The plan aims to support 160 million people, including those disproportionately affected by the COVID-19 pandemic. In Soweto, South Africa, poverty and crowded conditions made lockdowns much harder.

More than 235 million people worldwide will require humanitarian protection next year: an increase of 40% in 12 months.

The United Nations (UN)has announced an appeal for US$35 billion, which it estimates will be required to support 160 million of those most in need of support, across 56 countries.

The Global Humanitarian Overview (GHO) 2021, published on Tuesday 1 December, has outlined 34 appeals designed to support vulnerable populations who are disproportionately affected by conflict, displacement, and the impacts of climate change and the COVID-19 pandemic.

“In 2020, COVID-19 altered the landscape of humanitarian response,” the abridged report stated. Analyses of the impact of the pandemic have been considered alongside pre-existing crises.

UN Under-Secretary General for Humanitarian Affairs and UN Emergency Relief Coordinator, Mark Lowcock

In a press briefing on Tuesday, UN humanitarian chief Mark Lowcock said that money will be used from the UN’s Central Emergency Relief Fund (CERF) to curb the increase in violence against women and girls caused by or linked to the pandemic.

Lowcook said in a statement: “The rich world can now see the light at the end of the tunnel. The same is not true in the poorest countries. The COVID-19 crisis has plunged millions of people into poverty and sent humanitarian needs skyrocketing. Next year we will need $35 billion to stave off famine, fight poverty, and keep children vaccinated and in school.

“A clear choice confronts us. We can let 2021be the year of the grand reversal –the unravelling of 40 years of progress – or we can work together to make sure we all find a way out of this pandemic.”

70% of the people targeted for aid in 2020 were reached, but total donations reached $17 billion – less than half of what is required in 2021.

The report can be read here. The UN statement is available here.

Image Credits: UN Photo/Mark Garten, Matt-80.

HIV treatment
Around 1.7 million children are living with HIV around the world, but high costs mean the number who receive treatment is only half that. A new agreement could see the drugs reduced from $400 to $36 per child.

Two groundbreaking agreements with pharma companies that should greatly expand access to WHO-recommended HIV drugs for children and adults in low- and middle-income countries (LMICs) have been announced by the Geneva-based Unitaid and Medicines Patent Pool (MPP).

The announcements, coinciding with World AIDS Day, celebrated on Tuesday 1 December, both involve cheaper versions or new formulations of the WHO-approved antiviral dolutegravir-based (DTG) treatments for HIV.

The initiatives aim to reduce the 12.6 million people around the world who lack access to effective ARVs – many of them living in middle- and upper-middle-income countries.

One agreement, between the Medicines Patent Pool (MPP) and ViiV Healthcare – is designed to improve access to DTG HIV treatment to adults, while still prioritising investment in drug innovation. The agreement clears the way for the generic production of the ViiV Healthcare formulation by generic manufacturers at a much reduced price in several upper-middle-income countries, including Azerbaijan, Belarus, Kazakhstan and Malaysia.

A second agreement, facilitated by Unitaid, would also open the way for generic production and sales of a dispersible paediatric formulation of DTG for a price of just US$ 120 per child as compared to US$ 480. The long-awaited agreement on production and sale of an HIV treatment designed specifically for children is thanks to a landmark agreement between Unitaid and the Clinton Health Access Initiative (CHAI) on support for the product.

75% Cost Reduction for Children’s HIV Treatment in LMICs

Around 1.7 million children are living with HIV around the world, but the number who receive treatment is only half that, due in part to a lack of or limited accessibility to effective drugs, properly adapted for children.

HIV drugs for children are often incorrectly dosed or bitter tasting, which makes it harder for children to adhere to their treatment.

A new dispersible formulation of DTG treatment – WHO’s foremost recommendation for treating people living with HIV – will be launched at a cost of $36 per child, following an agreement between generic manufacturers Viatris and Macleods which saw the price reduced from $400.

Philippe Duneton, Unitaid’s executive director, said: “Children in LMICs often wait years to access the same medications as adults, hindering their quality of life, or even resulting in preventable deaths.”

Incorrectly dosed treatments and bitter tastes mean that many children living with HIV respond poorly to antiretroviral treatment and, despite WHO having recommended DTG for children for nearly 2 years, there are no affordable drugs for small children (under 20kg).

The new 10mg DTG tablet, produced ViiV Healthcare, under the plan supported by Unitaid and CHAI, has been given a strawberry flavour, to ensure children’s adherence to the medication, and preventing some of the 100,000 child deaths annually from HIV. The new product will be made available initially in Benin, Kenya, Malawi, Nigeria, Uganda and Zimbabwe in the first half of 2021.

“Today we can finally guarantee that countries have rapid access to the appropriate formulations needed to fully implement WHO guidelines; so that no child is left behind,” said Dr Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes at WHO. “Congratulations to all the partners involved for showing how quickly we can bring new formulations to market when we work together – clear proof that solidarity delivers results.”

“This groundbreaking agreement will bring quality assured dispersible DTG to children at a record pace,” Duneton added. “Ensuring access to this treatment will transform the lives of children living with HIV, helping them to remain on treatment and saving thousands of lives.”

The agreement is expected to save global health budgets an estimated US$60-260 million over 5 years.

MPP agreement  – New Adult DTG Formation For Azerbaijan, Belarus, Kazakhstan and Malaysia

For adults, a milestone licensing agreement will enable greater access to WHO approved antiretroviral DTG treatments for HIV, in several upper-middle-income countries, including Azerbaijan, Belarus, Kazakhstan and Malaysia. The four countries were excluded from a 2014 MPP licensing deal that covered dozens of other lower and middle income countries, because they were considered upper middle-income by World Bank definitions.

Under the terms of the new agreement reached between the Geneva-based Medicines Patent Pool (MPP) and the  pharma manufacturer ViiV Healthcare – generic manufacturers will be able to supply DTG regimens at a much-reduced prices, enabling greater access to HIV treatment in each country, MPP said.

Charles Gore, MPP Executive Director said in a statement: “Increasing access to life-saving medicines for low- and middle-income countries is at the core of our mission and we have been able to achieve that over the last 10 years through strong partnerships that span industry, generics manufacturers, governments and civil society. This new and first-of-its-kind agreement with ViiV Healthcare, that is specifically aimed at increasing access in these upper-middle-income countries, will mean that people living with HIV in Azerbaijan, Belarus, Kazakhstan and Malaysia will now have greater access to affordable and quality WHO-recommended dolutegravir-based treatment regimens.”

Meg Doherty, WHO’s Director of Global HIV, Hepatitis and STI Programmes.

In 2019, WHO recommended DTG as the preferred HIV treatment in all populations – including pregnant women – after two large clinical trials in the time since, however, have found that risks of birth complications are significantly lower than had been initially believed.

