Research into mRNA vaccines
The study found that if a vaccine was equitably distributed by population, 65% of global COVID-19 deaths could be averted.

Rather than hoarding vaccine supplies, rich countries that ensure global access to a new COVID-19 vaccine will pave the way to a larger reduction in pandemic related deaths worldwide, according to a new model developed by the Boston-based Northeastern University.

Their findings reinforce the argument the World Health Organization and other global health leaders that vaccine nationalism will boomerang, slowing down the progress combatting the pandemic.

Researchers at the Northeastern University MOBS Lab created two model scenarios: one in which 2 billion doses of a vaccine is monopolised by 50 high-income countries, and one in which the drug is distributed based on a country’s poupulation.

Both scenarios were run with two vaccines: one that had 80% and one 65% efficacy in terms of protective potential. A vaccine with a minimum efficacy of 50% could provide herd immunity, according to a separate study published in The Lancet.

The Northeastern University model found that if the 50 wealthiest countries stockpiled a vaccine with 80% efficacy, only 33% of the deaths that would otherwise occur that year could be averted, compared to 61% if the vaccine were to be distributed equitably. The same findings occurred in the case of the less efficient vaccine, where by hoarding would prevent 30% of deaths as compared to worldwide distribution, which would prevent 57% of deaths.

The study indicates that the planned COVAX vaccine facility, co-sponsored by Gavi, The Vaccine Alliance and the World Health Organization, could be an effective means of minimising the total number of coronavirus deaths across all countries.  See more details here.

 

Image Credits: Moderna, INC.

Vulnerable populations in Africa face falling through the cracks as resources continue to be focused on COVID-19, Matshidiso Moeti WHO Regional Director for Africa fears.

BRAZZAVILLE – The COVID-19 pandemic has dealt a heavy blow to key health services in Africa, raising worries that some of the continent’s major health challenges could worsen.

A preliminary analysis by the World Health Organization (WHO) of five key essential health service indicators finds a sharp decline in these services between January and September 2020 compared with the two previous years. The indicators included numbers of: outpatient consultations, inpatient admissions, births by skilled birth attendants, treatment of confirmed malaria cases, and provision of the combination pentavalent vaccine (a vaccine protecting against five diseases including tetanus and hepatitis B) in 14 countries.

The gaps in services provided this year and in previous years were the widest in May, June and July, corresponding to the period when many countries had imposed lockdowns to check the spread of COVID-19. During these three months, services in the five monitored areas dropped on average by more than 50% in the 14 countries surveyed, in comparison with the same period in 2019.

COVID-19 responders learn how to properly don and doff protective gowns in Kenya, May 2020.

“The COVID-19 pandemic has brought hidden, dangerous knock-on effects for health in Africa. With health resources focused heavily on COVID-19, as well as fear and restrictions on people’s daily lives, vulnerable populations face a rising risk of falling through the cracks,” said Matshidiso Moeti, WHO Regional Director for Africa at a press conference on Thusdsay.

“We must reinforce our health systems to better withstand future shocks. A strong health system is the bedrock for emergency preparedness and response. As countries ease COVID-19 restrictions, we must not leave the door open for the pandemic to resurge,” said Dr Moeti. “A new wave of COVID-19 infections could further disrupt life-saving health services which are only now recovering from the initial impact.”

Even prior to the COVID-19 pandemic, maternal mortality in sub-Saharan Africa was higher than almost any other region of the world, accounting for about two-thirds of global maternal deaths in 2017. During the pandemic, skilled birth attendance in all 14 countries surveyed dropped, an indicator of increased risks to mothers giving birth. In Nigeria, for instance, over 97 000 women gave birth somewhere other than health facilities and over 193 000 missed postnatal care within two days of giving birth. There were also 310 maternal deaths in Nigerian health facilities in August 2020, nearly double the figure in August 2019. 

An additional 1.37 million children across the African region missed the Bacille Calmette-Guerin (BCG) vaccine which protects against Tuberculosis (TB) and an extra 1.32 million children aged under one year missed their first dose of measles vaccine between January and August 2020, when compared with the same period in 2019.

Immunization campaigns covering measles, yellow fever, polio and other diseases have been postponed in at least 15 African countries this year, but the introduction of new vaccines has been halted and several countries have reported running out of stocks.

“Now that countries are easing their restrictions, it’s critical that they implement catch-up vaccination campaigns quickly,” said Moeti. “The longer, large numbers of children remain unprotected against measles and other childhood diseases, the more likely we could see deadly outbreaks flaring up and claiming more lives than COVID-19.”

WHO has issued guidance on how to provide safe immunization services, including ways to conduct vaccine campaigns while avoiding transmission of COVID-19.  The Central African Republic, the Democratic Republic of the Congo and Ethiopia have already carried out catch up measles vaccination campaigns. Thirteen other African countries aim to restart immunization campaigns for measles, polio and human papillomavirus in the coming months and WHO is providing guidance on COVID-19 prevention measures to keep health workers and communities safe, WHO said in a press release.

WHO has also provided guidance to countries on how to ensure the continuity of other essential health services by optimizing service delivery settings, redistributing health work force capacity and proposing ways to ensure uninterrupted supply of medicine and other health commodities.

As part of the COVID-19 response, health workers have received extra training in SARS-CoV-2 infection, prevention and control, and laboratories have been strengthened and data collection and analysis improved. These efforts support the fight against the virus while also building up health systems.

Image Credits: Twitter: WHOAFRO.

Schoolgirls line up to receive the HPV vaccine in Central Primary School in Kitui, Eastern Kenya.

Health experts will meet at the upcoming Geneva Health Forum to discuss the World Health Organisation’s (WHO) new roadmap for the elimination of cervical cancer. Hopes are high for funding to expand services in countries where they are needed the most.

At Newlands Clinic in Harare, Zimbabwe, the waiting room is always busy with women waiting to do a simple cervical cancer screen as part of the routine package of available reproductive and sexual health services. HIV positive women can receive free screening, and follow-up treatment if they are found to be at risk of cervical cancer, which is the most common form of cancer among women living with HIV.

Newlands is one of a growing number of clinics across Zimbabwe and other countries in sub-Saharan Africa that have started to incorporate cervical cancer prevention, screening and treatment services, into their women’s health programmes. The countries with the highest incidences of cervical cancer – Malawi, Mozambique, Comoros, Zambia and Zimbabwe – also have a high prevalence of women living with HIV/Aids, which makes rolling out these services all the more urgent.

Even so, the lack of public awareness and an equally large dearth of funding and international support have created challenges against making such services more mainstream.

“HIV, TB, Malaria – those are major killers so they tend to get the lion’s share of the attention,” says Dr Cleophas Chimbetete, deputy director of Newlands Clinic, who is one of a number of experts speaking at a keynote session on Cervical Cancer Elimination at the upcoming Geneva Health Forum running from 16-18 November.

“Cervical cancer can only be addressed if we have more international organisations coming in to assist, to make noise, and to make cervical cancer programmes. Because [at the moment] most cervical cancer screening is linked to HIV programmes.”

He and other experts gathering at the forum hope that a new global strategy from the WHO to eliminate cervical cancer as a public health problem will give more impetus to donor action. The WHO strategy sets out a roadmap for expanding vaccination, screening and treatment worldwide by 2030.

A Preventable and Treatable Disease

Cervical cancer is still the fourth most common form of cancer among women in the world, despite being one of the few malignancies that is preventable and highly treatable providing it is diagnosed and managed early.

The cancer also reflects global inequity, as its burden is greatest on low- and middle-income countries (LMICs) where access to public health services are limited. In 2018, nearly 90% of all cervical cancer-related deaths worldwide occurred in LMICs, where the proportion of women who die from the disease is greater than 60%. This is more than twice the number than in many high income countries.

The tools to prevent, detect and treat the disease already exist, yet developing countries face a number of challenges in expanding vaccination and screening programmes. The WHO’s strategy, therefore, marks a long overdue call to the global community to put the elimination of cervical cancer higher on their agenda, ensuring that all countries have the necessary policies, health services and funding in place.

