A demonstration in Bangkok against the US-Thailand free trade agreement which would have raised prices for medicines that underpin Thailand’s AIDS treatment program.

Two competing approaches to promote access to medicines were born during the HIV/AIDS pandemic in the year 2000. Today, at the height of the COVID-19 pandemic, these same approaches are once more on a collision course. 

On the one side is the ‘international’ COVID response, led in name by WHO, but in fact by what is now the world’s largest and most powerful global health institution, the Gates Foundation – with the backing of the pharmaceutical industry and high-income countries.

On the other side is the access-to-medicines movement, led by civil society alongside low- and middle-income countries (LMICs) such as India and South Africa, with the backing of hundreds of grassroots, civil society groups and non-governmental organisations that are challenging monopolies on medicines and promoting generic competition to successfully expand supply and lower prices of COVID-19 drugs, tests and equipment, and future vaccines.

These groups argue that meeting the COVID-19 pandemic requires broad use of the same strategies that revolutionized access to antiretroviral medicines (ARVs) during the AIDS crisis. Can we learn from the successes and mistakes made the last time around?

The Gates Foundation has leaned into the COVID-19 pandemic

Two decades after its establishment, the foundation that boasts a total endowment of US$ 50 billion dollars, has rededicated its entire organizational focus to the pandemic.

Gates has spent or committed to spending hundreds of millions of dollars on the development and procurement of COVID-19 medical technologies, partnering with both global health agencies and pharmaceutical corporations to accelerate the development and deployment of technologies. The Foundation’s leaders have also used their ‘moral voice’ to respond to the predictable health technology nationalism that has taken hold.

Sounds amazing, right? 

But on a more careful examination, what still emerges is a set of narrow, inefficient, and inadequate solutions that are exclusively based on what charity or the market will allow. This means prioritizing pharma monopolies of technology and intellectual property (IP) and secretive, technocratic, and top-down approaches that mostly exclude LMICs from decision making as well as avoiding public scrutiny.

Moreover, the Foundation’s role and outsized voice threaten to undermine the role involvement of civil society groups in decision-making that was effective at the height of the HIV/AIDS epidemic – and which is urgently needed again today.

As evidence of that, just look at how the money flows.

The Gates Foundation is the second largest funder of the World Health Organization, the global health agency of UN member states, which sets standards and issues public recommendations working on an annual budget that is just a fraction of Gates’ own. The Gates Foundation also is a leading funder of, as well as a Board Member on, most of the world’s other leading global health agencies and public-private partnerships (such as Gavi The Vaccine Alliance, The Global Fund to fight HIV/AIDS Tuberculosis and Malaria, and Unitaid). This provides the Gates Foundation with decision-making power on the most salient issues with respect to research, development and delivery of health care systems in developing countries.

The Gates Foundation is, moreover, heavily invested in the development and finance of new technologies, including direct investments into many pharmaceutical corporations. This has included R&D of technologies to address infectious and neglected diseases, and financial and institutional support to expand immunization.

The COVID-19 solutions proposed by the Gates Foundation are thus anchored in this world view. And in terms of health products, they trap most countries into a system that primarily benefits pharmaceutical corporations and high-income country governments, which can subsidize these corporations with both billions of dollars in upfront subsidies and paying high prices for treatments and vaccines. These practices and trends will likely endure even after the pandemic recedes.

What are the key problems?

1. A lack of transparency

The Gates Foundation is neither discouraging nor overcoming an enduring problem within the pharmaceutical system – secrecy. For the last two decades, there have been concerted efforts by governments, international agencies, regulators, and investors, to improve the transparency of the pharmaceutical system in the areas of public contributions to funding R&D, research priorities, patent status, clinical trial data, price, and overall cost of R&D. There have also been efforts at improving transparency of terms and conditions of licensing agreements between multinational and generic companies, primarily due to the publication of licensing agreements by the Medicines Patent Pool.

Yet throughout this pandemic, and well before it, the Gates Foundation has not been transparent. It does not share the terms and conditions of the agreements it signs with companies (much less provide a clear picture of what it is funding) and does not demand transparency of the businesses that the foundation funds or for which it has made investments. It seems that the Foundation considers transparency should be limited to information about its grants, which are published on its website.

This insistence on secrecy encourages the worst tendencies of the pharmaceutical industry to hide information, and places decision-making power in the hands of only two parties – the Gates Foundation and a pharmaceutical corporation.

On September 28 2020, the Gates Foundation signed a new agreement with two diagnostic manufacturers to supply just 20% of their new diagnostic tests to 133 LMICs. This announcement raises many questions. Why only 20%? Which 133 countries are eligible? Who selected the countries and how? Were the governments of the countries involved in decision making and the planning of the delivery of the tests? What is the number of tests in relation to the population size of the countries? Will tests be equitably distributed? Is there an agreement to expand production through other sources? Who bears liability if the tests are faulty? Who knows the answers?

The Gates Foundation signed a similar, secretive agreement with Eli Lilly for the provision of its monoclonal antibody candidate (to treat COVID 19) on behalf of LMICs. Many of the same questions should be asked. There is a capacity reservation, but how did the parties agree on the number of doses? What is the expected price and is it based on a cost-of-goods analysis (and will that analysis be made public)? Who decides the countries? All these details are shrouded in mystery.

In fact, the Foundation is entering into many “partnerships” with industry where the public only gets the headlines of ‘commitments’ to innovation and access.

2. A dogmatic defender of intellectual property rights and monopolies

Those who own intellectual property (IP), hold power. There are three primary holders of IP over technologies to fight COVID-19 – government research institutions and agencies that are paying for or developing COVID-19 technologies, companies that are developing these technologies (admittedly often with IP accrued before the pandemic), and the Gates Foundation. The Gates Foundation has invested in many of these technologies – before and during the pandemic – and in doing so is able to negotiate certain rights in the technology. That gives it some authority as to how the technology is managed.

Why does IP matter?

In 2000, as the HIV/AIDS epidemic accelerated across Africa and parts of Asia and Latin America, pharmaceutical corporations, armed with IP monopolies and the backing of the United States and European Union, charged outrageous prices for HIV medicines, even in poor countries. Moreover, they filed lawsuits to deter developing countries from using legal measures to promote competition and reduce medicine prices.

Nelson Mandela visiting a Médecins Sans Frontières project in South Africa in 2002, one of the pioneers in providing inexpensive antiretroviral treatment.

High prices for HIV medicines were reduced only because of measures taken to overcome strict IP rules that forbid generic competition. Owing to generic competition, prices for HIV medicines are now more than 99 percent lower than they were two decades ago. Generic competition, or in the case of vaccines, the entry of multiple competitors onto the market, has been largely responsible for the availability of affordable medicines and vaccines around the world, including in the US and Europe. Flexible intellectual property rules have also been critical to enabling third parties to develop appropriate formulations of new medicines and vaccines, whether for children or those in resource poor settings.

During the COVID-19 pandemic, the use of flexible IP rules is a critical step to expanding supply of new tests, medicines and vaccines required by all countries to address COVID-19. No one company can supply a test, medicine or vaccine to the whole world, and therefore maximizing production is critical to control COVID-19. Not only would overcoming IP barriers allow expanded supply to speed up equitable distribution, it would introduce competition that could lower prices. One mechanism to overcome IP barriers is the COVID-19 Technology Access Pool (C-TAP), a government and WHO-led initiative for the sharing of data, know-how, biological material and IP in order to facilitate low-cost production and increased supply of medicines, vaccines and tests.

More recently, India and South Africa submitted a proposal to the TRIPS Council at the World Trade Organization (WTO) to suspend enforcement of COVID-19-related IP rights until an effective health response to the pandemic has been realized. Unfortunately, a consensus was not achieved amongst WTO Members during discussions held in mid-October at the WTO, but it will come forth for further discussion and decision by the end of the year.

Yet the Gates Foundation has not publicly supported the C-TAP and is instead undermining it by messaging in discussions with civil society organizations (and apparently in discussions with other global health agencies) that IP is not a barrier and simultaneously that overcoming IP is not sufficient to enable expanded and competitive supply.

It also argues that technology transfer is too difficult to do on a large scale and should instead be done with a small set of Big Pharma partners or pre-vetted contract manufacturers. In doing so, the Gates Foundation ignores the fact that C-TAP also calls for sharing of know-how and access to cell lines, technology transfer measures that are essential to entry by generic suppliers, issues addressed in a limited way among companies working with the Coalition for Epidemic Preparedness Innovations (CEPI). Gates has also said nothing in support of the India/South Africa WTO waiver proposal, even as several other global actors have come out in support.

This defence of the IP status quo, including both rights in inventions and data, as well as proprietary control over know-how and cell lines, means that power over COVID-19 health technologies rests almost entirely with a handful of large corporations – subsidized by public and philanthropic funding that develop these technologies. It has also enabled the Gates Foundation itself to act as a heavy weight broker to facilitate secret deals between pharmaceutical companies and vaccine producers in developing countries. These agreements, negotiated out of reach of governments and the wider public, mean that the Gates Foundation and pharmaceutical companies decide who gets limited rights to make vaccines and who ultimately gets access to medicines, tests or vaccines.

The most concrete example of the consequences of the Gates Foundation approach to IP has been the decision of the University of Oxford to sign an exclusive agreement with AstraZeneca to complete development of a leading COVID-19 vaccine candidate.

In April 2020, when the vaccine was under development by the University, the institution had posted guidelines for organizations seeking to license or otherwise access University of Oxford IP relevant to the COVID-19 pandemic. When the University initially announced it was moving ahead with a vaccine candidate, it had committed to working non-exclusively with multiple partners on a royalty-free basis to support a vaccine that would be “free of charge, at-cost or cost-plus limited margin as appropriate” for the duration of the pandemic. Then, only weeks later, an agreement was signed on an exclusive basis between pharma giant AstraZeneca and the University of Oxford; this was inconsistent with the university’s commitment to an open license, which could have allowed other companies to manufacture the vaccine and expand supply. This outcome is, in large part, because Bill Gates had pushed the University of Oxford to sign an exclusive agreement, thereby limiting worldwide production of the vaccine to reach more people.