With reference to the announcement, Dr Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes at the World Health Organization said; “WHO recommends the use of dolutegravir (DTG) as part of the preferred first-line and second-line regimen for people living with HIV, including pregnant women and those of childbearing potential. WHO welcomes this licence and through our regional and country offices have worked alongside governments and MPP to ensure that this agreement responds to people’s HIV treatment needs in these countries.”

Vinay Saldanha, Special Adviser to the UNAIDS Executive Director, said: “Voluntary licensing agreements have proven to be an important tool to improve affordability of newer ARV formulations and products in low- and middle-income countries (LMICs), through increasing generic competition.

“Several upper-middle-income countries, however, have not been able to benefit from several access to medicines initiatives, with growing barriers to procure more affordable ARVs in the generic pharmaceutical market. We hope that the current agreement will be the first of many to come, opening the doors for countries in other regions, which are still paying higher prices for innovative health technologies that could advance treatment outcomes.”

Medicines Access Advocates Criticize MPP Deal As Setting Unfavorable Precedent on Secrecy

Medicines access advocates, however, criticized the MPP’s mediated licensing agreement, saying that the organization had allowed for the royalty provisions made between the countries and ViiV and (which is controlled by GSK, with a minority shared held by Pfizer) to remain secret.  That, they said, runs contrary to MPP’s longstanding tradition of transparency in the agreements that it mediates between pharma companies holding patents or other production rights, governments and generic manufacturers.

Brook Baker, a professor at Northeastern University School of Law, USA, and a senior policy analyst with Health GAP (Global Access Project), said in a blog post: “The MPP for the first time ever is acceding to industry demands to redact the royalty terms from its published licenses. The MPP has historically been committed to full transparency of its licenses.

“Now upsetting that commendable principle … a key term in an MPP license will be hidden from public view. This is a major setback to the principles upon which the MPP was founded and it is also a dangerous precedent in the COVID-19 era, where companies are hiding behind claims of transparency to maximize profits and power. They are insisting that everything – their R&D contracts, clinical trial protocols, research data, pricing decisions, advance purchase agreements and option contracts are entitled to full confidentiality as ‘trade secrets’.”

He also charged that the price to be charged could still wind up being five or six times higher than the US$75 paid by low-income countries under the 2014 agreement.

“MPP also admits that generic licensees will in all likelihood price their generic versions substantially higher than the $75 per year secured through by the Clinton Health Access Initiative and others in 2014,” Baker said. “In fact, the MPP anticipates an eventual price in the range of $400-$500 per year, a sign of both inexcusably high tiered pricing by generic licensees and an excessive royalty charged by ViiV.”

In response, an MPP spokesperson said a price for the product hadn’t yet been set, but said it would be half or more of what it currently is in the countries involved:

“We don’t have a price yet. Following consultations with both governments and generic manufacturers, MPP is confident that affordable DTG and DTG-based combinations will have a price reduction of 50% to 70%. Estimates have been discussed with the governments of the countries during our consultations with them and this price is agreeable to them, and that this will enable a gradual transition to the WHO recommended regimen.

As for the secrecy around the royalties, the spokesperson said: “The royalty rates of the agreement were redacted from the published licence because it was considered commercially sensitive information by ViiV Healthcare who requested its redaction.

“MPP discussed with its independent Expert Advisory Group and Governance Board. In view of the importance of the agreement for access in the four countries and the requests from the four governments to facilitate access to these products as soon as possible, MPP exceptionally agreed to redact these clauses. The rest of the agreement is made public on the MPP website. MPP continues to be the global public health organisation with the highest level of transparency in its licensing agreements and commits to continued transparency in its licensing practices.”

Image Credits: Paul Kamau/ DNDi, NIAID, WHO.

The US has reported 2 million new COVID-19 cases in the past 2 weeks, over the Thanksgiving holiday and in the month leading to Christmas.

WHO officials have expressed concern about yet another spike in COVID-19 infections and deaths across the Americas, following the Thanksgiving holiday on Thursday, and in the run-up to Christmas – echoing concerns already being expressed by United States health authorities.

The US has reported 2 million new COVID-19 cases in the past 2 weeks: a striking new record, considering the country had not recorded more than 500,000 cases a week before November. As a result, US health officials have urged those traveling nationwide to take measures to stem a further increase.

“If you’re young and you gathered, you need to be tested about five to 10 days later,” said Deborah Birx, the White House COVID-19 response coordinator, in an interview with CBS News. “You need to assume that you’re infected and not go near your grandparents and aunts and others without a mask.”

With new infections from the Thanksgiving holiday, “we might see a surge superimposed upon that surge that we’re already in”, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in an interview with NBC.

The delay between the time of infection, first symptoms and actual testing will also delay nationally reported rates of infection, hospitalization and deaths, experts warned. 

“Probably what this means is three or four weeks after Thanksgiving, we will see more people die than otherwise would have,” said Michael Mina, epidemiology at Harvard’s T.H. Chan School of Public Health. “We’ll see more people get infected over Thanksgiving. And unfortunately, it will probably be a lot of older people who are gathering together with their families.”

The number of cumulative cases in the Americas as of 30 November 2020. (Johns Hopkins)
WHO: Do You Really Need To Travel?

At a WHO media briefing on Monday, Director General Dr Tedros Adhanom Ghebreyesus asked  the general public to carefully consider their choices over the coming holidays, saying: “The first question to ask yourself is, do you really need to travel?

“The COVID-19 pandemic will change the way we celebrate, but it doesn’t mean we can’t celebrate. The changes you make will depend on where you live.”

Dr Tedros also urged holiday shoppers to “avoid crowded shopping centres, and shop at less crowded times”. The United Kingdom recently announced that shops can stay open up to 24 hours to aid economic recovery in the Christmas build-up, following a 4-week national lockdown. If people travel, mix households or shop in person, social distancing measures should be adopted and masks should be worn, Dr Tedros added. 

In his NBC interview, Fauci gave similar advice: “If we can hang together as a country and do these kinds of things [mask wearing and physical distancing] to blunt these surges until we get a substantial proportion of the population vaccinated, we can get through this.”

Dr Tedros Adhanom Ghebreyesus, WHO Dicrector General.

 

WHO Urges Brazil’s President to ‘Take It Seriously’

In a rare calling out of a head of state, Dr Tedros also said Brazilian President Jair Bolsonaro should take the pandemic “seriously,” citing the steep rise in active cases in Brazil, which threatens to surpass the country’s July peak if adequate action is not taken.

“I just would like to add one thing, because I want the president to take it seriously,” Dr Tedros said. The number of cases in Brazil climaxed in July, with 319,000 cases per week recorded, which then dropped to around 114,000. “It is back again to 218,000 cases per week.”

