggested that the “overall TRIPS system works well”. Countering that, advocates pointed to a recent South Centre study of IP regimes and TRIPS flexibilities in almost 30 African countries, which found that the regime is is “far from optimal”.

A handful of other middle and high-income countries countries, including Kenya, Jamaica and Argentina also expressed favorable views about the proposal. But the overriding objections from most of the WTO’s most industrialized member states effectively means that the WTO TRIPS Council – which oversees the WTO agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) –  will be shelved for the time being.

The next TRIPS Council meeting is in March 2021; meanwhile members have agreed to submit an oral status report to the General Council for next week.

Pardoxically, the meeting came just a day before the Medicines Patent Pool, a UN-backed organization, celebrated its 10 year anniversary. The MPP was created to facilitate access to medicines through voluntary licenses with patent holders. Over the past ten years, MPP has secured 15 billion doses of HIV, hepatitis and tuberculosis medicines across 141 countries.

COVAX: Insufficient Funds and Targets?

In Thursday’s debate South Africa also drew attention to the failings of the COVAX facility so far to raise sufficient funds for the massive distribution of 2 billion vaccine doses, sufficient for immunizing 1 billion people in 2021. So far, the facility has raised funds and made deals for the procurement of about half that amount of vaccine doses, said Dr. Tedros on Friday.

But even if the COVAX Facility’s 2021 targets were met, those would be “insufficient to meet global needs of the 7.7 billion people of this world”, South Africa said in its statement at the WTO meeting.

The COVAX target to provide 245 million courses of treatment for low- and middle-income countries is insufficient, the delegation said.

It noted that the targets to immunise 1 billion people globally, and bring 245 million courses of treatment and 500 million diagnostic tests to low- and middle-income countries are not enough to make equitable care and timely access “a reality.”

And anyway at the moment, South Africa charged, “more than 90% of all future production of likely vaccine candidates being reserved for rich developed countries”.

“Ad hoc, non-transparent and unaccountable bilateral deals that artificially limit supply and competition cannot reliably deliver access during a global pandemic,” warned South Africa on Thursday. “These bilateral deals do not demonstrate global collaboration but rather reinforces ‘vaccine apartheid’ and enlarges chasms of inequity.“

Switzerland, for instance, has already bought up some 16 million vaccine doses through bilateral deals with Pfizer, Moderna and AstraZeneca, enough to vaccinate its entire population, in spite of the fact that half of the country’s citizens have declared that they would not want to get a COVID-19 jab, even if it were proven to be safe and effective.

Image Credits: WHO, Eli Lilly.


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Commissioner Stephen Hahn said that the FDA had notified the officials handling vaccine distribution logistics for the US’ ‘Operation Warp Speed’ so they can begin timely execution of their plans.

United States Food and Drug Agency Commissioner Stephen Hahn Friday said that the agency will “rapidly work toward the finalization and issuance of an emergency use authorization” for the cutting edge Pfizer/BioNTech COVID-19 vaccine – following a vote by an independent FDA expert panel on Thursday recommending that the vaccine be approved.

Hahn said that the FDA had notified the US Centers for Disease Control and Prevention and officials handling vaccine distribution logistics for the US’ ‘Operation Warp Speed’ “so they can execute their plans for timely distribution” of the vaccine across the country. Currently, the US has more than 6 million active cases of COVID-19 and is seeing new cases reported at a rate of 200,000 a day.

The daily confirmed cases in the current 10 most affected countries.
US FDA Approval – Signal For WHO & The World

US FDA approval will not only open the floodgates of vaccine distribution in the United States. As the world’s flagship regulatory agency, it will send a strong signal to the rest of the world that the vaccine is effective and safe. The European Medicines Agency is next set to review the Pfizer request on 12 January.

To speed up regulatory approvals elsewhere in the world, WHO will also be issuing its own “Emergency Use Licenses (EUL)” for quality-assured vaccines, WHO Chief Scientist Soumya Swaminathan said at WHO’s Friday press conference.

She noted that the WHO assessments would be done with a number of other national regulatory agencies – and could then provide a  “stamp of efficacy and manufacturing quality”, upon which other countries could rely. The approvals would also support more rapid distribution of vaccines through the WHO co-sponsored COVAX vaccine facility.

Soumya Swaminathan, WHO Chief Scientist.

“We have asked countries to either accept the WHO EUL or another stringent regulatory agency approval,” said Swaminathan. “What we don’t want is for every country to start their own national assessment because that will take a lot of time.”

She said that WHO will review vaccines submitted to the agency for approval on a rolling basis as Phase III trials are completed.