The result? The accord has provided AstraZeneca excessive power in setting the price of the vaccine worldwide, including a unilateral power to declare the ‘end of the pandemic’ in July 2021, thereby freeing up the corporation to charge unaffordable prices even if the virus is not under control at that point.

3. A marriage with large pharmaceutical corporations 

Without transparency and without open access to IP, the only way forward is to leave decisions to pharmaceutical corporations and the Gates Foundation.

Thus, at the UN General Assembly on 30 September 30 2020, the Foundation and sixteen pharmaceutical corporations announced new ‘commitments’ to expand global access to COVID-19 diagnostics, vaccines and medicines. The declaration – described as a landmark by pharmaceutical corporations such as Johnson & Johnson – is anything but.

Consider the signal it sends. The responsibility for how pharmaceutical corporations should act is no longer the domain of governments, but the decision of a single philanthropy accountable only to itself. The irony of the Declaration is that while corporations and the Gates Foundation call for diversified representation from LMIC governments in decision-making, their framework for global access has been designed by a single foundation and pharmaceutical corporations without any such representation.

It also tries to institutionalize improper commercial practices of the pharmaceutical industry – in particular the unregulated use of price discrimination (tiered pricing). This is when corporations will charge different prices depending on inexact and often completely inappropriate measures of ability to pay (especially in a pandemic), without regard to the relationship between global sales and (risk and subsidy adjusted) development costs. A pledge to secure the lowest prices for low-income countries means that many countries that are at a slightly higher level of Gross National Income per capita (but are struggling under debt and devastation of their health system) will be forced to pay a higher price, decided unilaterally by corporations armed with monopolies. This will have a significant impact on the majority of poor people, because they live in middle-income countries.

The Foundation neglects to require drug corporations to make commitments to critical demands – notably transparency – as per a consensus resolution amongst governments at the World Health Assembly in 2019, as well as forging a commitment from corporations to share IP, data and know-how that has been promoted by many, including 41 governments that support the C-TAP.

A demonstration against the US-Thailand free trade agreement which would have raised prices for medicines that underpin Thailand’s AIDS treatment program.

Finally, the Gates plan does not address the need for and benefits of building out manufacturing capacity in more countries, so that the world is better prepared for what could be a long-term fight against COVID and other future epidemics and pandemics. This means vulnerable governments may have to continue relying on the supply/price charity of both the Gates Foundation and pharmaceutical corporations during subsequent pandemics.

In an interview in September 2020, Bill Gates noted: “[Pharmaceutical corporations’] response to the pandemic and this great work that pharma people are doing has reminded many of their capacities and how they can be helpful to the world – as opposed to the industry being viewed as kind of selfish and uncooperative.”

This faith and belief in the world’s largest drug corporations is hard to fathom. Even if we all believe that these corporations have a critical role to play in developing new technologies and ensuring access to such technologies, we are not so naïve to believe that they will take the necessary steps on their own to ensure that they are meeting global public health needs. Pfizer, one of the signatories to the Gates Foundation’s declaration, may earn up to $3.5 billion in just 2021 from the sale of its COVID-19 vaccine. In fact, just as the Gates Foundation was announcing its new partnership with pharmaceutical corporations in New York, the US House of Representatives Oversight Committee was holding its own hearings, in Washington D.C., just 200 miles away, to reveal a range of egregious practices by pharmaceutical corporations to overcharge patients, extend and abuse IP rights, pay executives excessive compensation and avoid taxes.

How the Gates Foundation funds Civil Society in the Pandemic Stifles Real Debate Over Hard Choices

It is normal today to look at any discussion in global health and see the Gates Foundation in the voice of almost every ‘independent’ actor. Even if there may eventually be concerns with the strategy of the Gates Foundation, there is no mechanism to hold the Foundation accountable to people and countries affected by its choices and influence.

The Gates Foundation, to its credit, is a major funder of civil society and advocacy. But this can also minimize or prevent non-governmental organizations from publicly criticizing the Foundation due to fear of losing funding or undermining access to funds in the future: critical in an environment of decreased government funding of advocacy-based NGOs. The Gates Foundation is also a major funder of journalism (including health and development journalism), raising concerns of the independence of the media to investigate and evaluate the Foundation’s activities.

The Foundation is funding new civil society organisations and networks that may simply mirror its own belief system or promote the views of non-governmental organisations that are both funded by the Gates Foundation and that do not challenge its worldview with respect to pharmaceutical corporations. Early in the pandemic, for example, a new network called the Pandemic Action Network – funded in part by the Gates Foundation and pharmaceutical companies, such as Johnson & Johnson – was created to represent civil society on the important question of pandemic preparedness and response. During the announcement of the Gates Foundation and sixteen pharmaceutical corporations at the UN General Assembly in September, the featured civil society speaker was the CEO of the ONE Campaign, whose organization has received at least $135 million from the Gates Foundation.

The Gates Foundation echo chamber is a concern because international health has become less about activism and human rights and more about power-point slides delivered from conference rooms in Geneva and Seattle. The response to the HIV/AIDS epidemic has always been just as much about what can be done through science, technology and money as about what can be accomplished through communities and civil society groups pressuring their governments and corporations to be accountable for their apathy or harmful decisions.

Activists Denied Seats at the Table 

Seasoned access to medicines activists from civil society organizations and affected communities have had a hard time gaining seats within the Access to COVID-19 Tools Accelerator, a collection of health agencies, public-private partnerships and foundations that is powered in large part by the Gates Foundation. The lack of civil society and community engagement and inclusion in decision making has been especially evident in the ‘Vaccines Pillar’ – which is primarily managed by Gavi and CEPI, two public-private partnerships that are closely tied to the Gates Foundation. Only after months of persistent advocacy did Gavi and CEPI agree to civil society representation, and yet still wanted to control the selection of representatives.

Even those civil society representatives that are integrated in the ACT-Accelerator are having a difficult time with involvement in the higher reaches of the Diagnostics and Therapeutics Pillars – where decisions are made and often brought pre-baked to work-stream meetings. Most commonly, the projects advanced in ACT-A are those that have been incubated and promoted by the Gates Foundation without any involvement by civil society and developing country governments. The capacity reservation for monoclonal antibodies previously described is one such Gates project.

Should governments cede management of a crisis to an unelected and unaccountable foundation? 

Even if we hypothetically agreed with some of the steps the Gates Foundation is taking, we question the self-appointed role that the Gates Foundation has assumed during the pandemic response. Many of the decisions the Gates Foundation, and the health agencies it works with, exclude the LMICs that are being left behind in the pandemic. These are the governments where people have received 4% of the diagnostic tests made available to people in rich countries. These are the governments that have not received allotments of Gilead’s remdesivir, a warning of what will happen when effective medicines and vaccines are eventually approved (recent clinical trial data indicates remdesivir may not provide a therapeutic benefit). These are the governments that have not been able to reserve vaccines, where instead over 50% of COVID-19 vaccine supplies have been hoarded by rich country governments with just 13% of the global population. Shouldn’t LMICs have a greater say in creating the architecture of the global response and in pounding out the policies needed to tackle this viral plague?

The Gates Foundation’s role, and the lack of leadership of governments, will have repercussions beyond the pandemic. We worry that donor governments, mostly unaffected by the practices of the Gates Foundation, are willing to let the Gates Foundation put its money into global health and other development priorities, thereby decreasing the moral and financial accountability of donor governments. It may also be that the sheer size of the Gates Foundation, its accumulation of information and ‘expertise’, as well as its investments in global health agencies, civil society, the media and companies, means that governments may no longer feel that they can challenge the Gates Foundation’s influence.

Developing countries see the Foundation as an integral part of the global health decision making architecture for these same reasons or may themselves not wish to challenge the overriding influence of the Gates Foundation. The result is a vicious circle of reduced government engagement and investment in global health, contributing and leading to even more Foundation intervention and influence, which leads to even less government influence and engagement.

Conclusion – Can We Avoid the Mistakes of the Past?

The COVID-19 pandemic is decimating health systems, economies, and communities around the world. Like the AIDS epidemic, COVID-19 is marked by injustice in the pharmaceutical system. Wealthy countries and philanthropies are paying for research and development and leveraging their investments to cut in line and hoard new vaccines, drugs and tests. In exchange, these same countries are allowing pharmaceutical corporations to control the supply and price through IP monopolies on technology. These policies are undermining any possibility of expanding manufacturing and supply of low-cost medicines, vaccines and tests that could save lives and livelihoods.

It is a moment made for a wider global movement to stop the pandemic in its tracks, to share medicines, tests, vaccines and other medical technologies fairly around the world. It is a moment to imagine and build a new pharmaceutical system that relies less on IP, monopolies and secrecy, and more on approaches to medical R&D that is driven by public health, openness, collaboration and sharing.

At the pinnacle of desperation in 2000, when medicines to treat HIV were unaffordable and pharmaceutical corporations were blocking access, a movement emerged – of people with HIV and AIDS, government officials and politicians in developing countries, treatment advocates, students, non-governmental organizations, health care workers, lawyers, and academics, to overcome the constraints of an IP-based pharmaceutical system that would leave millions of people without medicines.

Thanks to the efforts of this movement, public pressure encouraged developing countries to use legal measures to foster generic competition for antiretroviral medicines and forced pharmaceutical corporations to stop interfering with the efforts of developing countries to save lives. Today, over 90 percent of all medicines used in HIV treatment programs to treat an estimated 25 million people are low-cost generic medicines, including those supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR). Without generic competition, low-cost medicines, and increased funding, the global AIDS response would not have been possible.