More than 200,000 cases were reported in Brazil last week, and since the first week of November, the death rate has risen from 2,500 to nearly 3,900.

Dr Tedros described the situation as “very, very worrisome”, especially when local transmissions are considered in aggregate.

“In the case of Brazil, the disease numbers are going down in a number of states but rising in others,” said Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme. “As they begin to see a rising number of cases, countries need to look at a national and sub-national level.”

He added that Brazil, and countries facing similar regional challenges, need to be “very, very clear and directed [in locating] where cases are jumping back up and what’s driving this rise in cases”.

Tailored and targeted interventions are vital in stemming local transmissions, but just as important is a country’s ability to maintain a low case rate after a successful intervention.

“Bring it down, keep it down,” said Dr Maria van Kerkhove, WHO’s COVID-19 Technical Lead. “We have seen so many countries that have brought transmission under control, but they haven’t been able to keep it low.” She added that countries should jump on regional outbreaks urgently “so that they don’t have the opportunity to seed into something further”.

Ryan added: “We are not just trying to get the COVID numbers down for the sake of getting COVID numbers down. We are trying to get the core with numbers down so the health system can get back to what it’s supposed to be doing.”

WHO Calls Out Mexican President’s Refusal To Wear A Mask

When asked about Mexican President Andrés Manuel López Obrador’s refusal to wear a mask at public events, WHO officials reiterated the need for political leaders to set a model for citizens, especially as cases continue to rise in many countries.

The president has been notorious in his refusal to wear a mask to prevent transmitting COVID-19, even telling reporters in July that he will put on a mask “when there is no corruption. Then I’ll put on a mask and I’ll stop talking”.

“As we would say to leaders all over the world: it is very important that behavior is modeled,” Ryan said on Monday. “If we’re advising people to do things then it is really important that political leaders and society influencers are in fact modeling those behaviors [themselves].”

As of the end of November, Mexico has seen more than 1 million cases and reported more than 100,000 deaths with COVID-19.

If politicians do not adhere to COVID prevention measures and restrictions, Ryan said, the basic prevention etiquette “becomes politicized [and] that helps nobody”.

The WHO stance, he added, is that when measures are implemented they require the support of everyone in government: “Everyone in a position of authority and influence [should be] is trying their best to model those behaviors in the best way they can.”

 

Image Credits: Nathan Rupert, Johns Hopkins University & Medicine, WHO.

The 2020 G20 Riyadh summit, November 2020.

We are kicking off our expanded new series of opinion pieces, with Ilona Kickbusch’s reflections on last week’s G-20 and the mission of COVID vaccine distribution – what she describes as the most “defining global challenge” of 2021.  We invite contributions from health policy leaders, influencers and practitioners who wish to speak out on issues of concern – from wherever you may be in the world.   

In his global “wake up call” UN Secretary General, Antonio Guterres called on the global community to move from international chaos to the construction of an international global community that is capable of meeting and solving tomorrow’s challenges.

It was clear early on in 2020 that the Group of 20 most industrialized nations (G20) could not contribute much to resolve the present pandemic challenge – let alone the future – given the decision of the US president to disregard the pandemic, fight the World Health Organization (WHO) and to obstruct multilateral solutions.  It was even clearer last weekend that the G20 has not helped move this agenda forward.

COVID-19 is global, but the response to this collective global threat is still largely national. Its global dimension is still dependent on contributions in the form of development aid (ODA) and fundraising efforts of various types. This is also insufficient. Global health financing needs a full reset.

Instead, the rhetoric of global health in the speeches by global leaders has included regular mention of global goods and abounded with reference to equitable access to vaccines. “We will spare no efforts” said the G20 declaration at the conclusion of last weekend’s leaders summit, “we recognize the role of extensive vaccination as a global public good.” But the G20 has not stepped up to the plate to enable the ambitious goal to distribute 2 billion doses of COVID-19 vaccines before the end of 2021.

COVID-19 Vaccines is Test Case – But No Signal In Right Direction

The paradigmatic test case of common goods for health will be the equitable and fair access to a COVID-19 vaccine; this may be the defining global challenge of 2021. The G20 did not face up to a serious discussion on how to define and finance common goods. For example, recent estimates call for about US$ 26 billion a year of investment in common goods for health over the next five years, a manageable amount at just 0.32 % of total global spending on health.

Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Programme in Geneva.

The G20 is not a pledging forum but a signal in the right direction might have helped. The European Commission called for US$ 4.5 billion at the G20 meeting to be invested by the end of 2020 in the WHO co-sponsored ACT Accelerator – a new global collaboration for procurement and delivery of COVID-19 tests, treatments, and vaccines everywhere. Germany – which holds the EU Council Presidency – had already contributed more than €500 million (US$ 592.65 million) to this effort.

So if each G20 member had committed to paying only US$250 million (in cash or kind), the approximately $US5 billion would be available. They have not. Instead a small group of rich countries representing 13% of the world’s population has bought up more than half of the future supply of leading COVID-19 vaccines.  In response, India and South Africa (members of G20) have sent a proposal to the WTO asking “that it allow countries to suspend the protection of certain kinds of intellectual property related to the prevention, containment and treatment of COVID-19.”

But much more serious than the lack of easily affordable action on the present crisis is the lack of foresight in relation to the future.

During the global financial crisis in 2008, the structural problems that contributed to the crisis were addressed, leading to changes in the financial regulatory architecture at national and regional level.

In the same way the G20 should have used the pandemic to address the major structural financing deficits of the global order – especially in relation to financing global common goods for health. Economic losses from the pandemic are currently estimated to exceed 4.9%–7.6% of global GDP (US$4–US$ 6 trillion), an amount that is 20 to 30 times greater than the estimated cost of investing in epidemic preparedness. COVID-19 has resulted in the deepest recession in decades as the International Monetary Fund and the OECD have calculated – it will probably have 4-fold the impact of the 2008 financial crisis.

No Global Revenue Raising Mechanism For Global Goods – Leaves Health Leaders Fundraising With Music Industry 

The G20 finance ministers should have addressed the fact that after 75 years there is still no reliable mechanism at a global level to raise revenues for global functions produced by the United Nations system. Yet even in the face of the largest pandemic in 100 years there is no political will to address the financing of global common goods for health – except to embark on yet another round of fundraising, one fancier than the next.

This political neglect has left key institutions like the WHO severely underfinanced. As millions die of COVID-19, it must create a new foundation and reach out to the global music industry to engage in fundraising for vaccine development and distribution as well as for the pandemic response in low- and middle-income countries.

This does not bode well for a future where the world will not only have to deal with pandemics, but also with antimicrobial resistance and the impacts of carbon emissions on air pollution and climate change.  Even generous countries – like the United Kingdom (who will preside over the G7 next year) are pulling back on their ODA commitments and have announced a cut to the UK’s foreign aid budget, which will be reduced from 2021 from 0.7% of gross national income to 0.5%, “saving” approximately £4 billion.