Rolling out the Vaccine

As of 2020, less than a quarter of low-income countries have introduced the HPV (human papillomavirus) vaccine, a safe and effective way to protect women from a key cause of cervical cancer, into their national immunisation schedules.  In contrast, more than 85% of high-income countries have done so.

In recent years, however, more and more LMICs have taken steps to roll out the vaccine.

In Zimbabwe, where cervical cancer is the leading cause of cancer-related deaths among women, the country introduced the HPV vaccine into its national immunisation programme in 2018 with funding from Gavi, the Vaccine Alliance, which allocated funds sufficient to reach over 800,000 girls aged 10-14.

Gavi has been supporting the vaccine’s gradual roll-out to LMICs since 2013. That has enabled Dr Chimbetete’s clinic in Harare to offer the vaccine to adolescents, as well as screening and treating older women.

“Once people are aware, the uptake is good, but there still needs to be a lot of work to highlight the importance of HPV vaccination among the general population,” he says.

Beating the Stigma in Cameroon

Like Zimbabwe, Cameroon introduced the HPV vaccination onto its national immunisation programme last month following a six-year long pilot phase.

Completion of the pilot, first launched in 2011, faced many challenges. Dr Simon Manga, a reproductive health specialist for the Cameroon Baptist Convention Health Services (CBCHS), explains that parents initially were reluctant to have their children vaccinated, thinking it would make them sterile.

Now the national immunisation programme is getting started, some communities that initially accepted the vaccine earlier this year have later refused it, due to an unfounded belief that it is in fact an experimental COVID-19 vaccination. Misinformation has been rife on local and social media during the pandemic, with Gavi CEO Seth Berkley describing the situation in one article as “the worst I have ever seen.”

Dr Manga said: “People are afraid that they want to sterilise their girls, and worst of all it coincided with the period of COVID-19, so there’s an idea that the white man wanted to come and test the COVID-19 vaccine in Africa. There’s currently a lot of resistance.”

Dr Manga is a member of the National Planning Committee for the vaccine programme. He still hopes that with the help of the government and cooperation from community leaders, vaccine uptake will expand. A nationwide campaign is currently being organised to raise awareness about the importance of the vaccine and to quash the rumours that have been circulating.

Inexpensive Cancer Screening with Novel Methods

Dr Manga also supervises the CBCHS’ Women’s Health Programme (WHP) which offers cervical cancer screening as well as breast examinations as part of its other reproductive health and family planning services.

Like most facilities rolling out these services in Africa, the screening method used is not the traditional “pap smear” that requires expensive laboratory analysis, but rather an on-the-stop visual inspection of potential abnormalities on a cervix dabbed with acetic acid, and then exampled with the help of new digital cervicography. Here, too, HIV positive women are prioritised due to their increased vulnerability to cervical cancer.

Unlike the vaccine, there is no national programme for free screening services, and Dr Manga explains this is a major barrier for women. When the CBCHS have trialled free services before, the uptake has been unsurprisingly high.

In addition, encouraging those women who show signs of pre-cancer or cancer to return for follow-up treatment is also a challenge. Dr Manga explains many women do not understand the seriousness of the need for follow up, are put off due to the additional cost, or are advised not to return by faith healers in their communities.

Despite this, Dr Manga says the programme hopes to expand their services, increasing their use of mobile clinics and developing a “centre of excellence” by which local healthcare workers can gain training from different organisations and experts that they can use in their facilities. As with screening services, however, more funding is needed.

“One of the things that is slowing down our rapid expansion is funding – if we start getting funding then we can expand rapidly,” says Dr Manga. “[The WHO’s strategy] gives me hope that very soon there will be a lot of funding.”

Like in Cameroon, Costs are a Barrier to Treatment – More Funding is Needed

Because Dr Chimbetete’s clinic is funded by the Swiss-based Ruedi Lüthy Foundation, he has the mandate to provide the screening and treatment services free for HIV positive women. However this is not the case at public primary care clinics across the country.

At those clinics, while screening is widely available, follow-up treatment services generally come at a cost. Dr Chimbetete explains that the cost – which usually includes travel to a central facility that offers treatment as well as the treatment itself – prevents many women returning for follow-up, even when they know they have or are at risk of developing cervical cancer.

“Anything other than screening is not free, even in patients who are diagnosed with cervical cancer,” he explains. “Cost becomes an issue … especially now when we are going through economic challenges, it may not be a priority. So even though as a nation we are offering cervical cancer screening we still see very high incidences of cervical cancer because of all these issues.”

“Cervical cancer can only be addressed if we have more international organisations coming in to assist,” concludes Dr Chimbetete. “People need to make more noise. Noise has helped with HIV, noise has helped with TB, but I don’t think in my view we have made enough noise around cervical cancer. And now, because COVID has become such a huge global issue, there is a fear that everything else becomes insignificant. So some people really need to make noise around cervical cancer.”

Geneva Health Forum 2020 logo

This story was published in collaboration with Geneva Solutions – a new platform for peace & humanitarian, climate, global health, sustainable business & finance, and technology.

Image Credits: Keystone / EPA / Karel Prinsloo / GAVI, Geneva Health Forum.

US eleciton 2020 campaign signs
Signs supporting Biden and Trump split various small towns in Delaware County, upstate New York. The liberal state’s rural leanings have divided opinion.

While President Donald Trump’s mismanagement of Covid-19 may help Democratic contender Joe Biden turn the final corner in a tight US election, identity politics and the economy have loomed as bigger factors than health in voter choices. Voters in key battleground states, like Michigan and Nevada, explain why.

The United States election came just as the country was racking up some of the highest-ever daily rate of new coronavirus infections in the world. But in comparison to the economy, COVID-19 and health care issues still ranked lower on Americans’ priorities when people finally turned out to the polls.

US election 2020 signs
Signs supporting Biden and Trump split various small towns in Delaware County, upstate New York. The liberal state’s rural leanings have divided opinion.

All in all, the pandemic threat has failed to generate the kind of landslide support for the Democratic contender Joseph Biden that some had hoped for, or even anticipated – even if the vote count overnight early Thursday saw him inching his way toward victory.

Even so, “identity politics” – including a gaping rural-urban divide – remain more dominant factors in the campaign than the COVID pandemic that has transfixed the world.

Nor did health care seem to rate as high a concern either – even though some 20 million Americans stand to lose their health care coverage if the Affordable Care Act is finally overturned by a second-term Trump administration either through action in the US Supreme Court or Congress.

Massive ‘COVID Rebuke’ Didn’t Happen

While the mounting toll from the coronavirus has certainly played a role in a greater show of support among retirees and suburbanites for Biden in some places, a huge COVID-driven “rebuke” of Trump just did not occur at the magnitude that Democrats had expected.

This was already apparent in the early hours of Tuesday evening, before returns began to flow. A CNN exit poll found that about one-third of Americans considered the economy the most critical election issue. Only 1 in 6 voters considered the pandemic and 1 in 10 cited health care policy or violence, as their top issues. One in 5 people cited racial inequality.

Those attitudes were all the more apparent in the tsunami-like changes in early election results seen in key US “battleground states”, reflecting the log-jammed political divide between urban and rural voters, with suburban areas as wild cards.

Overnight Wednesday, mail-in ballots were still being counted in key states where battles raged,while a complicated calculus of 270 state “electoral college” votes, not the popular vote, determines the final outcome.

“There was a lot of energy and expectation – on the Democratic side and I would say even in America – that there was going to be a surge, a rebuke of Trump, particularly over the virus,” said political analyst, David Gregory, speaking to CNN.

“And what we’re seeing so far is that has not been the case. It’s a really tight race. We’re even seeing some evidence out of exit polling that a lot of voters out there are saying ‘hey, it’s really important we get this economy open, even if the virus spreads a little bit more.’”

Reported COVID-19 cases the day after the US election
A state-by-state map of US COVID-19 Cases Reported to the Centers for Disease Control over the Last 7 Days, as of 7pm CET, 4 November 2020.