The Gates Foundation, and its founders, are the most powerful force in global health today. As a philanthropy, the Gates Foundation may believe that the most we can expect of those with wealth and power is to do things that make sense for them, and not what they must do to best advance global health justice. But to have so much influence and authority means that the Gates Foundation cannot be secretive, cannot prefer monopolies over competition, and cannot applaud pharmaceutical corporations instead of holding such corporations accountable. When the Gates Foundation behaves this way, it excuses all other parties, whether corporations or governments, to fall back on their worst impulses and practices, while trapping everyone within a pharmaceutical system that works best for pharmaceutical corporations and the world’s most powerful countries.

The world cannot rely uncritically on the voice and ideas of billionaires, who made their own fortunes through intellectual property rights, to pull us out of this pandemic. We learnt from the HIV/AIDS epidemic twenty years ago and until today, that only by people around the world holding their governments to account, demanding transparency, and ensuring that corporations are not allowed to put profits ahead of people, will we succeed during these extraordinary times.

_______

Rohit Malpani

Rohit Malpani is a public health consultant and advocate, and also represents non-governmental organisations on the Board of Unitaid.

 

Brook Baker

Brook K. Baker is a professor at Northeastern University School of Law, USA; an honorary research fellow at the University of KwaZulu Natal; and a senior policy analyst with Health GAP (Global Access Project).

Mohga Kamal-Yanni

Mohga Kamal-Yanni MPhil MBE is a consultant in global health and access to medicines.

 

 

 

 

The views expressed here are solely those of the authors and not of the institutions with which they may be affiliated. 

 

Image Credits: Mohga Kamal-Yanni, Médecins Sans Frontières.

Local authorities in Lima, Peru promote cycling as part of a sustainable mobility effort.

Second in a series– Cities that clean up their air quality, and promote other urban sustainability measures can help reduce residents’ risks during the COVID-19 pandemic as well as going forward, say a growing number of urban air quality and sustainability experts.

That message was highlighted in two events last week and today, which were co-hosted by the World Health Organization, UN Habitat, UN Environment and others, in observance of World Cities Day, on Saturday 31 October.  

While of course infectious diseases can spread anytime people fail to take the appropriate individual precautions, the risks of COVID-19 infection in high-density cities drop when cities are well planned, organized and managed, as those kinds of cities are better able to facilitate social distancing and deliver health services, said Eduardo Moreno, Head of Knowledge and Innovation at UN Habitat, at last week’s event on “People-Oriented Urbanization: Planning and Public Health Working Together to Generate Healthy Urban Environments.”

The event was co-hosted by UN Habitat, WHO and the Norwegian Ministry of Foreign Affairs. Said Moreno: “What we can see is there is no correlation [in disease spread] with density.. what is strongly correlated is overcrowding, which is completely different….Cities with high level densities that are well-planned and well-organized will have more capacities to better organize delivery of health services and the possibility of affordable housing.”  

Eduardo Moreno, Head of Knowledge and Innovation at UN-Habitat, at the “People Oriented Urbanization” event.

Jens Aerts, a senior urban planner at the World Urban Campaign, described it as “urban planning as a spatial vaccine” for COVID-19. 

Lockdowns Brought Respite from Health-Harmful Air Pollution – What Next?

Meanwhile, lockdowns, however painful, also created a respite in heavy air pollution levels in many cities around the world as well as bringing to the fore sustainability innovations, like the rapid and massive addition of bicycle lanes in some cities, to provide people with safe transport options – which are also much cleaner over the long-term.

“The pandemic is really…demonstrating to some degree, how cities and countries are able to act swiftly and, in many parts of the world, collaboratively to address a global public health crisis,” said Glynda Bathan, Deputy Executive Director of Clean Air Asia at a BreatheLife into Cities for Clean Air, Climate and Health event on Friday. “In the aftermath [of the pandemic], we must focus on harnessing that same spirit and energy in continuing to fight the climate and air crisis as the next imminent existential threat.” 

The BreatheLife event was co-organized by the United Nations Environment Program (UNEP), the Climate and Clean Air Coalition (CCAC) and WHO. 

The BreatheLife initiative was established by WHO, CCAC, UNEP, and the World Bank as a venue for collaboration and exchange between cities in order to achieve safe air quality levels by 2030, based on the WHO Air Quality Guidelines, a goal that would also reduce pollutants like black carbon particles that contribute heavily to climate change. It has a network of over 70 cities, regions, and countries. 

Unhealthy Air in Cities and Air Pollution Solutions

Nine out of 10 people worldwide, and over 98 percent of people living in large cities in low-income regions breathe unhealthy air. Globally, air pollution leads to an estimated 7 million deaths every year from respiratory and cardiovascular diseases as well as lung cancer.

A growing body of evidence has also suggested that people who live in cities with high levels of air pollution may also be more at risk from serious illnesss with COVID-19, either directly or indirectly because they already suffer from chronic respiratory or heart conditions, which increase their risks of serious COVID-19 illness. Experiences from three cities were shared in the BreatheLife webinar, showing the actions cities are taking to implement air pollution solutions.

COVID-19 Accelerated Air Pollution Awareness – And Mitigation Measures
Nathalie Roebbel, WHO Coordinator for Air Pollution and Urban Health, speaking at the BreatheLife event.

In London, United Kingdom, which was the first mega city to join the BreatheLife campaign, the city has committed to reaching WHO air quality guideline levels. To that end, improved air quality monitoring measures and data assessment have been put in place to both inform the public and policymakers about how progress is advancing. Another programme has supported a shift to electric vehicles for the city iconic taxi system, an effort that has been embraced by London cab drivers.  

In Quito, Ecuador, meanwhile, priority has been placed on the use of cleaner bus technologies as part of a long-term plan, including shifting from diesel to electric vehicles to improve air quality. In addition, cycling and pedestrian lanes are being constructed across larger parts of Quito to incentivize everyday ecological means of mobility.

In Accra, Ghana, where open waste burning is a major air pollution source, measures to encourage domestic waste separation and control ad-hoc waste burning on street corners and in front of businesses are now being implemented. These should achieve multiple benefits for air quality and health. Community outreach and engagement programs have been put in place to inform individuals about the environmental and health risks of burning waste. Through partnerships with local community and religious leaders, and private waste disposal companies, city leaders have been making inroads on the behavior of individuals and households and contributing to cleaner air. 

“In Accra, most of our pollution…was from waste,” said Desmond Appiah, Chief Sustainability and Resilience Advisor to the Mayor of Accra. “There were over 46 waste dump sites in Accra. And we mapped it out, we were able to, through the leadership of the mayor, to close about 37 of these illegal dump sites. Some of these areas were created because of poor waste management in some communities.

Illegal waste dump site near Agbogbloshie, Accra, Ghana.

“We picked two communities that we believed had a very high incidence of burning of waste as a means of disposing of the waste, and we focused on those communities,” he added. To build support for the initiative, the city reached out to local community figures and launched school education programs to inform children, who would then inform their parents and households about the separation of waste and proper disposal of waste.

Cities are increasingly developing new visions for more equitable and sustainable urban systems, prompted by COVID-19 to reform national and city government organization, economies and fiscal priorities. The enormous range of efforts made by cities and cities leaders is captured in the hundreds of BreatheLife campaign stories, and specific to the COVID response, in the portfolio of case studies released by the WHO on Wednesday. 

“Addressing air pollution will have a benefit…on multiple levels of risk factors and health outcomes,” said Nathalie Roebbel, WHO Coordinator for Air Pollution and Urban Health. “If, for example, we change the…structur[ing] of the cities, [it] will maybe increase the opportunity for people to use bicycles or walking. Certainly this will not only have an impact on reduced car use, and therefore reduced air pollution, it will also have benefits in better physical activity and reduction of obesity.”

“[Communities] play a vital role in building economically, socially and environmentally sustainable cities,” said António Guterres, UN Secretary-General, in a statement about World Cities Day. “As we rebuild from the pandemic and engage in the Decade of Action for Sustainable Development, we have an opportunity to reset how we live and interact…Let’s put our communities at the heart of the cities of the future.” 

Moving from Reaction to Prevention 

Overall, collaboration between city planners, development and health sectors is key to curbing pollution emissions, promoting clean energy, and designing neighborhoods and cities that enhance the overall health of residents, and thus reduce fundamental risks associated with the  transmission of diseases, which can lead to the explosion of pandemics.

“The health sector is largely focused on curative and medical results through health infrastructure, ignoring preventative health…A lot of determinants that actually affect health are outside the control of the health sector: housing, air quality, etc.,” said Virinder Sharma, senior urban development specialist at the Asian Development Bank. 

“There is clear evidence that the health sector needs to be [more] knowledgeable on the health effects of air pollution, so capacity building needs to be done in order to have the healthcare workforce itself being able to inform patients, treat them, but also influence decision makers in other sectors,” said Roebbel. 

Image Credits: Partnerships for Health Cities, WHO, Accra Metropolitan Assembly.

WHO director-general Dr. Tedros Adhanon Ghebreyesus

It is “imperative” that governments recognize the long-term effects of COVID-19 and ensure that affected people can access health services, including primary health care as well as rehabilitation, emphasized the World Health Organization on Friday.

“Although we are still learning about this virus, what’s clear is that this is not just a virus that kills a significant number of people,” warned the Organization’s director-general Dr. Tedros Adhanom Ghebreyesus, just hours after a deadly earthquake jolted Turkey and Greece, killing over a dozen people and leaving some 400 injured. 

“This virus poses a range of serious long-term effects. While people do recover, it can be slow, sometimes [taking] weeks or months,” he added.

In past months, mounting evidence has revealed that COVID-19 can trigger a nasty array of long-term effects that range from fatigue, shortness of breath, inflammation and injury of major organs like the heart or lungs, as well as neurological and psychological effects, warned the director-general.