At the G20 it was obvious that the US would stall any move in the direction of a proposal that has even a whiff of WHO involvement linked to it –  outgoing President Donald Trump preferred to play golf rather than attend much of the conference proceedings.

In contrast the European Union has been particularly active in pushing funding for the COVAX facility, the global risk-sharing mechanism for pooled procurement and equitable distribution of possible COVID-19 vaccines. This must be recognized. But it too has not yet pushed for a longer-term blueprint for new financing mechanisms for global health.

Whether it’s a Digital Tax or Financial Transactions Tax Or Other Means – Paradigm Shift Still Needed 

A collective global problem typically requires a common response.  As outlined in a recent paper, this requires a paradigm change that would transform global health funding.

Rather than engage in declarations full of nice words, the joint meetings of the Health and Finance Ministers of the G20 should devise a financing framework that ensures a sustained source of revenue for global common goods for health. Possibly through a global or multinational taxation system or mix of national, global and regional taxation. A digital tax is frequently mentioned in this regard as well as taxing financial transactions. In the meantime, coordinated institutional mechanisms like COVAX should be supported to pool resources for common goods – such as vaccines – that are desperately needed.

Raising some US$ 25 billion a year for pandemic preparedness in a world whose GDP exceeds US$ 75 trillion would require a very minimal, and thus almost painless, level of taxation, making this a particularly feasible option.

But without political will it cannot be done. Not only must the heads of government come together and address this issue – in 2020 in both the G7 (chaired by UK) and G20 (chaired by Italy) – but also the many interest groups in global health covering a wide span of agendas and diseases must come together to address this larger issue of a new financing regime for common goods for health. The system that is build on ODA and philanthropy is broken and the sooner we address this issue the better. Because with a new financing paradigm the world will be more equitable and we will all be safer.

________________________

Professor Ilona Kickbusch is the Founding Director of the Global Health Programme at the Graduate Institute of International and Development Studies in Geneva. She is a member of the Global Preparedness Monitoring Board and the WHO High-Level Independent Commission on NCDs and co-chair of Universal Health Coverage 2030. She has been involved in German G7 and G20 health-related activities, and the development of the German global health strategy.

Image Credits: G20, European Health Forum Gastein.

As coronavirus policies initially forced many of us to turn into couch potatoes glued to our screens, the World Health Organization emphasizes that we can remain active and healthy even in COVID times. 

Regular physical activity of any type, and any duration, including dance, running, or even everyday household tasks like gardening or cleaning, can boost health and wellbeing, although more is always better, emphasized the WHO’s director of health promotion Ruediger Krech on Wednesday, at the launch of the Organization’s new guidelines on physical activity and sedentary behaviour.

The guidelines come on the heels of surprising statistics that a whopping four out of five adolescents, and one in five adults, are failing to get their minimum dose of physical activity, especially girls, women and lower-income groups. If they were widely adopted, the guidelines could help save five million lives a year that are lost to physical inactivity, as well as US$54 billion in direct health care, and another US$14 billion in productivity. 

“Being physically active is critical for health and well-being – it can help to add years to life and life to years,” added WHO Director-General Dr Tedros Adhanom Ghebreyesus at a press conference on Friday. “Every move counts, especially now as we manage the constraints of the COVID-19 pandemic. We must all move every day – safely and creatively.” 

There are few health promotion strategies that can hit so many diseases in one go as physical activity. In fact, regular exercise can help prevent and manage heart disease, type-2 diabetes, and cancer, which together account for almost three quarters of deaths worldwide, according to the WHO. Physical activity can also reduce symptoms of depression and anxiety, curb cognitive decline in older people, while also enhancing memory and bolstering brain health. 

The new guidelines call for moderate to vigorous aerobic activity for one hour a day in children and adolescents, 2.5 hours a week for pregnant women, and 2.5 to 5 hours a week for adults and older people, including those with chronic conditions or disabilities.

“The new guidelines recommend between 150 and 300 minutes of moderate to vigorous activity per week for for all adults, and an average of 60 minutes per day for children and adolescents,” said Dr. Tedros at the press briefing.

Older people should also engage in activities that promote functional balance, coordination and muscle strengthening to help prevent falls, which are the second leading cause of accidental deaths from injury worldwide.

The new, and more detailed guidelines replace the earlier guidelines on diet, exercise and physical activity issued a decade ago. In contrast to the guidelines from 2010, the latest guidelines are more inclusive because they offer specific advice on physical activity for pregnant women, postpartum women, as well those living disabilities and chronic conditions. 

The new guidelines are based on a comprehensive 500-page review of the most recent evidence on physical activity and its benefits, and are are part of the broader global action plan on physical activity, whose aim is to reduce physical inactivity by 15% in the next decade. 

WHO reccommends 2.5 hours a week of physical excercise for pregnant women

Image Credits: @WHO/Yoshi Shimizu, WHO.

Immunization programs ssuspended by COVID lockdowns have resulted in an increase in vaccine-derived polio cases in Africa.

Africa’s COVID-19 rollout is anticipated for Spring 2021, despite the continent’s low vaccine preparedness, multiple health leaders in Africa have said, as policy advisory groups flag the importance that other successful immunization campaigns will have on COVID recovery.

At a press briefing on Thursday, Dr. John Nkengasong, Director of Africa CDC, said: “Africa may have to wait until the second quarter of 2021 to roll-out COVID-19 vaccines. I have seen how Africa is neglected when drugs are available in the past.” The sentiment was echoed by WHO Regional Director for Africa Matshidiso Moeti, who specified an anticipated March roll-out.

The statements follow calls made by the African Regional Immunization Technical Advisory Group (RITAG) for countries to urgently resume routine and catch-up immunization services, while adhering to strict COVID-19 prevention protocols.

When African countries began to lockdown at the beginning of the pandemic, critical vaccination programs for diseases like polio were suspended for several months. Since the countries began reopening, governments have taken steps to undo the impact the pandemic has had on these campaigns, but the months-long interlude to routine immunizations has left its mark. While Africa was declared wild polio-free in August 2020, vaccine-derived polio cases have increased.

“Collective action to strengthen immunization is needed, now more than ever, as we approach the end of the Decade of Vaccines and COVID-19 limits access to essential health services across Africa,” said Professor Helen Rees, Chair of the RITAG, which is the principal advisory group to the WHO on regional immunization policies and programmes

Resuming routine vaccination could help countries prepare their systems for immunizing adult populations with up-and-coming COVID-19 vaccines.

Currently, African vaccine preparedness appears to be low, warned a WHO group on Thursday – which evaluated self-assessment of vaccine readiness levels in 40 of the region’s 47 countries, only to find that average readiness was only about 33% – in comparison to the WHO benchmark of 80%.