“We expect in the coming weeks we will be reviewing the Pfizer-BioNTech vaccine and coming out with something,” Swaminathan said, adding that she expected the Moderna and AstraZeneca vaccines to be next in line.

“Products issued by a stringent regulatory authority can also be used by the COVAX facility so there will be no barrier to speedy use,” added WHO’s Bruce Aylward, a senior advisor to the WHO Director General.

FDA Recommendation Is Not Without Reservations – Concerns About Vaccine Allergy & Hesitancy

Thursday’s 17 to 4 vote, with 1 abstention, by the Vaccines and Related Biological Products Advisory Committee (VRBPAC) reflected the overall high level of confidence that the vaccine had earned – but also some reservations.

Those centered largely around the safety of vaccines in young people and other vulnerable populations, as well as how vaccination centres would cope with potential allergic reactions – following two instances in the United Kingdom, which began rolling out the vaccine on Tuesday.

Reports of UK healthcare workers experiencing allergic reactions to Pfizer’s vaccine may have a negative impact on vaccine uptake in the US, the panel noted.

Two healthcare workers in the UK experienced allergic reactions after their injection on Tuesday, leading the British Medicines and Healthcare products Regulatory Agency (MHRA) to issue a warning that anyone with a history of severe allergies should refrain from getting the jab.

The two workers – who are believed to have suffered anaphylactoid reactions (less severe than anaphylaxis) – had a history of allergies, and are recovering well.

While there is currently not enough data to suggest how likely or severe a reaction could be, the FDA experts expressed concerns about how public concerns around allergic reactions could also impact vaccine uptake.

Tens of millions of Americans with a history of severe allergic reactions could now be hesitant to receive an injection, Paul Offit, vaccinologist from the Children’s Hospital of Philadelphia, said during the FDA panel meeting, which was broadcast live.

The FDA expert review group was already aware of the possibility that the Pfizer vaccine could cause an allergic reaction, prior to the occurrences in the UK when it launched its vaccination campaign on Tuesday.

This could have a significant impact on attempts to reach high levels of overall immunity, even as the most recent surveys show that the number of Americans willing to be vaccinated has risen to 6 in 10.

However, the FDA expert review group was already aware of the possibility that the Pfizer vaccine could cause an allergic reaction, prior to the occurrences in the UK.

Pfizer’s draft EUA had been updated several weeks ago warning that anyone with an allergy to a component of the vaccines should not get it, said Marion Gruber, director of the office of vaccines research and review at the FDA.

Equipment for dealing with severe allergic reactions should therefore be available on vaccine sites, the EUA draft request stated.

Questions Remain: Can Pregnant Women and 16 Year Olds Get the Vaccine?

A lack of sufficient data on the vaccine’s safety in pregnant and lactating women as well as adolescents aged 16-17 were the other key issues of debate among the expert panelists.

Pfizer’s EUA submission only included data on 153 participants aged 16-17. The overall lack of data appeared to be the main source of the concern, with no clear negatives or side effects specific to this age group reported.

As Offit noted: “We have clear evidence of a benefit. All we have on the other side is theoretical risk.”

Arnold Monto, an epidemiologist who chaired the panel, said: “We will get more data as we start using the vaccine more extensively. “With rare outcomes, you have to start using the vaccine in order to see them.”

It is highly unlikely the FDA will authorise a vaccine for these groups until a reproductive toxicity study is complete.

The experts also were undecided about whether pregnant and lactating women should receive the vaccine – due to a similar lack of evidence in the Phase III study trials. Pregnant women are often excluded from such trials, at least at the initial phases, in order to avoid unknown long-term effects on their fetus.

Manufacturers have been told to conduct developmental and reproductive toxicity (DART) studies, which indicate if a vaccine presents any risk to a fetus. Pfizer has reported that its preliminary results will be ready within days.

Until these studies are complete, it is highly unlikely the FDA will authorise a vaccine for these groups.

Image Credits: BioNTech, US Senate, Johns Hopkins University & Medicine, WHO.

2019 Asia Pacific Patients Congress in Taipei, Taiwan; IAPO’s Asia Pacific Patients Congress hopes to bring patients and patient groups together in the Western Asia and Southeast Asia region

Raising a conversation about patients rights and patient care over the din of the COVID-19 pandemic is not easy. But hundreds of patient groups and thousands of attendees drew together virtually last week at the 2nd Asia-Pacific Patients Congress to talk about how to reclaim a voice and space for patient rights in the wake of the COVID-19 pandemic – where patients have been more disempowered than ever before. 