While it is still unclear how many COVID-19 patients experience such long-term effects, it has become strikingly apparent that young people, male and female, with seemingly mild disease, are also affected by long COVID. Several direct testimonies by people who had COVID were aired at the press briefing: 

Patients Testimonies – Eight Months And Still Ill 

Lih Hismeh, 26-year old with long COVID

“It’s been eight months, almost eight months now,” said 26-year old Lih Hismeh, as he recounted his painful experience of long COVID at Friday’s press conference. “I’m still suffering from fatigue, brain fog, chest pain, palpitations, digestive issues, short-term memory loss. There is no system in my body that hasn’t been affected.” 

“I went back to work on reduced hours, but I couldn’t even cope with that because of the brain fog,” added Hismeh, who is a member of the UK’s long COVID SOS patient advocacy group. “I used to be a software engineer. I can’t do that. I also used to do research in artificial intelligence. And now I can’t do that either. I just want my mental focus back.”

As the world itches for a vaccine, governments and societies must do “all they can” to suppress transmission using the tools that are available, including testing, contact tracing and isolation of COVID-19 cases, emphasized the director-general. He noted that such simple measures are still the “best way” to prevent the long-term consequences of COVID, but “commitment” and “hard work” are required to follow through.

“It’s not rocket science, but it requires commitment,” added WHO’s head of emergencies Mike Ryan. “It requires sustained commitment and hard work. It requires bringing people together and not tearing them apart. It requires humility, not hubris. 

“I wish the answers were simple, and there was a magic solution,”said Ryan. “But like everything in our lives that’s complicated. It takes hard work and commitment to work our way out of it.”

Mike Ryan, WHO’s head of emergencies

IHR Emergency Committee Urges Governments To Focus On Measures That Work

This Thursday also marked the fifth meeting of the Emergency Committee on COVID-19 to review the current COVID-19 climate, and to assess how well its temporary recommendations from early August were implemented. 

The Committee’s advice, which was accepted by the WHO’s director-general, urged countries to focus on proven responses and strong science, and unanimously agreed that the pandemic still constitutes a public health emergency of international concern. 

“The take home message is that it’s important for governments and citizens to keep focused on breaking the chains of transmission,” Dr. Tedros noted.

The Committee also commended the WHO’s sustained efforts to bolster national, regional, and global responses to the COVID-19 pandemic through its evidence based-guidance, technical assistance, clear communication, and for convening the Solidarity Trials and the Access to COVID-19 Tools (ACT) Accelerator.

However, the Committee’s Chair Didier Houssin, who also spoke on Friday, said the WHO Secretariat should revise its guidance on international travel to ensure that it is evidence-based and coherent with the International Health Regulations – the WHO’s legal framework that governs countries’ behaviour during health emergencies. He also urged politicians to avoid using the pandemic to acquire or keep power, instead calling for national unity and evidence-based responses.

Didier Houssin, Chair of The Emergency Committee on COVID-19

A Global Mechanism For Rapid Sharing Of COVID-19 Genetic Data

Meanwhile, the WHO emphasized the need for a global mechanism to rapidly share COVID-19 genetic sequence data, as media attention focuses on the fact that a a novel variant of the SARS-CoV virus, which originated in Spain, is now spreading across Europe.  The virus mutation has been identified by a team of researchers from Spain and the University of Basel. 

WHO’s technical lead on COVID-19 Maria Van Kerkhove

WHO’s technical lead for COVID-19 Maria Van Kerkhove emphasised that although ‘mutations’ sounds like a “very scary word”, these are natural changes, noting that the SARS-CoV-2 virus is “relatively stable” with a relatively slow mutation rate in comparison to other viruses.

However, mutations must be monitored regularly to ensure that SARS-CoV-2 is not becoming more deadly or infectious, as this would have important implications for diagnosis of the coronavirus and vaccine development.

 “We must monitor genetic changes in SARS-COV-2 to determine if the virus behaves differently,” Van Kerkhove warned. “We need researchers and scientists to continue to share those full genome sequences.”

Image Credits: NIAID.

A map showing the spread of a novel SARS-CoV-2 variant
The “family tree” of sequences of the new variant indicates that it traveled between countries multiple times.

University of Basel. Researchers from Basel and Spain have identified a novel SARS-CoV-2 variant that has spread widely across Europe in recent months, according to an un-peer-reviewed preprint released this week in medRixv. While there is no evidence of this variant being more dangerous, its spread may give insights into the efficacy of travel policies adopted by European countries during the summer.

In Europe alone, hundreds of different variants of the new coronavirus SARS-CoV-2 are currently circulating, distinguished by mutations in their genomes. However, only very few of these variants have spread as successfully and become as prevalent as the newly identified variant, named 20A.EU1.

The researchers at the University of Basel, ETH Zürich in Basel and the SeqCOVID-Spain consortium analysed and compared virus genome sequences collected from Covid-19 patients all across Europe to trace the evolution and spread of the pathogen. Their analysis suggests that the variant originated in Spain during the summer. The earliest evidence of the new variant is linked to a super-spreading event among agricultural workers in the north-east of Spain. The variant moved into the local population, expanding quickly across the country, and now accounts for almost 80% of the sequences from Spain.

“It is important to note that there is currently no evidence the new variant’s spread is due to a mutation that increases transmission or impacts clinical outcome,” stressed Dr. Emma Hodcroft of the University of Basel, lead author of the study. The researchers believe that the variant’s expansion was facilitated by loosening travel restrictions and social distancing measures in summer.

Similar pattern as in spring in Spain

“We see a similar pattern with this variant in Spain as we did in the spring,” advised Professor Iñaki Comas, co-author on the paper and head of the SeqCOVID-Spain consortium. “One variant, aided by an initial super-spreading event, can quickly become prevalent across the country.”

From July, 20A.EU1 moved with travellers as borders opened across Europe, and has now been identified in twelve European countries. It has also been transmitted from Europe to Hong Kong and New Zealand. While initial introductions of the variant were likely from Spain directly, the variant may then have continued to spread onward from secondary countries.

Currently, 20A.EU1 accounts for 90% of sequences from the UK, 60% of sequences from Ireland, and between 30 and 40% of sequences in Switzerland and the Netherlands. This makes this variant currently one of the most prevalent in Europe. It has also been identified in France, Belgium, Germany, Italy, Latvia, Norway, and Sweden.

Travel facilitated the spread

Genetic analysis indicates that the variant travelled at least dozens and possibly hundreds of times between European countries. “We can see the virus has been introduced multiple times in several countries and many of these introductions have gone on to spread through the population,” said Professor Tanja Stadler of ETH Zürich, one of the study’s principal investigators. “This isn’t a case of one introduction just happening to do well.”

Though the rise in prevalence of 20A.EU1 corresponds with the increasing number of cases observed in many European countries this autumn, the study’s authors caution against interpreting the new variant as a cause for the rise in cases. “It is not the only variant circulating in recent weeks and months,” said Professor Richard Neher of the University of Basel, one of the study’s principal investigators. “Indeed, in some countries with significant increases in Covid-19 cases, like Belgium and France, other variants are prevalent.”

SARS-CoV-2 variant line graph indicating a correlation to the opening of borders
It was detected in the EU in August, correlating with border openings.

Analysis of the summertime SARS-CoV-2 prevalence in Spain and travel data show that these factors may explain how 20A.EU1 spread so successfully. Spain’s relatively high number of cases and popularity as a holiday destination may have allowed multiple opportunities for introductions, some of which may have grown into larger outbreaks through risky behaviours after returning home.

The study’s authors highlight the importance of evaluating how border controls and travel restrictions worked in containing SARS-CoV-2 transmissions over the summer, and the role travel has played. “Long-term border closures and severe travel restrictions aren’t feasible or desirable,” explained 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.”

Assessing the phenotype of the new variant

The new variant was first identified by Hodcroft during an analysis of Swiss sequences using the ‘Nextstrain’ platform, developed jointly by the University of Basel and the Fred Hutchinson Cancer Research centre in Seattle, Washington. 20A.EU1 is characterized by mutations that modify amino-acids in the spike, nucleocapsid, and ORF14 proteins of the virus.

Though the present state of knowledge does not indicate 20A.EU1’s spread was due to a change in transmissibility, the authors are currently working with virology labs to examine any potential impact the spike mutation, known as S:A222V, may have on the SARS-CoV-2 virus’ phenotype. They also hope to soon receive access to data that would allow them to assess any clinical implications of the variant.

The study’s authors emphasized the importance of monitoring the rise of new variants like 20A.EU1 closely: “It is only through sequencing the viral genome that we can identify new SARS-CoV-2 variants when they arise and monitor their spread within and between countries,” added Neher, “But the number of sequences we have varies widely between countries, and we might be able to identify rising variants sooner with faster and more regular sequencing efforts across Europe.”

Image Credits: University of Basel, Iñaki Comas.

Pandemic risk can be lowered by reducing human activities that drive the loss of biodiversity.

IPBES Media – Future pandemics will emerge more often, spread more rapidly, do more damage to the world economy and kill more people than COVID-19  – unless there is a transformative change in the global approach to dealing with infectious diseases, warns a major new report on biodiversity and pandemics by 22 leading experts from around the world.

The report, the product of a recent workshop convened by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), examines the links between degradation of nature and increasing pandemic risks. It argues that escaping the era of pandemics is possible, but that this will require a seismic shift in approach from reaction to prevention. IPBES is an independent organization supported by some 94 governments around the world, and housed at the UN Environment Programme.

COVID-19 is at least the sixth global health pandemic since the Great Influenza Pandemic of 1918, the report notes.  Although it has its origins in microbes carried by animals, its emergence has been driven by human activities, says the new report, which was released on Thursday. It is estimated that another 1.7 million currently ‘undiscovered’ viruses exist in mammals and birds – of which up to 850,000 could have the ability to infect people.