 

Biden Benefits from “COVID” Vote but Only Marginally

That’s not to say that there was no ‘COVID factor’ at all.  More people from key demographic groups, like seniors and suburbanites, shifted significant votes to the Democrat’s Biden – as compared to Hillary Clinton four years ago. That surge of support was being felt in Michigan and Wisconsin, as well as in expanding suburban regions of sunbelt cities in Arizona and Nevada – making these states the major players in the final election outcome.

Polling stations were fitted with sanitizing stations.

“A lot of seniors don’t feel like he’s handled this very well – because literally they’re dying… people are legitimately dying I mean,” said one Nevada resident, a construction worker whose 64 year-old wife’s pre-conditions puts her seriously at risk from COVID-19.

Adding to the uncertainty in all of these states was the fact that unprecedented numbers of voters cast their ballots by mail, and those ballots were being counted last, rather than first, creating a dizzying set of ups and downs in the results.

Amidts pandemic concerns, however, another systemically hot issue in US politics – abortion – was a countervailing factor keeping many people loyal to Trump – virus or not.

“Abortion is a HUGE factor, I have heard many people say it alll comes down to who ‘will save the babies’,” said one businesswoman in Ann Arbor Michigan, who voted for Biden, where Biden was hanging onto a slight lead Wednesday evening.

“I honestly don’t get it,” she added. “No thoughts or consideration to helping the babies after they are born, but the pro-lifers are faithful in their voting. I’m seriously thinking of moving to Canada.”

“As far as I can tell, people care about healthcare but apparently believed the false dichotomy Trump presented of pandemic lockdown or the economy, and many preferred the latter,” a New York City public health expert said. “When Trump says that he did everything he could about the pandemic, and it was all China’s fault anyway, his supporters and apparently many other people believe him… After almost four years, you’d think people would have learned.  But he’s very good at what he does.”

Identity Politics Overwhelms COVID – No Matter Who Wins

In Trump strongholds like eastern Tennessee’s Putnam County, nestled in the foothills of the Appalachian mountains, a local store that sells Trump memorabilia just opened, and pickup trucks have been parading around downtown shouting the president’s praises, relates a prominent lawyer with deep roots in the community:

Nominee Joe Biden and Senator Kamala Harris as the latter accepts the Nomination for Vice President of the Democratic Party, 19 August 2020.

“One of the trucks carries a big flag with Trump’s sagging jowly face placed on top of Rambo’s body, firing an M-60 machine gun. And he drives around the Square yelling ‘Trump Trump Trump’. A disturbing number of people honk in support of him. From my window, Trump support has nothing to do with rationality,” said the attorney, who asked not to be named.

“Trump is a cult figure in red states like Tennessee,” he added. “He received 71% of the vote in Putnam County. We were reliably 55% Democratic until the 2010 election.” This was when local politics flipped during Barack Obama’s presidency – as racist rumors about the president’s origins and religious persuasion became rampant.

“Trump’s supporters share his fears and hatreds. More ‘bad others’ – illegal immigrants, rioters, black people and the much-feared and utterly non-existent ‘ANTIFA’ – dominate their fears. Trump rails against them and tells these people that they are right, they are smarter than people with education, than people with money, than these bad others. He makes their irrational prejudices into virtues. And they love him for it,” he added.

“A huge number of Americans simply do not understand the connection between government and their lives. Government is a ‘bad other’: the enemy, something to be mistrusted and opposed at all costs.

“So the Trump voter doesn’t give a flip about health care when they walk into the voting booth.  They do not believe that the government could ever provide them decent health care.

US President Donald Trump at recent rally. Supports are not wearing masks.

“They ‘know’” Obamacare has failed and is bad – even though it only ‘failed’ because the GOP congress wouldn’t fund it or implement it. The Trump voters vote on issues like their professed opposition to abortion and transgender rights, and their support for gun rights. Their vote for Trump has nothing to do with their own economic interests, except to the extent that their information system has told them that socialism is bad. And a vote for Trump is a vote against the undefined bad other, socialism.

“As for COVID, the Trump voters mostly do not believe it is real. They won’t wear masks. They assemble in groups, at churches and proms. Our hospital numbers are through the roof, but they don’t believe it, because their information sources tell them, doctors overreport COVID to get money – ‘those educated greedy doctors again.’

“And they chuckle to themselves, congratulating themselves on how they’ve seen through the liberal conspiracy, because at least THEY aren’t falling for this COVID nonsense. This is from people who have family members who have died with COVID. The denial is astounding, and inexplicable to me. But it is as real as the coffee in my cup.”

Conservatives See the Robust Trump Support Very Differently

Scott Jennings, a Republican campaign adviser from Kentucky, argued that Trump’s base of support had, in fact, expanded in this election to include new African American and Latino voters in areas like Miami-Dade county, where Trump had campaigned heavily and did even better than he had in 2016 against Hillary Clinton.

The COVID-driven “rebuke” anticipated by the Democrats did not happen quite as expected.

Jennings said in an interview with CNN: “Republicans are pretty well stunned at how well Donald Trump did.

“There has been a clear realignment here for the Republican party to attract new working class voters of all races. When you look at the resilience of the Republican party in all these states with these large rural areas, among working class voters, the attraction of some new hispanic voters, even some African American voters.

“I also think there has been a rejection of the Democratic party, and in some cases the media, of the liberal elites in rural America. They feel like they are held to different rules: double standards. They’ve been browbeaten for their support of Donald Trump, and they turned out in droves yesterday to let folks know it. It’s not all bad for the party right now.”

Atmosphere of fear

Yet, despite the positive spin of some conservative pundits, Americans of all persuasions were bracing for Trump’s legal challenges, possible violence and more uncertainty, while a decisive vote still remained elusive.

With Michigan and Wisconsin finally swinging toward the Democratic contender Wednesday evening, the projected electoral college count for Biden stood at 253 out of the golden 270 votes needed. But large final counts of the mail-in vote remained outstanding in key states like Pennsylvania, Arizona and Nevada; wins in just two of the three would clear his path to victory.

From New York City to Washington DC and Dearborn, Michigan, more and more storefronts were being boarded up in the anticipation of potential violence from both left and the alt-right – depending on the way the election falls.

Supporters of President Donald Trump at a “Make America Great Again” campaign rally last week without masks in Phoenix Arizona. The state flipped in Biden’s favour in 2020.

The electric tensions were being fuelled by Trump’s comments already on election night. Appearing at about 2:30 a.m. Wednesday morning at a White House party of some 250 campaign supporters, Trump claimed victory and said that he would contest the continued tabulation of mail-in ballots still underway in many states.

“We want all voting to stop.  We don’t want them to find any ballots at 4 o’clock in the morning and add them to the list, OK,” Trump said in his televised remarks protesting the counting of mail-in ballots, as districts in key states around the country tried to process huge ballot backlogs.

“This is a fraud on the American public… an embarrassment to our country.  We were getting ready to win this election. Frankly we did win this election,” he said. “So our goal now is to ensure the integrity for the good of this nation. This is a very big moment… We want the law to be used in a proper manner. So we will be going to the US Supreme Court.”

People in rural and working class neighborhoods who bucked trends to support Biden have been keeping their heads particularly low – as Trump supporters roam their neighborhoods demonstrably, sometimes visibly armed.

The Reno construction worker who voted Biden said he had been afraid to post a campaign sign on his lawn for fear of violent reprisals. He is fearful that roaming brigades of Trump supporters parading through his neighborhood might also somehow finger him as a target – and has alerted a police officer just in case.

“They’re not hard to identify,” he said. “They drive around in jacked up pickup trucks with tattered American flags hanging out. It’s really sick what they have done with our flag.

“Our flag is considered a symbol of freedom and democracy and they’ve turned it into a symbol of racism and hatred and bigotry.”

Kerry Cullninan and Raisa Santos in New York City contributed to this story.

This story was published in collaboration with Geneva Solutions – a new platform for peace & humanitarian, climate, global health, sustainable business & finance, and technology.

Image Credits: Kerry Cullinan, Adam Schultz/Biden for President/Flickr, GPA Photo Archive/Flickr, Gage Skidmore/Flickr.