COVID-19 has greatly altered the patient experience, shifting people more than ever from an active to a passive role in their health care, especially in the initial stages of the pandemic, said Dr Sanjiv Kumar, Chair of the India Alliance of Patient Groups.

“[Patients] were picked up from homes and placed in hospitals. They were not allowed initially to even make phone calls to their friends and relatives; no visitors were allowed. It was more like putting somebody in a jail,” he said.

Speaking at the keynote event, ‘Patients’ co-creation in future proofing health systems: preparedness for the next phase of the pandemic’, Sanjiv reflected on how COVID-19 has been “treated not as a health problem, but as a law and order situation” in India and many other countries.

The stigma has been reinforced by measures created by the government and police authorities, where the implementation of restricted areas and red zones prevented people and patients from entering and leaving areas.  

According to Dr Sanjiv, healthcare must shift to a people-centered approach that allows patient participation and respects their needs and preferences – if goals for equity, quality and universal access are ever to be achieved..

“The patient community underscored the reality that for sustainable universal health coverage, there needs to be active patient engagement at all levels of the health system decision-making process,” said Karen Alparce-Villanueva, Secretary of the International Alliance of Patients’ Organisations (IAPO), speaking at the event. 

IAPO 2nd Asia Pacific Patients Congress – inaugural launch, featuring, clockwise, Karen Alparce-Villanueva, Dr Neda Milevska, and Dr Ratna Devi
Patients As Experts in Healthcare 

The Congress – which ran  3 – 4 December and drew in 298 patient groups and 3046 attendees from 66 countries – included presentations on topics such as digital literacy, patient registries, clinical trials and increased participation, patient safety, reducing harm, patients led research, patient co-authorship, regulatory reliance and harmonisation, and building back better healthcare systems post COVID-19.

“COVID-19, took a lot of the attention and resources globally, but we wanted to leave no one behind,” said Dr Neda Milevska Kostova, Vice-Chair at IAPO, who spoke on initiatives created by IAPO, such as the Congress, that have been organized to “make patient voices heard.” The Congress is one of several regional conferences organized by IAPO that occur annually in order to fulfill the vision of seeing patients and patient groups at the center of healthcare. 

Speakers flagged that patients’ right to choice and their role as experts in healthcare should be acknowledged and given appropriate space and environment to contribute meaningfully. 

Said Dr Ratna Devi, Chair at IAPO. “This is a huge opportunity for patient groups to come together to lend their voices.” 

She stressed that healthcare is “not one size fit all,” since providers are working with diverse patients from diverse backgrounds. “Healthcare needs to be customized, messaging needs to be customized, and how you ask people to change their behaviors needs to be customized.”

At the same time, to become more empowered, patients need to be more aware of the need to act pre-emptively when accessing health care, she said, adding: “If patient groups integrate themselves and understand that early diagnosis, and early seeking of treatment, could be a better option, things could change for them.”

Health Authorities Need to Build Patient Trust & Engagement  – COVID Vaccine Rollouts Will be a Litmus Test 
Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks

Health authorities need to implement strategies that engage and empower people and communities. Patient leaders must become active participants in the implementation of health policies that ensure they are at the center of equitable health access. 

“Every one of us is a potential patient, and everyone one of us has the motivation to be involved in combating the pandemic,” said Dr Martin Taylor, Director of Health Systems and Services in the WHO’s Western Pacific Regional Office. He addressed the role played by patients, their families, and communities in shaping the collective and societal response to COVID-19. 

Dr Martin Taylor, Director of Health Systems and Services at the WHO Western Pacific Region

Community engagement has become a key strategy in a successful COVID response, Taylor noted.  “Trust is central to this in the Asia Pacific region,” he added. An effective response to COVID-19, said Dr Martin, requires that governance, health systems, populations, communities, patients, all work together. Community health leaders who have succeeded in curbing transmission trends and assuring quality care have done so by building trust and engagement in solutions that worked for health workers, patients and their families, as well as the broader populoation.  

Looking ahead, the development and rollout of COVID-19 vaccines will be the next great opportunity for new models of patient engagement. A successful rollout is dependent on extremely effective engagement with groups, making sure that instead of misinformation, there is trust, and that vaccine supplies and delivery are carefully managed.  

Added Taylor: “Our vision [for the future] will only be possible if patient and patient groups, and communities, engage, and are engaged, both in shaping and advocating for a vision in which health is at the core of society’s values.” 

Image Credits: Flickr: Rumi Consultancy/World Bank, APPC, APPC.