The study suggets plans for ecological restoration should integrate health considerations

“There is no great mystery about the cause of the COVID-19 pandemic – or of any modern pandemic,” said Dr. Peter Daszak, President of EcoHealth Alliance and Chair of the IPBES workshop that produced the report. “The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment. Changes in the way we use land; the expansion and intensification of agriculture; and unsustainable trade, production and consumption disrupt nature and increase contact between wildlife, livestock, pathogens and people. This is the path to pandemics.”

Pandemic risk can be significantly lowered by reducing the human activities that drive the loss of biodiversity, by greater conservation of protected areas, and through measures that reduce unsustainable exploitation of high biodiversity regions. This will reduce wildlife-livestock-human contact and help prevent the spillover of new diseases, says the report.

“The overwhelming scientific evidence points to a very positive conclusion,” said Dr. Daszak. “We have the increasing ability to prevent pandemics – but the way we are tackling them right now largely ignores that ability. Our approach has effectively stagnated – we still rely on attempts to contain and control diseases after they emerge, through vaccines and therapeutics. We can escape the era of pandemics, but this requires a much greater focus on prevention in addition to reaction.”

“The fact that human activity has been able to so fundamentally change our natural environment need not always be a negative outcome. It also provides convincing proof of our power to drive the change needed to reduce the risk of future pandemics – while simultaneously benefiting conservation and reducing climate change.”

The report says that relying on responses to diseases after their emergence, such as public health measures and technological solutions, in particular the rapid design and distribution of new vaccines and therapeutics, is a “slow and uncertain path”, underscoring both the widespread human suffering and the tens of billions of dollars in annual economic damage to the global economy of reacting to pandemics.

Pointing to the likely cost of COVID-19 of $8-16 trillion globally by July 2020, it is further estimated that costs in the United States alone may reach as high as $16 trillion by the 4th quarter of 2021. The experts estimate the cost of reducing risks to prevent pandemics to be 100 times less than the cost of responding to such pandemics, “providing strong economic incentives for transformative change.”

The report also offers a number of policy options that would help to reduce and address pandemic risk. Among these are:

Jungle burned for agriculture in southern Mexico
  • Launching a high-level intergovernmental council on pandemic prevention to provide decision-makers with the best science and evidence on emerging diseases; predict high-risk areas; evaluate the economic impact of potential pandemics and to highlight research gaps. Such a council could also coordinate the design of a global monitoring framework.
  • Countries setting mutually-agreed goals or targets within the framework of an international accord or agreement – with clear benefits for people, animals and the environment.
  • Institutionalizing the ‘One Health’ approach in national governments to build pandemic preparedness, enhance pandemic prevention programs, and to investigate and control outbreaks across sectors.
  • Developing and incorporating pandemic and emerging disease risk health impact assessments in major development and land-use projects, while reforming financial aid for land-use so that benefits and risks to biodiversity and health are recognized and explicitly targeted.
  • Ensuring that the economic cost of pandemics is factored into consumption, production, and government policies and budgets.
  • Enabling changes to reduce the types of consumption, globalized agricultural expansion and trade that have led to pandemics – this could include taxes or levies on meat consumption, livestock production and other forms of high pandemic-risk activities.
  • Reducing zoonotic disease risks in the international wildlife trade through a new intergovernmental ‘health and trade’ partnership; reducing or removing high disease-risk species in the wildlife trade; enhancing law enforcement in all aspects of the illegal wildlife trade and improving community education in disease hotspots about the health risks of wildlife trade.
  • Valuing Indigenous Peoples and local communities’ engagement and knowledge in pandemic prevention programs, achieving greater food security, and reducing consumption of wildlife.
  • Closing critical knowledge gaps such as those about key risk behaviors, the relative importance of illegal, unregulated, and the legal and regulated wildlife trade in disease risk, and improving understanding of the relationship between ecosystem degradation and restoration, landscape structure and the risk of disease emergence

Speaking about the workshop report, Dr. Anne Larigauderie, Executive Secretary of IPBES said: “The COVID-19 pandemic has highlighted the importance of science and expertise to inform policy and decision-making. Although it is not one of the typical IPBES intergovernmental assessments reports, this is an extraordinary peer-reviewed expert publication, representing the perspectives of some of the world’s leading scientists, with the most up-to-date evidence and produced under significant time constraints. We congratulate Dr. Daszak and the other authors of this workshop report and thank them for this vital contribution to our understanding of the emergence of pandemics and options for controlling and preventing future outbreaks. This will inform a number of IPBES assessments already underway, in addition to offering decision-makers new insights into pandemic risk reduction and options for prevention.”

Image Credits: The IPBES Media Team, Jami Dwyer.

The Food Aid System of Milan – Dispositivo di Aiuto Alimentare initiative

First in a Series: While COVID continues to cast a long shadow over our everyday lives, from Baku, Azerbaijan to Bogota, Columbia, there are also countless examples of how cities and communities have mobilized to respond to the social and economic fallout from the pandemic – building new forms of cooperation that also promote a wide range of longer-term social and health benefits.  

The stories cut across cities of all regions, income levels and sizes.  Some of the examples are captured in a series of case studies released yesterday by WHO ahead of World Cities Day, which is observed on Saturday, 31 October. Innovations include the dramatic expansion of cycle lanes in Bogota, Colombia; safe bus transport in Baku, Azerbijian; upgrading informal settlements in Buenos Aires, Argentina and new, city-wide food bank efforts in Milan, Italy and Freetown, Sierra Leone that linked up existing food charities to ensure more systematic coverage of people needing support, and also put an emphasis on healthy, nutritious foods.

Safe, Sustainable Public Transport in Baku and Bogota    
In Baku more than 2000 buses operate on 150 routes, carrying more than 2 million passengers daily across the city.

In Baku, the Baku Transport Authority (BTA) has more than 2000 buses operating on 150 routes. The BTA became a key member of the government’s coordinated pandemic response plan, which included acting as the primary transport providers after the suspension of operations of the Baku metro. There were also awareness raising campaigns implemented by the BTA in a show of solidarity for the government, with posters and educational booklets on how to protect against the virus distributed in stations and the city’s main transport exchange. 

“Public transport professionals are part of the front liners in these critical times and our first priority is to keep the citizens safe and healthy”, said Vusal Karimli, Chairman of BTA. “We are proud to be serving our people by providing continuous mobility services for essential travelers.”

Bogotá’s Ciclovías (bike lanes)

In addition to public transportation, Bogotá’s world-famous Ciclovías (bike lanes) have been expanded even more to promote the use of active, alternative, and sustainable transport during pandemic times.  Bogota has long had a reputation as a pioneer in sustainable bus rapid transport as well as cycle transport, with 550 kilometers of bike lanes in operation even before the pandemic began. During the pandemic, the city added another 84 kilometers,  making Bogotá’s Ciclovías network among the largest in the world, and giving people a safe, healthy and sustainable way of getting around during the  lockdown and its aftermath. Workshops are also offered to Ciclovía users to remind them to keep their hands and bikes sanitized, and to remain a safe distance from other cyclists, in an effort to stop the spread of COVID-19. 

Creating Stronger and Healthier Food Safety Nets in Milan and Sierra Leone 
Freetown, Sierra Leone, has been working with partners to provide healthy, nutritious food to its citizens during the pandemic

Food security has been a big concern in the midst of the pandemic from the wealthiest to the poorest cities. In Freetown, the capital city of Sierra Leone, which survived a decade-long civil war (1991-2002) civil war only to be hit brutally hard by the 2014-16 West Africa Ebola epidemic, the municipal government has been providing its most vulnerable residents with food packages so they can stay safe and healthy in quarantine. Around 30% of Freetown’s 1.2 million residents have a family income of less than 1 USD per day, and 47% do not have direct access to running water. Food insecurity was highlighted in a national survey conducted in April, where only 12% of respondents said that they had sufficient foodstocks to last even one week. 

The city government provided food to 6000 households across three informal settlements; an urban farming initiative also has been created to support sustainable access to nutritious food while helping city residents become more prepared for future crises. 

The Food Aid System of Milan, or the Dispositivo di Aiuto Alimentare, sought to organize more systematic distribution of food stocks during the spring 2020 lockdown, in partnership with many public and private organizations and charities that operate food banks and similar programmes.  A longer-term feature of the initiative is the ambition to ensure vulnerable households can access  fresh produce, and not only processed food. 

“Milan Food Policy has once again become an instrument to face emerging needs of citizens. By building alliances with many players in the city we built the Food Aid System, in order to get close to families and fragile people who, in addition to a health emergency, were also going through a food crisis, ” says Anna Scavuzzo, Vice Mayor of Milan in charge of Food Policy

The “Lethbridge Helping Organizations COVID-19 Response” was launched by city authorities to strengthen collaboration by local groups to serve the needs of all residents.

Other cities have also partnered with organizations to assist their citizens. In the Canadian province of Alberta, the city of Lethbridge launched “The Lethbridge Helping Organizations COVID-19 Response” to strengthen collaboration with local groups in order to serve the needs of city’s residents. Community members offered to pick up medications, offered rides, lent out house supplies, etc, on a Facebook COVID-19 support page. Other programmes supplied volunteer wellness checks and the delivery of food boxes to older people. 

Buenos Aires, Argentina  – Strengthening Pandemic Resilience in Informal Settlements

The City Housing Institute (IVC) of Buenos Aires, collaborated with local grassroots organizations to strengthened resilience in the Villa 20 neighborhood. In this informal urban settlement, home to 30,000 people, 14% of families have at least one household member with a disability, and 30% with a chronic or pre-existing health condition. 