Through COVAX – a program aiming to accelerate the development of COVID-19 vaccines – Africa will be able to access vaccines for up to 20% of its population but at the outset, early dose will only reach about 3% of the population : namely, health workers and the elderly.

Nkengasong added that the continent needs to provide vaccine access to up to 60% of its population before it can achieve herd immunity indicating that additional funding needs to be arranged to extend COVID-19 vaccine coverage in Africa beyond what the continent would get through COVAX. He put the cost at up to US$12 billion.

How COVID-19 has impacted immunisation in Africa

Africa has a regional immunization target of 90% but in 2019, immunization coverage in the region stagnated at 74% for the third dose of the diphtheria-tetanus-pertussis containing-vaccine (DTP3), and at 69% for the first dose of the measles vaccine. WHO and its partners had hoped there would be improvement in 2020.

Moeti stressed that pre-existing gaps in immunisation coverage have been exacerbated in 2020 by the COVID-19 pandemic, putting millions of children at risk for deadly diseases.

An additional 1.37 million children across the African region missed the Bacille Calmette-Guerin (BCG) vaccine which protects against tuberculosis, and an extra 1.32 million children below the age of one missed their first dose of measles vaccine between January and August 2020, when compared with the same period in 2019, WHO said in a statement.

Moreover, immunization campaigns covering measles, yellow fever, polio and other diseases have been postponed in at least 15 African countries in 2020.

“Current outbreaks of vaccine-preventable diseases are an apt reminder of the work that remains to be done,” said Dr. Richard Mihigo, Programme Manager for Vaccine-Preventable Diseases at the WHO Regional Office for Africa. “How we respond to these outbreaks amid the COVID-19 pandemic will be critical to protecting children and communities, and to preventing further disease outbreaks.”

Image Credits: WHO, United Nations Photo.

Young school girls organize themselves before the March to End Gender-Based Violence in Dar es Salaam, Tanzania.  One sign reads: “Refrain from using abusive language for Women and Children”.

Violence against women and girls has been neglected during and worsened by the COVID-19 pandemic, and urgent efforts are needed to protect women, UNAIDS has said.

One in three women likely to experience violence at least once in their lifetime. Evidence indicates that the COVID-19 pandemic has resulted in significant increases in gender-based violence in nearly all countries.

Speaking on International Day for the Elimination of Violence Against Women, 25 November, UNAIDS called for urgent efforts for nations to improve or follow-through on neglected health services and outreach programmes to support victimes of violence or abuse.

“The growing evidence confirms that the impacts of the COVID-19 pandemic are not gender-neutral,” said Winnie Byanyima, UNAIDS Executive Director. “The impacts of lockdowns and travel restrictions imposed in many countries to curb the spread of the COVID-19 pandemic, the failure to designate sexual and reproductive health services and services for survivors of violence as essential services, and the undermining of women’s economic security have compounded the barriers for women and girls experiencing abuse, especially those who are trapped at home with their abusers.”

Ending violence against women is everyone’s business, and it is possible to make a difference during the 16 days of Activism against Gender-Based Violence

The pandemic has both amplified violence against women, as well as currently existing gender inequalities, a panel of representatives from various ministries of health said. Service providers, representing Spain, Argentina, India and Iraq, discussed how their countries have implemented strategies to combat violence against women, including actively searching for cases of violence in COVID-19 patients, improving connectivity between victims and authorities, and creating outreach services.

Argentina – Actively Assisting Victims of Violence Who Do Not Come Forward

Argentina has implemented a program that actively searches out COVID-19 patients in their homes and social circles for cases of gender-based violence, as lockdown measures designed to curb the COVID-19 pandemic have made made it harder to connect with victims.

The country has focused its approach on implementing preventative measures to protect potential victims from future abuse, and has expanded its response to protect LGBTQ+ people. It has also made its sexual and reproductive health services more accessible, with non-discriminatory policies established. There has still been an increase in femicides between January and November, however, with 265 women murdered this year.

“We have learned during this long pandemic that we have to adjust our current mechanisms in place to defend women and combat gender-based violence,” said Argentina Minister of Health Dr. Gines Gonzalez Garcia. Garcia addressed the significant changes that have come with the pandemic – in people’s behaviors and emotional states. Economic changes especially can increase violence against women, and has stated that “there is still more to be done.”

Young Syrian refugees performed a silent play on the importance of education in preventing early marriage in the UN Women-led ‘Women and Girls Oasis’ in District 4 of the Za’atari refugee camp (Jordan) on the occasion of the 16 Days of Activism Against Gender Violence campaign 2015.
Iraq – Addressing the Connection Between Health Emergencies and Gender-Based Violence

Iraq’s Ministry of Health has drafted human rights strategies and action plans to provide protective maternal, newborn, and child and adolescent health policies related to the pandemic. It has also developed education and communication materials and is assessing care provided for gender-based violence during the pandemic.

“COVID-19 showed us the link between health emergencies and gender-based violence,” said Dr. Riyadh Adbul Ameer Alhifi, of the Iraq Ministry of Health, noting that the role of the health system is to address both issues, with many survivors during the pandemic seeking mental health and psychosocial support.

Iraq saw high levels of domestic violence even before the pandemic, and the number has only risen since. At least 46% of married women are exposed to at least one form of spousal abuse, and 57% of them to domestic violence. Gender-based violence is also rooted in child marriages, with 20% of girls aged 15-19, and 5.5% of girls under the age of 15.

“It is important that gender-based violence services are included in the list of essential health services, and health facilities are equipped to properly answer survivors’ emotional, physical, and practical needs.”

Riyadh discussed the need to strengthen the referral system for gender-based violence survivors within the health system, and the need to address the social traditions and beliefs that perpetuate this violence. If these issues are not addressed, this will remain confined to the Ministry of Health – services will not improve and the number of victims will increase.

“Violence against women connot be reduced unless those beliefs and traditions change. This needs a great force in which all sectors in the country must contribute.”

Orange the World 2018 – Uganda
Ugandan police joined with UN Women Uganda, UN in Uganda & SafeBoda for a safe ride to mark the 16 Days Of Activism under the theme ‘Safe ride to end violence against women and girls’. Over 300 boda riders and other participants took part in the activity.
Spain – Facilitating Communication Through Technology and Pharmacies

Spain’s gender-based violance helpline has observed nearly 30,000 requests for assistance during the pandemic: an increase of nearly 60% from 2019. Emotional and psychological assistance against gender-based violence, which was devliered via WhatsApp during the strictest period of lockdown, received 2,500 requests. This service ended in June, when in-person services could be provided again.