The White House, Washington DC. There is currently no clear winner for President
The morning after election day, the winner is still unclear.

With the winner of the presidency and party control of the Senate still unclear the morning after Election Day, the future of the nation’s health system remains uncertain. At stake is whether the federal government will play a stronger role in financing and setting the ground rules for health care coverage or cede more authority to states and the private sector.

As of 4pm CET, Biden has a small lead of 227 electoral votes – compared to Trump’s 213 – having overtaken the incumbent president in key states Michigan, Wisconson and Arizona. Pennsylvania, North Carolina and Georgia are undeclared.

US Presidential Nominee Joe Biden.

Should President Donald Trump win and Republicans retain control of the Senate, Trump still may not be able to make sweeping changes through legislation as long as the House is still controlled by Democrats. But — thanks to rules set up by the Senate GOP — the ability to continue to stack the federal courts with conservative jurists who are likely to uphold Trump’s expansive use of executive power could effectively remake the government’s relationship with the health care system even without signed legislation.

The president has also pledged to continue his efforts to get rid of the Affordable Care Act, and if the Supreme Court overturns the sweeping law as part of a challenge it will hear next week, the Republicans’ promise to protect people with preexisting medical conditions will be put to the test. In a second term, the administration would also likely push to continue to revamp Medicaid with its efforts to institute work requirements for adult enrollees and provide more flexibility for states to change the contours of the program.

If former Vice President Joe Biden wins and Democrats gain a Senate majority, it would represent the first time the party has controlled the White House and both houses of Congress since 2010 — the year the ACA was passed. A top priority will be dealing with the COVID-19 pandemic and the economic fallout. Biden made that a keystone of his campaign, promising to implement policies based on advice from medical and scientific advisers and provide more directives and aid to the states.

Current US President Donald Trump.

But also high on his agenda will be addressing parts of the ACA that haven’t worked as well as its authors hoped. He pledged to add a government-run “public option,” which would be an alternative to private insurance plans on the marketplaces, and to lower the eligibility age for Medicare to 60.

While Democrats will continue to control the House, the final makeup of the Senate is still to be determined. And even if the Democrats win the Senate, they are not expected to come away with a majority that would allow them to pass legislation without support from at least some GOP senators, unless they change the Senate’s rules. That could lower expectations of what the Democrats can accomplish — and may lead to some tensions among members.

But who controls Washington, D.C., is only part of the election’s impact on health policy. Several key health issues are on the ballot both directly and indirectly in many states. Here are a few:

Abortion

In Colorado, a measure that would have banned abortions after 22 weeks of pregnancy — except to save the life of the pregnant person — failed, according to The Associated Press. Colorado is one of seven states that don’t prohibit abortions at some point in pregnancy. It is also home to one of the few clinics in the nation that perform abortions in the third trimester, often for severe medical complications. The clinic draws patients from around the nation, so residents of other states would have been affected if the Colorado amendment passed.

In Louisiana, however, voters easily approved an amendment to the state constitution to say that nothing in the document protects the right to, or requires the funding of, abortion. That would make it easier for the state to outlaw abortion if the Supreme Court overturns Roe v. Wade, which makes state abortion bans unconstitutional.

Medicaid

The fate of the Medicaid program for people with low incomes is not on the ballot directly anywhere this election. (Voters approved expansions of the program in Missouri and Oklahoma earlier this year.) But the program will be affected not only by who controls the presidency and Congress, but also by who controls the legislatures in states that have not expanded the program under the Affordable Care Act. North Carolina is a key swing state where a change in majority in the legislature could turn the expansion tide.

Drug Policy

In six states, voters are deciding the legality of marijuana in one form or another. Montana, Arizona and New Jersey were deciding whether to join the 11 states that allow recreational use of the drug. Mississippi and Nebraska voters were choosing whether to legalize medical marijuana, and South Dakota became the first state to vote on legalizing both recreational and medical pot in the same election.

Magic mushrooms are on two ballots. A measure in Oregon to allow the use of psilocybin-producing mushrooms for medicinal purposes passed, and a District of Columbia proposal to decriminalize the hallucinogenic fungi was leading.

Also approved was a separate ballot question in Oregon to decriminalize possession of small amounts of hard drugs, including heroin, cocaine and methamphetamine, and mandate establishing addiction recovery centers, using some tax proceeds from marijuana sales to establish those centers.

California

As usual, voters in California faced a lengthy list of health-related ballot measures.

For the second time in two years, the state’s profitable kidney dialysis industry was challenged at the ballot box. A union-sponsored initiative would have required dialysis companies to employ a doctor at every clinic and submit infection reports to the state. But the industry spent $105 million against the measure. The measure failed, according to AP.

Voters were also asked to decide, again, whether to fund stem cell research through the California Institute for Regenerative Medicine via Proposition 14. Voters first approved funding for the agency in 2004, and since then, billions have been spent with few cures to show for it. The measure was winning in early returns.

California has been at the forefront of the fight over the so-called gig economy, and this year’s ballot included a proposal pushed by ride-hailing companies like Uber and Lyft that would let them continue to treat drivers as independent contractors instead of employees. Under Proposition 22, the companies would not have to provide direct health benefits to drivers but would have to give those who qualify a stipend they could use toward a premium for health insurance purchased through the state’s individual marketplace, Covered California. The measure was approved.

Finally, voters in the Golden State were asked whether to impose higher property taxes on commercial property owners with land and property holdings valued at $3 million or more, which could help provide new revenue earmarked for economically struggling cities and counties hit hard by COVID-19, as well as K-12 schools and community colleges. Community clinics, California nurses and Planned Parenthood jumped into the thorny political battle over Proposition 15 — taking on powerful business groups — eyeing revenue to help rebuild California’s underfunded public health system. The measure was too close to call in early returns.

Democrats in California, who control all statewide elected offices and hold a supermajority in the legislature, have been positioning for a Biden win, and some were already penning ambitious health care legislation for next year. Should Biden win, they said they plan to crack down on hospital consolidation and end surprise emergency room bills, and some were quietly discussing liberal initiatives such as pursuing a single-payer health care system and expanding Medicaid to cover more unauthorized immigrants.

 

KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.

Image Credits: Library of Congress/Carol Highsmith, Mike Beaty/Flickr, Gage Skidmore.

Protestors stuggle for universal access to anti-retroviral treatment and against AIDS denial, in Cape Town, 2002.

IBADAN, Nigeria – In the wake of George Floyd’s death in June 2020, the decentralized protests initially organized by the Black Lives Matter (BLM) movement triggered an awakening and an echo that has reached well beyond the borders of the United States.

Protest at the 3rd precinct in Minneapolis for the murder of George Floyd by four police officers.

What started as a non-violent movement protesting against incidents of police brutality and racially motivated violence, has also inspired people around the world, including scientists to take a closer look at how colonialist attitudes and structures continue to influence their institutions and career paths. For individuals from comparatively disadvantaged countries, these attitudes often make it difficult or even impossible for them to enjoy equal opportunities and mutually favorable metrics in their chosen careers.

And this is true for global health too. “Little or no attention is being given to the issue. This isn’t something people are funded to look at. Doing it in of itself comes from a position of privilege,” says Dr Mishal Khan, Associate Professor at the London School of Hygiene and Tropical Medicine (LSHTM).

While decolonisation has been discussed in an educational context in the past, in terms of curriculum choices as well as well as the preference of western to indigenious professionals, Khan argues that the fundamental structures underpinning global health should also be closely examined.

“It’s not really researched or taught as much as it should be, and this is why people often don’t think about it so much,” she says, noting that while relics of colonialism remain and debates continue across sectors, the issue has been far less discussed in the context of global health. “The implicit assumption is certain groups are more knowledgeable and better than the others.”

The topic of ‘decolonizing global health’ will be a featured topic on the Geneva Health Forum’s agenda, taking place 16-18 November, where Dr Khan will be a keynote speaker.