Under the authority of the Ministry of Social Development and Housing and the Ministry of the City Government of Buenos Aires, IVC implemented prevention and protection measures and provided assistance to families in need. The interventions covered five areas: food security, health, urban hygiene, and communication. The quick action also helped curb the spread of the virus, resulting in fewer COVID-19 cases.

Ahmedabad, India – Reducing Tobacco Use That Breeds COVID-19 Infections 

In the largest city in India’s western state of Gujarat, the city government of Ahmedabad made a decision to reduce the use of tobacco products during the COVID-19 pandemic period. Smokeless tobacco, in particular chewing tobacco products such as gutka, khaini, zarda, and paan, induce salivation and trigger the urge to spit. Spitting can, in turn, facilitate the spread of infectious diseases, potentially including the SARS-CoV-2 virus that causes COVID-19. In March, a ban on spitting on roads and in public places was implemented as an effort not only to reduce the spread of the virus but is acting on continued efforts to prevent tobacco-related cancers and other noncommunicable diseases in the city. 

These cities and more are part of the Partnership for Healthy Cities – a global network supported by Bloomberg Philanthropies in partnership with WHO and Vital Strategies. This initiative enables cities around the world to deliver high-impact policy or preventative intervention to combat noncommunicable disease and injuries in their communities, and has since expanded its support during the COVID-19 pandemic. 

Says WHO Director Dr. Etienne Krug, who leads the effort for WHO:  “These case studies show how cities are innovating to protect the health and well-being of their citizens, while under the stress of the pandemic. They show how city leaders are addressing challenges in food security, city planning, or safe mobility by taking a longer-term sustainable approach.” 

“The legacy of these innovations and programmes will last beyond COVID-19.  They are great examples of strong local actions during the pandemic and beyond.”

Image Credits: Pietro Baroni , Baku Transport Agency, Fernanda Lanzagorta, OPS Columbia, WHO , Trevor Page.

Researchers in Sanofi’s laboratory in France.

Sanofi and GlaxoSmithKline, two drugmakers, announced that they would provide 200 million doses of their potential COVID-19 vaccine to the WHO and Gavi Alliance co-sponsored COVAX procurement facility, which more than 180 countries have joined.  

“To address a global health crisis of this magnitude, it takes unique partnerships. The commitment we are announcing today for the COVAX Facility can help us together stand a better chance of bringing the pandemic under control. This moment also reflects our long-term commitment to global health and ensures our COVID-19 vaccines are affordable and accessible to those most at risk, everywhere in the world,” said Thomas Triomphe, Global Head of Sanofi Pasteur. 

Sanofi and GSK began their Phase 1/2 clinical trial in September and they expect to start late-stage testing by the end of the year. Although Sanofi and GSK aren’t leading in the race to develop a COVID-19 vaccine, compared to Pfizer, Moderna, or Johnson & Johnson, their recombinant protein-based vaccine could become an important player in the long-term push for a COVID-19 vaccine.

Mortality Rates Decreasing, Even As Many Countries Experience Rising COVID-19 Cases, Finds Study

Meanwhile, although COVID-19 infection rates are rising globally, a recent report published last week in the Journal of Hospital Medicine found declining rates in mortality. The study conducted in New York among COVID-19 patients observed a significant drop in mortality rates from 25.6 percent in March to 7.6 percent in August. 

The other trends in COVID-19 hospitalization and infection were shifts in demographics and severity of the illness. The median age of COVID-19 hospitalization dropped from 63 years old in March to 49 in August. The comorbidities of patients diagnosed with COVID-19 has also decreased from 80.7 percent to 71.6 percent. 

The researchers adjusted for the demographic changes and found that the results represented actual improvements. The 18.2 percentage point decrease between March and August could be attributed to improved treatment of COVID-19 in hospitals. 

“This is still a high death rate, much higher than we see for flu or other respiratory diseases,” said Leora Horwitz, director of NYU Langone’s Center for Healthcare Innovation and Delivery Science. “I don’t want to pretend this is benign. But it definitely is something that has given me hope.” 

Developments in care of patients with SARS-CoV2, including using ventilators, blood thinners, steroids, and knowing what complications to watch for, contributes to better illness outcomes, said Horwitz. “We don’t have a magic bullet cure, but we have a lot…of little things that add up.”

SARS-CoV2 Antibodies decline within Two Months of Exposure, New Study Finds

At the same time, results from recent study by Imperial College London found declining rates of antibody prevalence among individuals in England from June to September 2020. The results suggest rapidly decreasing population immunity and increasing risk of reinfection. 

The “REACT-2” study included 365,104 adults in three random, non-overlapping samples, and tested for antibody prevalence at three points after the peak of COVID-19 in England in April. 17,576 tested positive for SARS-CoV2 antibodies. The prevalence of antibodies was highest in individuals aged 18-24 and lowest in the 75 and over age group. 

The first round of testing in June found that six percent of those tested had detectable antibodies. In August, the prevalence had reduced to 4.8 percent, and September recorded a rate of 4.4 percent. The highest decline in antibody prevalence was in the oldest population group, 75 and over. 

Image Credits: Sanofi.

Ngozi Okonjo-Iweala, in her former role as Nigerian Finance Minister, speaking at French-African economic conference

Ngozi Okonjo-Iweala, board chair of Gavi, The Vaccine Alliance, on Wednesday was named as the favored candidate to be the next World Trade Organization director-general  – after a months-long WTO campaign process and in a decisive moment of the COVID-19 pandemic.

But as the United States came out in favor of the Republic of Korea’s Yoo Myung-hee, stalling the final consensus-building process, WTO officials said that a final decision will have to go before the full 164-member General Council of member governments on November 9 – a week after the US presidential elections.

The US opposition to a recommendation by the WTO’s “Troika” selection committee, is a double slap in the face since Iweala is a dual US-Nigerian citizen. She also comes to the table with strong global health credentials at a time in which the WTO is being asked to broker sensitive issues of patent rights versus medicines access.

The new WTO Director General will play a critical role in negotiating the rough waters ahead between countries in the global South that want to create a broad “patent waiver” for COVID-19 health products and high-income countries in the G7 and the European Union that oppose such a move. Iweala, a former Nigerian Trade Minister, is serving as a special African Union envoy charged with mobilizing economic support for the fight against the pandemic.

In the final, late September round of her campaign, Iweala made it clear that she sees WTO as playing a pivotal role in pandemic response, saying that “trade can contribute to public health and the WTO can lead”.  While she has also issued positive signals to business leaders, she also   tweeted that “the health of populations is the business of the WTO… The world can’t wait WTO must play a central role in the COVID-19 supply chain.”

India and South Africa’s Bid for A WTO “Waiver” on COVID-related Intellectual Property

Not since the HIV/AIDS crisis of the late 1990s, has the WTO been so much in the health limelight. India and South Africa recently proposed that the WTO agree to a blanket “waiver” on the WTO trade-related agreements (TRIPS) rules regarding patent and copyright restrictions and trade secrets related to any COVID-19 health products and equipment for the duration of the pandemic. This, they argued, would enable easier production, export and access to generic versions of not only drugs but vital equipment like respirators and diagnostic tests.

The fact that the European Union has lined up in favor of Iweala’s candidacy reflects widespread confidence among skittish developed countries that she will be able to steer contentious WTO debates in a fair and balanced manner.

“I am pleased to announce that the European parliament is endorsing @NOIweala as the Director-General of the WTO,” said EU parlimentarian Sven Simon in a tweet last week. “After our joint hearing on Monday, we are convinced by her vision for the future of multilateralism and advise WTO members to support her bid.”

Indeed, among the 27 delegations that spoke at today’s WTO meeting, only the US went on record opposing Iweala’s candidacy – saying that her Korean rival had more trade experience and could “hit the ground running.”.

“The Troika presented to the membership their assessment of the candidate that had th best chance of attaining the consensus of the [WTO] membership — that candidate is Dr. Ngozi Okonjo-Iweala of Nigeria,” said said WTO’s director of information, Keith Rockwell, at the Wednesday briefing. “One delegation could not support the candidacy of Dr Ngozi, and said they would continue to support South Korea’s Yoo Myung-hee. That delegation was the United States of America.

”The US says that they supported Minister Yoo because of her 25 years of trade experience – that she would be able to hit the ground running,” Rockwell said. “They said that they could not endorse Dr. Ngozi.”

He added: “There will be a General Council meeting held on the ninth of November, at which we hope to take a decision on this very important matter.”

“This [meeting] was never intended to make a final decision,” Rockwell underlined at the Wednesday afternoon briefing,  delayed for nearly two hours while more than two dozen countries debated the recommendation of the “WTO Troika” that has been managing the DG selection process.

That “Troika” led by WTO Ambassador David Walker of New Zealand, along with Honduras’ Dacio Castillo and Harald Aspelund of Iceland.

Rockwell said that the Troika had made their recommendation after a wide-ranging series of  private consultations with member states. The Troika’s consultations found that Iweala had “by a wide margin, the most preference, that she had wide support across all regions and across levels of development, LDCs (least developed countries) developing countries and developed countries.

“They said she had had these since the very beginning of the process.”

However, no formal roll-count of WTO members has been taken, Rockwell added, noting that WTO elections aim to build a consensus of all 164 members.

“The process of consultation is confidential. It’s not a vote.  It’s very important to understand that this is a process of building a consensus around one candidate, so that the Director General will be the director general for all WTO members.”

“There will be a General Council meeting on the 9th of November, in which we hope to take a final decision on the matter.”

Navigating a Pandemic, Bickering Economies and National Protectionism

Ngozi Okonjo-Iweala at the Igniting Innovation in Financial Access panel, 2020.

On October 26, the European Union joined African and Caribbean states, among others, in endorsing Okonjo-Iweala. China has also reportedly expressed support for her appointment.