As a result, Spain has established a contingency plan against gender-based violence with the Ministry of Equality, following the declaration of a state of emergency. These were strategic measures designed to help, prevent, control, and minimize the negative consequences for many victims of gender violence. While health laws in Spain allow for diagnosis and care for people suffering from violence in both primary and specialized health services, it is a common problem that seriously impacts health, said Dr. Pilar Apracio, Director of the National School of Public Health in Spain.

The government of Spain has taken measures to prevent femicide, facilitating connections through telephone and internet. A network in pharmacies has also been created that allows women who go into pharmacies to contact the pharmacist, connecting the pharmacy to the helpline and authorities.

Added Apracio: “If you facilitate the communication, this contributes to solving problems women have to face in gender violence situations.”

The second wave of COVID-19 indicates the possibility that there will once more be an increase of physical violence in the new phase of the pandemic, and people have been urged to not let their guard down against gender-based violence.

Activism against Gender-Based Violence at the National University of Lao, Dong Dok campus
India – Health Experts Ensuring Safety for Victims of Gender-Based Violence

India has seen a decrease in incidence of domestic and sexual violence reported, due to a lack of transportation during lockdown and fear of contracting COVID-19. The severity of the cases of those victims who have come forward, however, has increased.

The Government Medical College and Hospital Aurangabad has created a section of the hospital for victims of sexual violence, where experts such as gynecologists, pediactricians, surgeons, forensic specialists, and psychiatrists are on staff to console and treat victims. A shelter has also been created in the medical college admission ward to ensure the safety of its patients.

Dr. Shrinivas Gadappa of the Government Medical College brought up the importance of training practitioners to recognize the signs of gender-based violence, especially in the primary healthcare system, citing difficulty in screening for both domestic violence and COVID-19, and called it a “loophole in this pandemic”.

Workshops to train practitioners is very important in increasing sensitivity towards and awareness of gender-based violence, Gadappa added. Primary health care centers should be strengthened to deal with such cases during the pandemic which will, in turn, increase the amount of women reporting instances of violence, he said.

WHO Director General Dr Tedros Adhanom Ghebreyesus, in a final statement, said that countries need to increase accessibility to healthcare that aids women affected by violence, implementing it as an essential service, as well as offering more resources towards training health professionals on how to identify women experiencing abuse, and how to provide first line support.

“All women have the right to live free of violence and coercion, working together, we can build gender responsive, health and social protection systems to keep all women safer and healthier.”

Image Credits: UN Women Tanzania/Deepika Nath, UN Women, UN Women, UN Women/ Martin Ninsiima, DANHO/Daniel Hodgso.

Nairobi.  Africa’s limited cold-chain capacity will constrain the continent’s ability to take up the more cutting-edge Pfizer and Moderna vaccines that are likely to win approval first from regulatory authorities, said WHO’s African Regional Director Dr Matshidiso Moeti on Thursday.

Those same constraints make the AstraZeneca (AZD1222) vaccine the most attractive option, despite its lower efficacy results, so far, which has averaged about 70 %, Moeti observed in a press briefing on Africa’s vaccine preparedness. 

WHO’s African Regional Director Dr Matshidiso Moeti

“The latter vaccine is much better and easier to handle with storage required…  unlike the Pfizer vaccine that would pose a big challenge with distribution,” Moeti said, referring to the ultra-freeze conditions at  -70° C that the mRNA-based vaccine candidate, Pfizer requires. Moderna’s vaccines can be stored at more moderate freezer temperatures of 2-4° C. In contrast, the AstraZeneca vaccine, which relies up an older, adenovirus delivery technology, only requires refrigerator temperatures of 2-8° C.   

“In any case at an efficacy rate of 70% the AstraZeneca vaccine is still good enough,” she added. Most regulatory authorities have said even a bar of 60% efficacy would be acceptable to clear the way for new COVID vaccines. 

Shortly after she spoke, AstraZeneca’s CEO Pascal Soriot told Bloomberg News that the company would run a fresh global trial to test a dosing option that seems to attain much higher, 90% efficacy levels. The higher results were in one arm of the trial already under way in the United Kingdom, the USA, and Brazil, after a serendipitous under-dosing of one group of volunteers under the age of 55 was found to yield better interim results than the 70% average.  

“Now that we’ve found what looks like a better efficacy, we have to validate this, so we need to do an additional study,” Soriot was quoted as saying. Based on its existing results, however, Soriot said that he is also optimistic that AstraZeneca, which co-developed its vaccine with Oxford University, will remain on track to obtain regulatory approval for the vaccine in the United Kingdom and Europe by the end of the year. 

Due to its low cost and modest cold chain requirements, AstraZeneca is expected to be one of the main vaccines to be supplied to many low and middle income countries, including through the COVAX facility global vaccine procurement and distribution facility, co-led by WHO and the Global Vaccines Alliance (GAVI). COVAX aims to support the vaccination of up to 20% of Africa’s population against the SARS-CoV virus by the end of 2021, Moeti said. But doing so is highly dependent on the rollout of cheap and accessible vaccines. 

Under the plans of the COVAX facility, an initial 3% of Africa’s population – mainly health workers and the elderly will be immunized, with hoped for coverage of  20% of the population by the end of 2021, said Moeti.  Following that, Africa Centres for Disease Control (CDC) has said that it will lead another effort that will aim to vaccinate up to 60 % of the population, revealed Dr Moeti.

She added: “the COVAX vaccine will be highly subsidized thanks to donor contributions and will ensure Africa gets vaccines at the same time as everybody else”.

COVAX aims to support the vaccination of up to 20% of Africa’s population against the SARS-CoV virus by the end of 2021
African Vaccine Preparedness – Rates 33% 

Beyond cold chain limitations, Africa’s overall preparedness for COVID-19 immunisation campaigns is low, Moeti said.  She referred to a recent WHO assessment that ranked the countries’ average readiness at only about 33%, significantly lower than the WHO benchmark of 80%, Moeti said at the briefing, where a WHO assessment of the continents “vaccine readiness” was presented.

The low level of readiness is worrying, given that the continent hopes to commence administering vaccines for the disease toward March, 2021, she said. 

The WHO evaluation was based on national vaccine preparedness surveys performed by 40 out of the 47 countries in the WHO Africa Region. The national self-assessments evaluate vaccine country readiness based upon  10 key sets of indicators, including:  planning and coordination, resources and funding, vaccine regulations, service delivery, training and supervision, monitoring and evaluation, vaccine logistics, vaccine safety and surveillance, communications and community engagement.

After seeing the results of the surveys,  WHO held a meeting with ministers of health from across the continent two days ago, to brief them on the urgent need to up their preparedness levels, to ensure Africa was not left out of the global vaccination drive.

“At WHO, we are supporting countries to increase their preparedness levels and we will do everything possible to ensure Africa is not left out of COVID-19 vaccination initiative,” Dr Moeti told a press briefing on Thursday.