“In global health there is an additional element,” Khan adds. “By nature, global health is about higher income countries trying to support low-income countries. It’s not just about teaching global health, but also the practice.”

UN Born With First Decolonialist Wave

According to the United Nations, fewer than 2 million people now live under colonial rule in the 17 remaining non-self-governing territories. out of which only one – Western Sahara – is in Africa.

“The wave of decolonization, which changed the face of the planet, was born with the UN and represents the world body’s first great success,” the UN stated.

HIV activists protesting against patent laws that pushed up costs of essential medicines, in Cape Town, 2014.

The UN’s key global health agencies, such as the UNICEF and the World Health Organization were born in the post-World War II era of 1946-48, in the waning years of colonialism. UNAIDS, on the other hand, came much later, during the worldwide AIDS pandemic, as states in the global south asserted the need for affordable solutions and more recognition of their health challenges. While these international organisations continue to champion and foster partnerships toward achieving global health goals, they are also implicated in these discussions.

In a September 2019 commentary, Richard Horton, editor of The Lancet medical journal said the success of any western institution that was more than hundred years old was built on the savage legacy of colonialism – even if the institution claims to stand for peace and justice.

“Perhaps we deal with uncomfortable pasts by burying them, excusing them, or atoning for them,” Horton wrote.

In their recent commentary on decolonising global health for the British Medical Journal, Ali Murad Büyüm and colleagues noted that histories of slavery, redlining, environmental racism and the predatory nature of capitalism underpin the design of global and public health systems, resulting in structural, racial and ethnic inequities within Black, Indigenous and People of Color (BIPOC) communities globally.

Connecting the inequities to the COVID-19 pandemic, the authors noted that exclusionary colonialist patterns that centre around Euro-Western knowledge systems have also shaped the language and response to the pandemic, which in turn can have adverse health outcomes.

“Decolonising global health advances an agenda of repoliticising and rehistoricising health through a paradigm shift, a leadership shift and a knowledge shift,” the authors state. “While the global response to COVID-19 has so far reinforced injustices, the coming months present a window of opportunity to transform global health.”

The Genesis Of Misconceptions

For her part, Khan notes that the emergence of developed countries as the worst hit by COVID-19 (contrasting earlier predictions that countries in Africa would be the worst hit) is an indication that there is imbalance in the flow of knowledge and resources in global health.

“That was the mindset with which the global health organisations were working: ‘we need to do something to help these countries or they will crumble. But you can see how countries like Nigeria have brilliantly handled things. The political leadership has been much better’,” Khan says.

A map indicating Africas comparatively low number of cumulative COVID-19 cases.

She adds that the experience of African and Asian countries that are avoiding poor outcomes in COVID-19 are not included in the writings and independent reviews on COVID-19 – often because the authors of such publications are largely people in the Global North: “It is as if the reality can be ignored. Those expertise and the skills are there and there is a lot to learn in both directions, rather than in just one direction.”

Questionable metrics for Public Health Careers

Beyond ignoring and under-representing the achievements of low-income countries in the fight against COVID-19, the need for decolonisation is also evident in the attachment of institutional brand names to successful careers in public health.

Lilian Mutua, WHO Kenya Health Promotion Coordinator, reaching out to nomadic communities to ensure people know how to protect themselves from COVID-19 in May.

Khan notes that young scientists in developing countries have to incur exorbitant costs to be able to afford an education

that would bring them closer in line with their contemporaries in Western countries.

“For instance, the schools of global public health, and the brands that are associated with them, are largely concentrated in western countries. Employers look for those names,” Khan says.

“If you don’t have the brand name from one of those top universities, it’s much harder to progress. People from low-income countries have to pay massive fees, advancing the cycle of inequality.”

In a similar vein, she argued that papers submitted by individuals from developing countries who are not products of the elite institutions will be judged much more harshly by white reviewers.

“You will get more scrutiny, you might not be able to write very well, you might not get invited for presentations: those things that grant you credibility as an expert are much harder for people of color. So those structures are there,” Khan tells Health Policy Watch. “To get promoted, they ask for how many papers published, how many grants. Naturally, people of color will have less because to have one paper, you have to work much harder to get one grant.”

She also drew attention to the existence of an unchallenged system that ensures that people of color do not progress as quickly as their colleagues from elsewhere: “When you look at organisations, there are a lot more people of color at the bottom doing the groundwork than people at the top in senior positions.”

Changing the status quo – Equity in Career Advancement Metrics

In spite of evidence that supports of the existence of unfavorable metrics that disenfranchise BIPOC and other marginalised groups from making bigger impact in global health, there appears to be a deafening silence among the key organisations in the ecosystem – a development Khan attributed to those in charge of the organisations who favour the status-quo.

Dr Mishal Khan spoke to Health Policy Watch on decolonisation in global health.

“For a long time, they’ve been able to get away with not addressing it. If you’ve got a leadership that is predominantly white and not from the country you serve, you think that’s not important. If that’s what you like because if it benefits you, why would you change it?

“There has been a lot of media attention lately so there has been a lot more scrutiny. We need to create the incentives for change,” Khan argues. “I don’t think the incentives are necessarily in there, we need to know that the change will be opposed. Nobody gives up power willingly.”

One of the changes that Khan is advocating for is a comprehensive review of the metrics being used for career advancement in global health. She tells Health Policy Watch that current metrics are such that certain people will rise to the top and others will struggle to rise to the top.

“The system doesn’t value skills,” she notes. “A good example is connection with the local context in which research or service delivery work is being conducted. Being able to speak the local language – being from the country – is given a lot less rating than it should, whereas being able to write and speak really well in English is given a lot more. And that’s why certain people will score more highly than the rest. I think the metrics do matter.”

Timing concern and what can work

The deafening silence from those who would be beneficiaries of moves to decolonise global health raises concern regarding the timing of the call, especially considering the global health ecosystem is largely preoccupied with controlling COVID-19. But Khan said the situation will not change unless it is compelled to change:“The people in power are essentially not going to change the metrics and therefore reduce their power so it favors people that do not look like them.

“I think we have to be conscious of that. People will not consciously or unconsciously reduce their own power,” Khan affirms.

To truly decolonise global health, Khan is calling for a review of the governance system in a number of global health organisations. “Broader than issues of racism and decolonisation, we are also seeing massive governance failure in terms of sexual abuse of some to these international organisations. That’s another symptom that there are people who are being exploited within these organisations that are supposed to be believing in justice and implementing justice. It just has to be done with political will,” Khan says .

Although it would take a while to systematically uproot colonisation, Khan argues that individuals have roles to play to address the narrative.

“One thing about COVID-19 is that it has shown us that if you’re okay in your bubble while other countries are not okay, it will soon spread to your little bubble,” Khan tells Health Policy Watch.

“We need resources to be spread out more equitably.”

Geneva Health Forum 2020 logo

Image Credits: Louis George 2011 , Jenny Salita, Louis George 2011 , Johns Hopkins University and Medicine, WHO African Region, Geneva Health Forum.

Dr Maria Van Kerkhovem warned the northern hemisphere to continue influenza testing
WHO’s technical lead, Dr Maria Van Kerkhove, warned the northern hemisphere to continue influenza testing.

As predictions of a difficult winter pour in, projecting rapid increases in COVID-19 infections, the World Health Organisation (WHO) has urged countries in the northern hemisphere to test for influenza alongside coronavirus.

WHO reassrerted today that surveillance systems are in place to help identify which influenza viruses are circulating, and suggested that countries be proactive in testing for the virus during the COVID-19 pandemic to prevent overwhelming healthcare systems with late or misdiagnoses.

The warning comes as the United States and countries across Europe reached record numbers of cases detected.

“There is also substantial work underway to ensure that patients enter the correct clinical care pathway as they enter the public health system,” stated Dr Maria Van Kerkhove, COVID-19 Technical Lead at the WHO, asserting that entering the clinical care pathway earlier will save lives. Some of these steps include detecting cases that may have been imported from overseas, identifying case clusters and investigating outbreaks.