A former finance minister and World Bank managing director, Okonjo-Iweala is currently the African Union’s Special Envoy to Mobilise International Economic Support for the Continental Fight Against COVID-19. She has been named as one of Transparency International’s 8 Female Anti-Corruption Fighters Who Inspire (2019).

In a recent interview with Reuters she said: “I feel I can solve the problems. I’m a known reformer, not someone who talks about it. I’ve actually done it both at the World Bank and in my country.”

If her bid is successful, Okonjo-Iweala will need not only to navigate a pandemic, but also wider issues involving bickering economies as national protectionism has risen during the pandemic. She will need to overhaul the WTO’s top appeals body which has had judge appointments repeatedly blocked by US President Donald Trump’s administration.

Gavi Board Chair Ngozi Okonjo-Iweala.

Even if Trump is defeated next week by Democratic contender Joe Biden, Trump will remain a “lame duck” president until the inauguration of his successor in January 2021.

Potentially, if Trump digs in his heels, that could prolong any WTO debate over the final choice of a director-general for a couple of months, leaving the organization with no one at the helm — even as the expected announcement of COVID-19 drug and vaccine breakthroughs will make the scramble for health products and the urgency of resolving emerging disputes over patent rights even more immediate.

Commitment to Health and Global Immunization Goals

Okonjo-Iweala first moved to the United States in the 1970s to study Economics at Harvard University, graduating magna cum laude. She later received an International Fellowship from the American Association of University Women (AAUW) to support her doctoral studies at the Massachusetts Institute of Technology (MIT).

She later served as Nigeria’s longest-running finance minister from 2003-2006 and 2011-2015, during which time she negotiated a $US 30 billion reduction in the country’s external debt.

In 2015, Okonjo-Iweala was appointed Chair-elect of the Gavi Board, and four years later received the Lasker-Bloomberg Public Service Award for her role in supporting work to provide sustained access to childhood vaccines for more than 760 million children.

It was that same year she became a dual US citizen, having spent several decades already working and studying in the country.

Image Credits: DGTresor , WTO, World Bank Photo Collection, Ngozi Okonjo-Iweala.

More than 200m people in sub-Saharan are infected by playing in contaminated water.

It starts with a child bathing in a stream to escape scorching temperatures. Silently, beneath the water, larvae that have emerged from a tiny snail burrow into their leg before entering the bloodstream. Over the next few weeks, the larvae turn into adult worms which mate and produce hundreds of eggs every day. This is schistosomiasis, also known as bilharzia – a neglected tropical disease (NTD) affecting more than 200 million people in sub-Saharan Africa, many of whom are children who have acquired infection just by playing or washing in contaminated water.

People across the world have become attuned to the fight for public health on a global scale in 2020. Never before has there been this amount of discussion about vaccines, treatments and prevention of disease. This year’s World Health Summit – held virtually from Berlin and which I had the honour to address earlier this week – had a strong focus on preparedness and resilience in the age of COVID-19, and the importance of global cooperation. Yet while the world rightly fights coronavirus, we must not forget about another widely prevalent and devastating subset of infections: the neglected tropical diseases (NTDs).

What are Neglected Tropical Diseases (NTDs)?

NTDs are a diverse group of 20 infectious diseases that are prevalent in tropical and subtropical conditions of some 149 countries worldwide. They affect more than 1.5 billion people, and cause an estimated 500,000 annual deaths globally.

Despite these shocking figures, they are termed ‘neglected’ because they continue to receive little attention.

Dr Mwelecele Ntuli Malecela, World Health Organization

During the World Health Summit, I spoke of the need to change how we think about NTDs. They not only compromise people’s health, keep children out of school and cause disfigurement and mental distress that disproportionately affects and stigmatises women. NTDs do not just affect health – they also hamper the economic growth and productivity and impede education. The good news is that most NTDs are easy to treat and can be prevented. The moral responsibility now lies with us to invest in their treatment and prevention and help the poor and marginalized communities who are mostly affected.

In fact, investing in treatment and prevention of NTDs not only helps alleviate suffering against these diseases, but also prevents other diseases that share the same origins: namely, poor sanitation and inadequate access to clean water. This investment would lead to better sanitation and access to clean, safe water that will help prevent NTDs and minimise other serious threats across the African continent, including COVID-19.

Eliminating NTDs while meeting COVID-19 Challenges

As a community, we are continuing our mission to eliminate NTDs, while ensuring that the challenges of COVID-19 are met. Investing in NTDs is one of the most cost-effective buys in public health, with treatment for the top 5 NTDs costing less than $0.50 per person, yet it is instrumental to improving development and equality, and lifting up communities.

The lessons that we have learned from NTDs can also be applied to other public health threats, like COVID-19 which is now pervasive across the world. This is also the case in Africa, with almost 1.5 million cases and over 35,000 deaths reported by the African Centre for Disease Control and Prevention. Many of those affected by NTDs also live in poverty without adequate access to water, hand sanitizer and masks, all of which are non-pharmaceutical public health interventions recommended to reduce their risk of contracting COVID-19. With so much at stake, it is now more important than ever to focus on investing in NTDs to prevent more deaths from COVID-19. To look at it from another angle, an investment in public health measures to combat COVID-19 is also an investment in the fight against NTDs.

The World Health Organization is set to launch its 2021-2030 Global NTD Roadmap, setting out important milestones and targets in our ongoing endeavour to eliminate and eradicate these diseases. These milestones will be even more important and will also benefit the work the global health community is undertaking against COVID-19.

The new NTD roadmap will provide the direction needed to ensure that the global health community does not take its foot off the pedal when it comes to the fight against NTDs. A lot remains to be done to ensure that those who require interventions against NTDs receive them. I urge countries, donors, political leaders and citizens to not lose sight of these low-cost, high-impact interventions.

We must ensure that NTDs and those who suffer from them do not find themselves neglected even furhter while the fight against COVID-19 rages on. The livelihood of 600 million African people depends on us all.

Dr Mwelecele Ntuli Malecela is the Director of the Department of Control of Neglected Tropical Diseases, WHO.

After weeks of inaction, Prime Minister Narendra Modi’s government has signalled that it will create a comprehensive law to halt rice stubble burning in rural areas of northern India, where drifting smoke from thousands of fires is a major contributor to Delhi’s annual autumn air pollution emergencies.

But experts remain skeptical, stating that there are already enough laws on the books and yet another one could just cause more confusion; what is really missing, they say, is strong central government action.

India’s solicitor general announced the plans for the law on stubble burning in a hearing on Monday before the Supreme Court, as the Court again reviewed the state of  government planning and options for judicial intervention.

“The Centre has taken a holistic view of the matter and now a comprehensive law is being planned with a permanent body with the participation of neighbouring states,” said Tushar Mehta, the solicitor general for the government at the hearing, referring to the federal government led by Prime Minister Narendra Modi.

Recent view of air pollution haze over Delhi

The Government announcement on Monday came after weeks in which Delhi Chief Minister Arvind Kerjiwal, pledged to declare “war” on air pollution caused by the crop stubble burning, but so far has failed to advance his attack from a high-tech “war room” in the city itself.

India’s Supreme Court also has championed solutions – none of which have really been implemented.  Meanwhile air pollution levels have already mounted dangerously in the city and throughout the northern India region, as a result of the unabated crop burning.

This is happening even as India also struggles to manage one of the world’s highest rates of COVID-19, a respiratory infection whose hallmark is breathing difficulties even in the best of air quality.

Critics skeptical 

Against those setbacks and a budding crisis, critics remained doubtful about whether government action could even be effective at this late date.  Historically, the prime minister has been largely indifferent to the chronic air pollution hazard of India’s northern region and Delhi itself.

“The problem lies in the fact that political will is missing when it comes to implementation,” Polash Mukherjee, environment health and air pollution management researcher, told The Tribune newspaper. “Having said that, it will be welcome if there is a specific provision to deal with crop residue burning at a national level, and not leave it contained as a problem in Punjab and Haryana only. Satellite images from central and southern India show the extent of crop residue burning in these parts as well, which have an impact on local climate resilience.”

“Let’s see what they come up with,” said Vimlendu Jha, founder and executive director of environmental non-profit Swechha, adding, “anything will be better than the one-member judicial committee.”

“Hazardous” air quality in Anand Vihar, Delhi: 9pm CET 27 October 2020. (AQICN.org)

He was referring to the October 16 move by the Supreme Court to appoint a single judge to monitor and manage crop stubble burning with a team of volunteers from the National Cadet Corps and Bharat Scouts and Guides. On Monday, the court suspended the order after Modi finally said he would act. The Court said the October 16 order would be “kept in abeyance”.

Jha said that that any plan devised by the central government would have funding as well as legally binding provisions. “And I hope it’s not just the stubble burning issue, but an overall airshed approach,” he added.

“I hope that this is not just a reactionary step that creates a hastily conceived new agency,”  said Dr Santosh Harish, Fellow at the Centre for Policy Research who specialises in energy and environment policy and air quality governance in India. “The present crisis could provide us an opportunity to make much needed institutional changes for more effective coordination and implementation at the NCR level. While various powers can be provided to a new agency on paper, several other factors determine how those powers get used– funds and staffing being two critical inputs,” he added.

Experts remain doubtful that any sort of  “comprehensive law”, even if enacted immediately, would be able to dampen down the farm fires, midway through the stubble burning season.

Sunil Dahiya, an analyst at Centre for Research on Energy and Clean Air, said: “Coming up with new legislation alone is not going to help clean the air. Actual action on pollution sources is needed.”

Smoke Envelopes Delhi and Northern India

NASA satellite data began showing fires and small spikes in fine particulate matter (known as PM2.5) in early October.

Now, thousands of crop stubble fires are already burning across the states of Punjab, Haryana and Uttar Pradesh in the north Indian plains, and smoke blowing into Delhi is driving up air pollution levels to emergency levels.