“We can say that we are far from getting there, each pillar has a different average that is supposed to be achieved before we can safely deploy vaccines and reach a maximum number of people,” said Dr Richard Mihigo, a WHO Immunization and Vaccine Development officer, at the briefing. 

While cold storage capacity remains a big concern, countries can still rely upon pre-existing infrastructure – built over decades of vaccine campaigns – for vaccine cold storage. WHO is working with governments to support countries fill “cold chain gaps” before the exercise started, he said without providing details.

Information Campaign Also Needed 

Along with that, a systematic media campaign needs to accompany the vaccine drive, to counter misinformation already appearing in social media, said Professor Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute at the University of the Witwatersrand, South Africa.

Recent studies in South Africa have indicated that different socio-economic groups have different perceptions towards vaccines, with men generally less willing to be immunized, and educated members of the society being more willing, she offered. On the other hand, young people feel less vulnerable to the disease like their counterparts around the world, she added.

“For these reasons we need to develop different messages for different groups and be transparent with what we know about the vaccines. For example we need to explain why a vaccine prioritizes group ‘A’ and not group ‘B’, added Rees, who is also the Chairperson of  WHO’s African Regional Immunization Technical Advisory Group (RITAG).

“Vaccines are one of the biggest global health goods we have, and we must ensure they reach as many people as possible,” the professor added.

Ensuring the vaccine reaches as many people as possible can be done through effective media campaigns.
Ongoing Studies Needed To Determine Which Vaccines Are Best For Africa

It was important to have ongoing studies on available vaccines even as vaccinations begin, to see how they respond to the “African situation” said  Professor Pontiano Kaleebu, director Uganda Virus Research Institute (UVRI).

Currently some of the COVID vaccines in various stages of clinical trial appear to be more effective in preventing development of severe disease, while others seem to offer better protection against infection in the first place. 

The latter would be more desirable, over time,  especially in Africa, where more of the cases are mild, he said. He echoed the sentiments of Moeti, that overall, the Pfizer vaccine is untuiable for African conditions, noting that even laboratories have trouble handling samples that need storage at -70 C.

So far Africa is the continent with the fewest infections — around 2.1 million cases and 50,000 deaths. More than 84 % of the infections have been mild or asymptomatic. It has also participated in the fewest number of trials for both drugs and vaccines. Although one major multi-country African trial of COVID-19 drug treatments, supported by the Drugs for Neglected Diseases Initiative (DNDi), just got underway this week. 

Image Credits: Twitter: @WHO, WHO, Jernej Furman/Flickr, CDC Global/Flickr.

Shelters in Central America overcrowded by hurricane evacuees have increased risk of COVID-19 transmission

New York City. The pandemic has been exacerbated by recent hurricanes in Central America, as a result of outbreaks in overcrowded emergency shelters, as well as travel during the American Thanksgiving season, health leaders said at a Pan American Health Organization (PAHO) press conference.

Last week, saw an increase of 1.5 million cases reported in the WHO “Americas” region, mostly in the USA where new cases are now averaging close to 180,000 a day, but also with climbing numbers in vulnerable populations and among indigenous communities in Central America, who are especially vulnerable due to their remote location and the challenge of access to the health infrastructure.

“Since the start of the pandemic, there have been more than 25 million cases and more than 700,000 deaths due to COVID-19 in the Americas,” said Dr. Jarbas Barbosa, Assistant Director at PAHO.

Back-to-Back Hurricanes Impact Pandemic Response in Central America

Central America’s pandemic surveillance system has been greatly impacted by recent hurricanes Eta and Iota. The number of cases reported has dropped dramatically in Honduras and Nicaragua, which have seen approximately 640 testing centres and other facilities hit by the hurricanes, which have affected more than 8 million people, also leading to widespread evacuations to hurricane shelters. 653,000 people have been evacuated in the region. The Caribbean, Guatemala, and El Salvador have also been similarly impacted.

“Shelters organized to host thousands of people in these countries do not necessarily have the conditions to prevent transmission from COVID-19,” said Dr Ciro Ugarte, Director of Health Emergencies. “This creates a very challenging situation.”

Decreased reporting of cases following Hurricanes Iota and Eta.

In Central America, hospitals and shelters have reported a lack of care personnel and capacity – increasing the risk of transmission of disease – as already vulnerable populations, like the elderly, have been left with limited or no access to healthcare. The region has also seen decreased water and sanitation services, making it difficult to maintain infection, prevention, and control efforts: all important in preventing the spread of waterborne and other communicable diseases like COVID-19. Collapsed roads have also prevented timely humanitarian response.

Ugarte noted at the PAHO conference that the health sector, supported by PAHO and other international NGOS, have been assisting assessment as well as emergency response.

Holiday Season Brings Good News of Promising COVID Vaccines but also Increased Transmission Risk

While Central America is facing increased transmission from a damaged healthcare infrastructure, there is another source also driving increased disease transmission and that is traveling and family gatherings during the holiday season, which began with Thanksgiving celebrations in Canada and this weekend in the United States.

“During an epidemic there is no such thing as a risk free holiday season. Every gathering, every shopping trip, every travel plan, you increase the chance of spreading the virus,” Dr Barbosa warned, advising against large social gatherings, especially indoors. He recommended that any gatherings be held in well-ventilated areas, with masks, or outdoors, and if that is not feasible postponed entirely.

The US CDC also has issued stiff warnings against travel and mixing between households. But on Thursday the United States Supreme Court also issued a stiff blow to authorities’ attempts to curb religious mass gatherings that can be superspreader events. The Court on Thursday ruled that limits which had been imposed by the City of New York on the number of people gathering in churches, mosques and synagogues – were unconstitutional because they impinged on people’s freedom of worship.

Travel Not Risk-Free Even With a COVID Test

Speakers also flagged that many people falsely assume that being tested means safe travels, free of infection. Testing often leads travelers into a false sense of security, as it does not guarantee risk of infection is eliminated. Countries must continually use data on the spread of the virus to reassess their travel guidance to make travel safer, they said.

Although November saw announcements of the very positive interim efficacy results of several potential vaccine candidates announced, with vaccine candidates produced by Pfizer and possibly Moderna, in line for emergency use approval by the US FDA by mid- or end of December, PAHO officials warned that vaccines are still some months off, in terms of reaching the general public.

“Unfortunately, we will not have enough vaccines to vaccinate everyone and stop the transmission,” Barbosa said. Once the vaccine is released, however, its use is still recommended in order to save lives. Achieving herd immunity, in theory, would only be possible if a population reached a threshold of 60-70% immunity, either through natural infection or vaccination.

The total number of confirmed vaccine doses procured, displayed by income level.