Restrictions that have been implemented to restrict the spread of SARS-CoV-2 will also be beneficial in curbing the spread of influenza, but diagnosis of these illnesses could present a significant challenge as both viruses share similar symptoms. Because of this, testing and identifying which virus a patient has will be vital in making sure they receive appropriate care.

“We don’t yet know how the influenza season will unfold,” said Dr Van Kerkhove, COVID-19 Technical Lead at the WHO, speaking at a media briefing. Referring to a vaccine rollout, she added: “The good news is that we are prepared for this.”

‘Virtually no Influenza Circulation’ During Southern Hemisphere’s Winter

WHO’s warning for countries continuing to test for influenza comes despite the southern hemisphere’s relatively low number of cases seen during its winter, which recently concluded.

When the pandemic began in March, the southern hemisphere was entering its flu season. But flu cases dropped significantly compared to previous years, with the US Centers for Disease Control and Prevention stating there was “virtually no influenza circulation” in the southern hemisphere.

According to WHO, which tracks influenza activity around the globe, only 0.1% of people who were tested for flu in the southern hemisphere proved positive. This is contrasted to a typical rate of 5 in 10. The cause behind the sharp drop was attributed to COVID-19 restrictions and guidance like social distancing and hand washing.

Children and Pregnant Women at More Severe Risk from Influenza
People over 65 are currently prioritised for vaccination given double COVID and flu risk.

While some at-risk categories for the two viruses do overlap, there are unique groups at risk for each. One of the most notable examples is young children. COVID-19 poses very little risk among younger children, however they are at increased risk for severe disease with influenza. Pregnant women are also at risk of severe disease with influenza but are not with COVID-19 – even two weeks after delivery.

“If [you know] someone with an acute respiratory infection and they are a young child or they are pregnant, that patient does need to be tested,” said Dr Janet Diaz, Head of Clinical Care at the WHO.

Current recommendations indicate that healthcare workers and people over 65, who are at double risk, need to be prioritised for vaccination. Pregnant women and children under 5 are to be offered vaccinations as supplies allow. WHO is due to publish further guidance on influenza soon.

Dr Diaz also noted that while corticosteroids are currently being used for treating patients with severe and critical COVID-19, as it reduces mortality, those drugs may not be suitable for influenza. With flu, there is concern that corticosteroids can increase viral replication.

She warned that governments must “understand when influenza starts to circulate in the community” in order to remain on top of cases.

Image Credits: Flickr: Joseph Gage.

Supporters of President Donald Trump at a “Make America Great Again” campaign rally last week in Phoenix Arizona. Supporters are crowding with no masks.

New COVID-19 cases reached record worldwide peaks in the United States over the weekend,  hitting 98,583 new cases on Friday – as debates over management of the pandemic also fueled intense political duels in the last, heated days of campaigning between US President Donald Trump and his Democratic Party contender, Joseph Biden. 

Hospitalizations were also rising across most of the country, and health experts, including those who have tried to remain out of the political line of fire, were breaking ranks with the increasingly blatant White House disregard for infection trends and infection control protocols, including at President Trump’s blitz of events. . 

“We’re in for a whole lot of hurt. It’s not a good situation,” said top White House infectious disease expert and advisor, Anthony Fauci in an interview with The Washington Post. “All the stars are aligned in the wrong place as you go into fall and winter season, with people congregating at home indoors. You could not possibly be positioned more poorly.” 

Trump, speaking at a rally on Sunday morning suggested that he might soon fire Fauci, the director of the National Institute of Allergy and Infectious Diseases. 

“Don’t tell anybody, but let me wait until a little bit after the election…He’s been wrong a lot,” shouted out Trump, before a crowd chanting “Fire Fauci.” 

Fauci hasn’t spoken with Trump in more than a month. And although Trump doesn’t have the power to directly fire Fauci, the president could dramatically restrain his role as a member of the White House’s coronavirus task force, observers say.

On Monday, new COVID-19 cases cases dipped slightly again, to 77,398 according to the US Centres for Disease Control – but the seven day US average remained at an all time high of 81,336.  

“We’re at a point where the epidemic is accelerating across the country. We’re right at the beginning of the steep part of the epidemic curve,” Dr. Scott Gottlieb, the former U.S. Food and Drug Administration commissioner, told CNBC.

“You’ll see cases start to accelerate in the coming weeks,” he said, predicting the height of the country’s new surge will be reached around Thanksgiving, adding that: “December’s probably going to be the toughest month.”

This upward trend in cases makes this the pandemic’s third peak in the United States, as cases were growing by an average of 5% or more in 43 states accoring to Johns Hopkins University. There are now more than 9 million reported COVID-19 cases in the United States. There have been more than 230,000 deaths.  

Trump Rallies Accelerated COVID-19 Cases In States Where He Appeared – Says New Study 
US President Donald Trump at recent rally

Researchers at Stanford University estimated that at least 30,000 COVID-19 infections and 700 deaths could be attributed to the 18 campaign rallies that Trump held between June and September; 15 of the events studied took place indoors. Trump has drawn criticism for continuing to hold events with large, tightly packed crowds in states that are currently experiencing outbreaks, such as Pennsylvania, Minnesota, and Wisconsin. Many in attendance, including Trump, have no worn masks. 

In the Stanford study, the spread of the virus after each event was compared to parts of the country that didn’t host rallies, illustrating risks of not heeding public health warnings to wear masks and avoid large gatherings to mitigate the risks of COVID-19. 

“The communities in which Trump rallies took place paid a high price in terms of disease and death,” authors of the study, including B. Douglas Bernheim, the chair of Stanford’s economics department, reported.

List of Trump rallies included in the Stanford University analysis

Berhneim said he hoped  the study will help inform policymakers the tradeoffs that come with holding large public gatherings during the pandemic. 

 “There’s currently this very important debate going on about the costs and benefits of lockdowns, restrictions and so forth,” Bernheim was quoted as saying. “It’s important that debate be informed by good information.”

The White House has reportedly called this study “flawed” in its attempt to shame Trump supporters. “As the President has said, the cure cannot be worse than the disease and this country should be open armed with best practices and freedom of choice to limit the spread of Covid-19,” said spokesperson Judd Deere in a statement made Saturday.

Biden’s campaign has used the study as evidence that Trump hasn’t been taking the pandemic seriously. “He’s even costing hundreds of lives and sparking thousands of cases with super spread rallies that only serve his own ego,” said Biden spokesperson Andrew Gates. 

US Presidential Nominee Joe Biden has consistently worn a mask and held “socially-distanced” drive-in rallies

Former vice president Joe Biden and Senator Kamala D. Harris have consistently worn masks in public and have held socially distanced events. When two people close to Harris tested positive for coronavirus in October, the senator canceled travel for several days. 

When asked about the differences between Trump and Biden’s campaign approaches, Fauci has said, Biden “is taking it seriously from a public health perspective” and Trump is “looking at it from a different perspective.” That different perspective is “the economy and reopening the country.” 

“It’s not a major stretch,” to say that large unmasked gatherings are likely to spread the virus, said Dr. Amesh Adalja, an infectious disease expert at Johns Hopkins Center for Health Security. Adalja called the Stanford paper “suggestive” of spread from the events, but not definitive because it was not based on an investigation of actual cases. 

Minnesota public health officials have also blamed four COVID-19 outbreaks and more than 25 cases to Trump rallies held in the state in September and October. 

Rigorous contact tracing from large events such as these could help predict how infectious rallies could be. However, the United States has fallen behind other countries in this regard, due to the lack of funding and coordinated efforts to support contact tracking by the Trump administration. 

“The problem is we’ve not done anything to get real numbers,” said Dr. Eric Topol, a genomics expert and director of the Scripps Research Translation Institute in La Jolla, California. 

“If we even had one rally where there was definitive tracing, then you could extrapolate. But we’ve had none. Our country has performed as if contact tracing doesn’t exist,” Topol said.

Europe
Active cases of COVID-19 around the world and COVID-19 deaths globally (top right) as of 12:24PM EST 2 November 2020.

Meanwhile, Europe surpassed 10 million confirmed COVID-19 cases on Sunday, as more and more countries applied increasingly stricter lockdown measures. 