Delhi’s Air Quality Index (AQI) levels on Sunday were 303 – considered to be ‘very poor’ according to the government’s SAFAR app India Air Quality service – but had improved slightly to 256, with some wind movement later in the week.

Crop burning contributes about 5-8% of Delhi’s pollution over the course of the year. But in  the late autumn peak period, crop fires can contribute to as much as 40% of Delhi’s daily air pollution load – due to a combination of unfavorable geography, wind direction, and the lack of rainfall.  Earlier this week, Indian Express reported that according to SAFAR, the Ministry of Earth Sciences’ air quality monitor, “farm fires accounted for 22% of the air pollution in the national capital on Saturday, and 17% on Sunday.” It seems that any measures to deal with crop stubble, if successful, would be significant.

“Managing for winter burning of crop residue has to be a year-long effort and cannot be started in September each year,” said Karthik Ganesan, Research Fellow at the Council on Energy, Environment and Water. “No matter what the size of the committee, unless we clearly have a consultation process that captures inputs from relevant stakeholders – and most importantly the farmers – and put up final recommendations for public review, these are unlikely to achieve any more success than past efforts,” he added.

The “Wild Card of Meteorology” Likely To Decide  

Delhi’s AQI levels have already breached 300 several times in October. Before the fires began, the AQI dipped to 41 on Sept 1, 2020, a record low since 2015 when AQI monitoring began at national level. By the time agricultural fires have peaked, these index usually cross levels well beyond 500.

And with October this year showing many more early fires, some experts fear pollution could be worse.

An analysis by the Council on Energy, Environment and Water (CEEW), for instance, stated that 9,000+ fires had been observed by satellite data covering the period between September 1 and October 20. Last autumn, in comparison, farm fires peaked to around 4,000 per day by October 31. The day after crop residue burning in the States of Punjab and Haryana accounted for 44% of total air pollution, Central Pollution Control Board Member Secretary Prashant Gargava stated.

On the other hand, since the fires began a little bit earlier this year, prevailing winds may yet blow some of the smoke away from the city, other observers say. In addition, more mechanical machinery has been introduced to grind, rather than burn the stubble quickly, so that farmers can plant their next crop right away.

In addition, there has been a 10% reduction in plantations of the kinds of industrial rice stalks, that are the hardest to manage: more local basmati rice varieties are being grown, less of which is burnt. “We believe that this year should see lower levels of burning and more spread out burning” depending on the wild card of meteorology, said Karthik Ganesan & Tanushree Ganguly, researchers at the Council on Energy, Environment and Water.

No National Plan For Integrated Air Pollution Solution 

Indeed, with no accountability and no political party at the state or central government levels right up to the Prime Minister, a population larger than that of the entire continent of north America now depends on meteorology to save it from disease, disability and death triggered by toxic air.

New Delhi, India – Toxic smog blocks out the sun.

“On one hand we have courts which have good intentions, but not the expertise, on the other, the government and its large cohort of expert institutions, which have the expertise but not the intention to solve this issue,” said Dr Amrita Bahl, another CFA board member.

Said Vimlendu Jha: “Each year the Supreme Court passes strong worded observations, reprimanding every stakeholder, and this year has gone a step ahead and appointed a retired Justice.

“Rather than creating new mechanisms and institutions, it is important to strengthen existing ones, collectively, collaboratively and responsibly. We need to fix accountability of our government servants and departments. Stubble burning in particular and air pollution in general cannot and will not be fixed unless we relook at our agricultural practices including crop choices, construction and demolition regime, production and management of waste in our cities and its disposal, enhancing public transport.”

Delhi’s ‘GreenWar Room’ Fails To Advance To Battlefield

Just two weeks ago, Delhi’s chief minister Arvind Kerjriwal had said that he was setting up a ‘war-room’ to fight pollution and said he would be promoting a miracle composting agent amongst his rural neighboring states, which could rapidly degrade the rigid rice stalks that are the lion’s share of the crop stubble problem.

These cheap, easy and accessible Pusa decomposer pills that the Delhi chief minister has been promoting convert the stalks into valuable fertilizer as well – something that should be an incentive to stop farmers burning.

Delhi sky on a clean air day earlier this summer, when the COVID-19 lockdown brought many factories, transport and construction – which are other major sources of the city’s air pollution.

But although his Green War Room is up and running with technical experts who meet every day in an office equipped with large screens displaying NASA-ISRO images to monitor real-time data and hotspot conditions, actually moving out into the smoke-filled rural regions with the Pusa decomposer pellets or other solutions, isn’t being given much importance, said one insider, speaking on the condition of anonymity.

And it remains unclear how readily Delhi’s political leaders could really influence policies among their rural neighboring states. It is equally unclear if Kerjiwal will be getting much backing from Prime Minister Narendra Modi – a political rival.

Modi has remained largely indifferent to the criticism heaped upon him nationally and globally over his failure to take action on practical matters like stubble burning – as well as the bigger picture of expanded dirty coal power production. Modi’s ruling Bharatiya Janata Party is already grappling with farmers agitating against the passage of three agriculture bills in Parliament last month.

1.67 million Indians Died from Air Pollution in 2019

The latest air pollution crisis comes as the The State of Global Air 2020 was released, showing that 1.67 million Indians died from air pollution in 2019. That represents an increase of 61% over deaths in India attributable to air pollution nearly a decade ago in 2010. It’s also roughly one-quarter of the total deaths attributable to air pollution worldwide.

In addition, India has been steadily recording average annual increases in PM2.5 pollution since 2010, contrary to the federal government’s claims that annual air pollution levels are falling. This is despite marked regional reductions in pollution levels in east Asia driven primarily by declines in China.

Last October, the University of Chicago’s Air Quality Life (AQLI) tool showed the average citizen living in the Indo-Gangetic plain region – comprising the states of Bihar, Delhi, and West Bengal, among others – can expect to lose about seven years of life expectancy because air quality fails to meet the WHO guideline for fine particulate pollution. Particulate pollution rose 72 per cent from 1998 to 2016 in an area that is home to around 40% of India’s population.

Solutions Abound – Incentives For Alternative & More Nutritious Grains    

Even if the Pusa decomposer doesn’t gain rapid, widespread acceptance, there are plenty of other solutions that would likely trigger rapid change. Most of them revolve around money.

In 2019, stepping in once more to the national vacuum in air quality decision-making, the Supreme Court ordered governments in the three states with the highest level of fires to actually pay farmers a set sum, per paddy crop, as an incentive for not burning their crop stubble. The initiative was opposed even by environmentalists – and later set aside.

“There should be deterrence but not a perverse incentive. That works against the polluter pays principle,” Sunita Narain, Director General of Centre for Science and Environment told The Indian Express.

However, environmentalists say that positive incentives for farmers to cease growing water-hungry rice – and shift fields to other types of nutritious grains would be a welcome corrective to distortions in existing policies.

Punja, India – Crop burning reduces soil fertility and worsens air pollution

The hybrid rice varieties that have come to predominate in the region, are heavily subsidized by the government.  But the rice also depletes the water tables of the water-scarce Punjab region – while much of the production actually creates a huge surplus that goes for export.

Rather than subsidizing the wrong crop in the wrong place, they say, the government should incentivize farmers to shift their fields back into more of the indigenous grains that used to predominate on India’s northern plains, use far less of precious water reserves.

Minimum support prices are an easy way to guide farmers on what they should grow. The Ministry of Food and Agriculture could trigger a shift in growing patterns simply by offering higher subsidies via minimum support prices, said agricultural economist  Ashok Gulati, in one recent blog.

Growing patterns of the traditional crops, and the stubble they produce, both would give farmers a longer window of time to clear their fields so they don’t have to burn their fields in a rush to prepare a field for the next planting season.

These crops also are healthier. They include nutrition dense grains like pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize (makki) – all of which are native to the area. Punjab was once known for its makki ki roti, a flat bread made from cornmeal.

Gulati referred to the potential to incentivize corn as a “crop for clean air.” But the same solution could be used for traditional grains that have a high iron content and are perfect for a country that harbors one quarter of the world’s cases of anaemia.

“Stubble burning needs a well-understood multi-pronged strategy: easy access to happy seeders and other in-situ methods, markets for collected stubble, and a shift away from paddy cultivation in the long term. And yet, the execution by the state governments remains poor. The ban on burning was always going to have a limited impact, and we should not expect new committees to monitor the situation to yield very much,”  said Harish.

Zero Till  – Another Immediate Option. 

Tere is yet another solution, which if implemented sincerely and rapidly can still firefight and help north India from suffocating this winter – even at this late date. It has been around since 2016, with the International Maize and Wheat Improvement Centre (CIMMYT) advising and propounding this simple, zero-till practice. 2016 was the year NASA reported the higher number of crop residue fires.

If adopted, this would bring emissions down by almost 80%. It can also increase productivity and maximize profits for farmers, according to a 2019 study published in Science.

No-till practices that leave straw on top of the soil as mulch can preserve soil moisture and improve soil quality and crop yields in the long-run, said Principal Scientist of the International Maize and Wheat Improvement Center M.L Jat, who co-authored the study.

All these are solutions that have existed for years, but the lack of both the state and central government’s intentions have continued to allow north India’s residents to suffer the severe pollution levels that we breathe each winter. Last winter, the Supreme Court had pulled up the chief secretaries of all the surrounding states, berating them for allowing stubble burning.

Now in place of the might of the entire government which should have been working to solve this problem stands a vague proposal for yet another new law.  Meanwhile, the population of northern India holds its breath.

Jyoti Pande Lavakare is a New Delhi-based journalist and the author of “Breathing Here is Injurious to Your Health: The Human Cost of Air Pollution” to be published by Hachette next month.

Image Credits: @pawanpgupta, Jepoirrier, AQICN.org, Sumitmpsd , Neil Palmer.