Even in the US, which has amassed the largest stock in the world of pre-purchased vaccine supplies from Pfizer, Moderna and others, it is yet to be determined who will be vaccinated first. In addition, officials are concerned about public resistance to vaccines. The most recent US poll showed 51% of people were inclined to be vaccinated, and while that is an increase from previously, it is still far lower than the 90% levels that would need to be achieved.

A much stronger public information effort needs to be undertaken to inform people about the personal and community-level benefits of vaccination against COVID-19, PAHO officials said. And more awareness raising needs to be done to inform the public of how the virus can be transmitted, particularly during the holidays.

Barbosa noted: “The individual decisions we make this holiday season affect the people closest to us. They will also impact our communities. Solidarity has been our region’s response to COVID-19. [Solidarity] is more important than ever, during the holidays.”

Image Credits: PAHO, Duke Global Health Innovation Center.

Winnie Byanyima, Executive Director of UNAIDS.

Far greater investment in global pandemic response is required to ensure that core public health initiatives, like AIDS prevention and treatment aren’t thrown off course by future pandemics, while roll-out of a cheap and accessible “People’s Vaccine” would help get other core public health programmes quickly back on track, UNAIDS has said.

In a message at the launch of the annual World AIDS Day report, Prevailing against pandemics by putting people at the centre, UNAIDS Executive Director Winnie Byanyima also called on the global pharma industry to unlock the secrets to their COVID-19 vaccine technologies to produce a cheap and accessible “People’s Vaccine”.

“Even today, more than 12 million people are still waiting to get on HIV treatment and 1.7 million people became infected with HIV in 2019 because they could not access essential services, said the UNAIDS head in her message. “That is why UNAIDS has been a leading advocate for a People’s Vaccine against the coronavirus. Global problems need global solidarity.

“As the first COVID-19 vaccine candidates have proven effective and safe, there is hope that more will follow, but there are serious threats to ensuring equitable access,” she said. “We are calling on companies to openly share their technology and know-how and to wave their intellectual property rights so that the world can produce the successful vaccines at the huge scale and speed required to protect everyone and so that we can get the global economy back on track.”

Byanyima’s comments followed upon her open letter to the The Financial Times, and published Thursday, which said that media coverage of fast-moving vaccine research has too often ignored “the fundamental problem of the failure of pharmaceutical firms to openly share their technologyand knowhow, and waive their intellectual property rights.

“The Pfizer/BioNtech and Moderna vaccines have received millions in public money, from the US and EU to develop these vaccines,” Byanyima added in her letter, referring to the two companies most likely to win regulatory approval in the next few weeks for the first vaccines against COVID to show efficacy, but which rely upon expensive mRNA technologies that are out of the price range of low- and middle-income countries.

“These vaccines are not private property to be sold for a profit, but public property to be mass produced for the global common good. We would urge all corporations to join the World Health Organization’s Covid technology access pool (C-TAP) and for their rich country backers to insist that they do so, given the huge public subsidy they have received. Only this will enable every vaccine producer in the world to manufacture on the huge scale required to protect everyone, and get our global economy back on track. We cannot let this be a profit vaccine; it must be a peoples’ vaccine,” Byanyima wrote in the FT letter.

Weak Health Systems Left World Unprepared For COVID

The UNAIDS report notes how insufficient investment and action on HIV and other pandemics left the world exposed to COVID-19. State UNAIDS: “Had health systems and social safety nets been even stronger, the world would have been better positioned to slow the spread of COVID-19 and withstand its impact. COVID-19 has shown that investments in health save lives but also provide a foundation for strong economies. Health and HIV programmes must be fully funded, both in times of plenty and in times of economic crisis.”

“The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” Byanyima also said. “Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”

There are bright spots nonetheless, the UNAIDS report notes: “The leadership, infrastructure and lessons of the HIV response are being leveraged to fight COVID-19. The HIV response has helped to ensure the continuity of services in the face of extraordinary challenges. The response by communities against COVID-19 has shown what can be achieved by working together.

But the Organization warned that countries risk repeating the “mistakes” of the early days of HIV response – when millions of people in Africa died as a result of being unable to access expensive new antiretroviral drug treatments that were being rolled out in developed countries:

“The world must learn from the mistakes of the HIV response, when millions in developing countries died waiting for treatment. Even today, more than 12 million people still do not have access to HIV treatment and 1.7 million people became infected with HIV in 2019 because they did not have access to essential HIV services,” said the statement.

“Everyone has a right to health, which is why UNAIDS has been a leading advocate for a People’s Vaccine against COVID-19. Promising COVID-19 vaccines are emerging, but we must ensure that they are not the privilege of the rich. Therefore, UNAIDS and partners are calling on pharmaceutical companies to openly share their technology and know-how and to wave their intellectual property rights so that the world can produce successful vaccines at the huge scale and speed required to protect everyone.”

When asked at a press conference on Thursday about how young people will be considered in this startegy, she flagged that the risks posing young people today are different to those experienced by young people at the start of the AIDS crisis.

“The HIV pandemic is in its second – even third – generation, and the attitudes toward the disease each geneeration keep changing,” she said, citing that Uganda’s younger generation as viewing the disease as “just a chronic illness, like diabetes or hypertension”.

“They have no sense that it kills. They think you just live with it because they never saw the deaths,” she added. “I saw the deaths.” Young people today, in countries with a high number of cases are made more vulnerable by this lack of education, she said.

Countries Falling Way Behind – New 2025 Targets for Getting Back on Track

Modelling of the pandemic’s long-term impact on the HIV response shows that there could be up to 293,000 additional new HIV infections and up to 148,000 additional AIDS-related deaths between by 2022, the new UNAIDS report finds.In its latest report UNAIDS outlined a series of new targets for reducing HIV infections by 2025  – aimed at  getting progress that was admittedly already “off track before the COVID-19 pandemic hit” – back on the rails.

New HIV/AIDS treatment targets set out in the report aim at achieving a 95% coverage for each sub-group of people living with and at increased risk of HIV. By taking a person-centred approach and focusing on the hotspots, countries will be better placed to control their epidemics.

The targets  also focus on a high coverage of HIV and reproductive and sexual health services together with the removal of punitive laws and policies and on reducing stigma and discrimination. They focus on people most at risk and marginalized— including young women and girls, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men.

And the 2025 targets also include the promotion of more ambitious anti-discrimination laws and policies – so that less than 10% of countries have punitive laws and policies vis a vis people living with HIV; less than 10% of people living with and affected by HIV experience stigma and discrimination; and less than 10% experience gender inequality and violence.

Although some countries in sub-Saharan Africa, such as Botswana and Eswatini, have achieved or even exceeded the targets set for 2020, many more countries are falling way behind, the Organization also noted, stating that nonetheless. “The high-performing countries have created a path for others to follow.”

 

Image Credits: UNAIDS.