Britain closed pubs, restaurants and retail shops, requiring that people stay home unless they are seeking medical care, going grocery shopping, or employed at an essential business. 

“We’ve got to be humble in the face of nature,” said Boris Johnson, Prime Minister of the United Kingdom, at a news conference on Saturday. “In this country, alas, as across much of Europe, the virus is spreading even faster than the reasonable worst-case scenarios of our scientific advisers.”

The scientific models “suggest that unless we act, we could see deaths in this country running at several thousand a day, a peak of mortality, alas, bigger than the one we saw in April,” warned Johnson. 

Germany entered a ‘light lockdown’ on Monday, restricting gatherings to 10 people, advising against non-essential travel, and closing recreational facilities and restaurants. 

“We are seeing an exponential rise in numbers, with the number of cases doubling in an ever shorter time,” said German Chancellor Angela Merkel after a meeting with state premiers of Germany’s federal states last week. “We know now that we must further restrict person-to-person contacts and thus reduce the risk of becoming infected.” 

“I am very optimistic that we can now, in November, bring the virus under control. I will say it again: we have done it before, I am very sure we will do it again,” said Jens Spahn, German Federal Minister of Health, in an interview with ZDF Heute. 

In Switzerland, Geneva also instituted a partial lockdown, which will go into effect from 7pm on Monday until November 29. Bars, restaurants, and non-essential businesses will be closed, gatherings of over 5 people in public spaces will be banned, and public and private events with more than 5 people will be restricted. 

Nationwide, Switzerland has reported 21,926 new cases since Friday, with 497 hospitalizations and 93 deaths, making its new case rate one of the highest in Europe. Geneva is one of the hotspots in Switzerland. “Over the past few days, more than 1,000 people have tested positive for coronavirus on a daily basis (peaking at 1,338 positive cases on October 30),” said the Geneva Cantonal government in a statement released on Sunday. 

“One of the challenges that we’re seeing across North America and Europe is that the increase in cases and the increase in hospital admissions to ICU are happening at the same time,” said Maria Van Kerkhove, WHO Health Emergencies technical lead at a Monday press conference.

“Health systems are becoming overwhelmed so that poses challenges for countries that were able to facilitate their workforce around managing the most intense areas,” she added.  

Dr. Michael Ryan, WHO Executive Director of Health Emergencies

As Europe also faced a rising wave of civil protests over the new government-imposed imitations, governments in Europe face “very limited options” in getting the COVID surge under control, underlined WHO Health Emergencies Executive Director, Mike Ryan.

“We need to push this virus down, we need to take the heat out of this epidemic right now in Europe, and governments have limited options right now in how to do that. Their options are limited,” Ryan said. “People have every right to question when authorities indicate that certain measures need to be taken, but we would prefer that to be a dialogue between governments and communities,” he added, stressing that protests should not, however, put more people at risk of infection. 

Virus Variant Prevalent – But Not Any More Dangerous

Although speculation has been rife about whetehr the surge is also being fueled by a novel SARS-CoV-2 variant,  named 20A.EU1, that has spread widely across Europe in recent months one of the, lead authors of the study on the newly identified variant, said that so far, it does not appear to be any more deadly or infectious. 

“We do not have any evidence that the new variant is more transmissible or has a different clinical outcome,” Dr. Emma Hodcroft of the University of Basel, told Health Policy Watch. “We think the main factors here were the rising cases in Spain, travel over summer, lack of screening/successful quarantine, and failure of countries to contain rising cases.

While there are hundreds of different variants of the new coronavirus circulating in Europe alone, only few of these variants have spread as successfully and become as prevalent as the newly identified 20A.EU1, which likely originated in Spain. 

From July, 20A.EU1 moved with travelers as borders opened across Europe, and it has been identified so far in twelve European countries. Currently, 20A.EU1 accounts for 90% of sequences in the UK, 60% of sequences in Ireland, and between 30-40% of sequences in Switzerland and the Netherlands, making it one of the most prevalent variants in Europe. 

Though this rise in prevalence of 20.EU1 corresponds with the increasing number of cases being observed in Europe this autumn, the authors of this study caution against interpreting the new variant as a cause for the rising numbers. 

“Long-term border closures and severe travel restrictions aren’t feasible or desirable,” explains Hodcroft, “but from the spread of 20A.EU1 it seems clear that the measures in place were often not sufficient to stop onward transmission of introduced variants this summer. When countries have worked hard to get SARS-CoV-2 cases down to low numbers, identifying better ways to ‘open up’ without risking a rise in cases is critical.”

The global COVID-19 death toll surpassed 1.2 million on Monday and global COVID-19 cases reached 46 million. 

 

 

 

Image Credits: Gage Skidmore/Flickr, GPA Photo Archive/Flickr, B. Douglas Bernheim, et al , Mike Beaty/Flickr, Johns Hopkins, R Santos/HP Watch.

Regeneron’s lab developing antibody medicines.

Regeneron Pharmaceuticals suspended enrollment of critically ill and hospitalized patients in its COVID-19 antibody cocktail treatment clinical trial on Friday, due to what it said was a safety concern. 

The pharma company’s independent data monitoring committee (IDMC) recommended this pause “based on a potential safety signal and an unfavorable risk/benefit profile,” advising on the collection and analysis of further data. 

Eli Lilly’s antibody treatment clinical trial, examining the efficacy of bamlanivimab, was meanwhile halted altogether for hospitalized COVID-19 patients, after initial trial data suggested that the drug was unlikely to help them recover. 

The Regeneron decision to pause applies to hospitalized patients receiving mechanical ventilation or high-flow oxygen and was taken following the recommendation by the IDMC. The trial will continue the enrollment of patients requiring no or low-flow oxygen. 

Some experts suggested that biologically the treatment could attack the virus better earlier on, but an overactive immune response could reduce the efficacy of the drug cocktail. The safety issues in patients severely ill with COVID-19 do not necessarily raise concerns about the safety for those with mild to moderate illness. 

“There is a tiny window and it’s the earlier the better,” said Eric Topol, director of the Scripps Research Translational Institute, in an interview with Financial Times. He emphasized the need to treat COVID-19 early or preventatively.

Regeneron’s announcement comes after the company revealed early results on Wednesday that their drug cocktail reduced COVID-19 related medical visits by 57 percent overall and 72 percent in patients with one or more risk factors. 

George Yancopoulos, CEO of Regeneron

“Today’s analysis…prospectively confirms that REGN-COV2 can indeed significantly reduce viral load and further shows that these viral reductions are associated with a significant decrease in the need for further medical attention,” said George Yancopoulos, President and Chief Scientific Officer of Regeneron. 

“We continue to see the strongest effects in patients who are most at risk for poor outcomes due to high viral load, ineffective antibody immune response at baseline, or pre-existing risk factors,” he added. 

Regeneron’s decision to pause enrollment is seen as the second recent setback for a COVID-19 antibody therapy. The first was the suspension of Eli Lilly’s monoclonal antibody trial on hospitalized patients last week.  

Eli Lilly’s Clinical Trial Halted by NIH
Eli Lilly researchers developing a COVID-19 antibody treatment.

The independent Data and Safety Monitoring Board recommended to the National Institutes of Health (NIH), the sponsor of the Eli Lilly trial, that no further hospitalized COVID-19 patients receive the drug, because of a “low likelihood that the intervention would be of clinical value in this hospitalized patient population.” 

The discontinuation of the trial “tells us they stopped the trial due to futility” and “suggests that the timing of monoclonal antibody administration – early – will be important,” said Topol to the New York Times. 

Trials of the drug will continue in patients with mild to moderate COVID-19. 

“While there was insufficient evidence that bamlanivimab improved clinical outcomes when added to other treatments in hospitalized patients with COVID-19, we remain confident based on data from Lilly’s BLAZE-1 study that bamlanivimab monotherapy may prevent progression of disease for those earlier in the course of COVID-19,” said Eli Lilly in a statement. 

Both Eli Lilly and Regeneron submitted emergency use authorization requests to the US Food and Drug Administration (FDA) in early October to treat patients with mild to moderate COVID-19. 

Front-runner Moderna in COVID-19 Vaccine Race Prepares for Global Launch 

Meanwhile, Moderna announced on October 22 that their Phase 3 clinical trial for a potential COVID-19 vaccine completed the enrollment of 30,000 participants. The biotechnology company is preparing for the global launch of its potential vaccine. 

Stéphane Bancel, CEO of Moderna

Among the trial participants, 37 percent are from diverse communities and 42 percent are at high risk of severe COVID-19 disease, either over the age of 65 or with co-morbid risk factors. All participants have received their first shot of the vaccine candidate and the majority have received the second. 

Moderna is currently on track to file an emergency use authorization to the FDA in late November, if they gather sufficient safety and efficacy data, as announced by Moderna CEO, Stéphane Bancel, in early October. 

“We are actively preparing for the launch of mRNA-1273 and we have signed a number of supply agreements with governments around the world,” said Bancel in a press release on Friday. “Moderna is committed to the highest data quality standards and rigorous scientific research as we continue to work with regulators to advance mRNA-1273.”

Britain Health Regulator Began Rolling Review of AstraZeneca’s COVID-19 Vaccine

In Britain, the Medicines and Healthcare Products Regulatory Agency (MHRA) started an accelerated rolling review of AstraZeneca’s potential COVID-19 vaccine, produced in collaboration with researchers at the University of Oxford.

“We confirm the MHRA’s rolling review of our potential COVID-19 vaccine,” said an AstraZeneca spokesperson to Reuters on Sunday. 

AstraZeneca scientist developing potential COVID-19 vaccine.

The health regulator will analyze trial data and potentially accelerate the approval process, if the data reveals that the vaccine is safe and effective. This review helps fast track potential vaccines and drugs in ongoing trials. 

On Wednesday, the MHRA began a rolling review of Moderna’s vaccine candidate and a review of Pfizer’s vaccine candidate also started recently. These three pharmaceutical companies, along with Johnson & Johnson, are leading the race to develop a COVID-19 vaccine. 

Image Credits: Regeneron, Regeneron, Eli Lilly, Moderna, AstraZeneca.

Cyclists in Bogota take advantage of car-free roads

Third in a series – Cities are major drivers of public health and the COVID-19 pandemic has brought increasing and urgent necessity for effective, innovative leadership and collaboration within and between cities.

“The COVID-19 pandemic has upended lives around the globe and nowhere has the impact of this virus been more evident than in urban areas, home to more than 50 percent of the world’s population,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, at the COVID-19 and Beyond: Cities on the Front Lines of a Healthier Future event on Thursday. “Many [cities] have fought back, with people and leaders uniting to suppress the virus and save both lives and livelihoods.” 

The event on Thursday, co-sponsored by Partnership for Healthy Cities, WHO, Bloomberg Philanthropies, and Vital Strategies, highlighted and celebrated the critical leadership provided by mayors and city governments. The event followed the release of a portfolio of case studies exhibiting efforts by urban leaders to develop a course of action to combat the pandemic, and occurred ahead of the upcoming World Cities Day on October 31. 

“Mayors and other urban leaders around the world have risen to the challenge of responding to COVID-19 and continue to make incredibly difficult decisions to protect people’s health, while maintaining economic stability and social cohesion,” said José Luis Castro, President of Vital Strategies. “City leaders entered the COVID-19 era in many cases without a playbook. They have nevertheless mounted a remarkable pandemic response.” 

The mayors of Bogota, Colombia, Athens, Greece, and Kampala, Uganda shared their experiences tackling the unique challenges facing their cities and populations. The mayors – who Dr Tedros referred to as urban health champions – detailed their actions to impose lockdowns, provide support to vulnerable communities, and implement forward looking health policies. 

Bogota, Colombia
Bogota also expanded its bike network during the national lockdown for healthy, safe transport.

Controlling the spread of the pandemic and increasing the capacity of the health system was prioritized early on with a six week lockdown in Bogota, implemented by the city government and Mayor Claudia López. The national lockdown in Colombia was promoted by the collaboration between 500 mayors, including López, to institute city-wide lockdowns. 

The rapid response by city leadership enabled the health system capacity to double between April and August, from 935 intensive healthcare units to 2,200, and from 200 tests per day to 15,000. 

In order to deal with the economic hardship and rising poverty levels that accompanied the lockdown, the city government collaborated with the national government to provide cash transfers to more than 700,000 families. This network of income and social support has been incorporated into Bogota’s long-term development plan to assist with social and economic recovery. 

Investment in small businesses, which delivers 60 percent of employment in the city, kept them in business and contributed to reducing unemployment from 26% in July to 19% in August. 

“I think we have an incredible opportunity during this pandemic, and then afterwards, to change things definitively for the better for cities. To improve sustainable mobility and to leave in place the social contract for women, for youth, for poor families,” said Mayor López. 

Athens, Greece
Staff from Hellenic Liver Patients Association
“Prometheus” in Athens delivers essential supplies to vulnerable community members.

The city government of Athens, led by Mayor Kostas Bakoyannis, took strategic actions to prioritize disenfranchised people who were vulnerable to the health and economic effects of the pandemic. The pandemic is not only a health issue, but a huge socioeconomic issue also, said Mayor Bakoyannis. 

The pandemic reveals and exacerbates existing inequalities and structural injustices. To address these inequalities and those at high risk, shelters were set up for homeless Athenians and those struggling with drug addiction, providing protection and medical attention. 

A system, Health at Home Plus, was established to deliver food, medicine, and aid to the homes of tens of thousands of residents during the lockdown. The system has continued until today, providing services and meeting needs of the population. 

“[Local authorities’] strength is working bottom up and our true power is in the street,” said Mayor Bakoyannis. “In order to be able to respond to the needs of the city, we understood that the city organization had to change. That’s why for us the pandemic was also an opportunity to move forward with long overdue reforms. It was a catalyst.”

Kampala, Uganda
Kampala Capital City Authority staff provide food relief and healthcare aid.

Kampala, one of the most densely populated cities in Uganda, has had 37% of total COVID-19 cases reported in the country. While the city-wide lockdown implemented in March slowed transmission of the virus, it also brought numerous challenges for workers relying on daily jobs to survive. 

The leaders of the Kampala government established a food distribution system to assist residents during the lockdown. A stimulus package was introduced to support small businesses and address some of the economic challenges. 

“As leaders, at times we need to take firm decisions regardless of the consequences,” said Deputy Mayor Doreen Nyanjura. “And we have seen this work in Uganda, where some attempts even had to involve the police because they are looking at saving the lives of our citizens.

“We need to unite as leaders with our citizens.”

The collaboration between the city government and national government hasn’t run smoothly during the COVID-19 pandemic, Deputy Mayor Nyanjura noted. The efforts of local authorities were constrained by the lack of funding from the national government. As a result, the city government has faced increased pressure to support medical teams, increase the capacity of health systems, and educate and empower the public with a limited budget. 

Advice For Other City Leaders

The three mayors provided advice for leaders of cities currently dealing with effectively tackling the pandemic and meeting the needs of residents: 

“We prioritized facts, science, and truth over politics and partisanship. We placed expertise over populism. It worked. It worked on a national level and it worked on a city level” to get cooperation from citizens for the lockdown and for compliance with pandemic prevention measures, said Mayor Bakoyannos. 

“Follow the facts and science. I think it’s amazing that in the 21st century we’re still seeing this debate in some very prominent democracies about science…follow the facts and tell people the truth [about] the risks that they are facing,” said Mayor López. “As long as we have science, leadership, decisions, and assertiveness…we will learn how to save lives.”

“Unite and take firm decisions, and consider the lives of those that [the government] represents,” said Deputy Mayor Nyanjura. “We need to unite with our citizens, we need to unite with our technical team…[and] with the government.”

Image Credits: Climate and Clean Air Coalition , Fernanda Lanzagorta, OPS Columbia, Partnership for Healthy Cities, Partnership for Healthy Cities.