Remdesivir received emergency use approval for COVID-19, only to fall by wayside in WHO Solidarity trial.

Two more experimental COVID-19 drugs, including the much-touted Remdesivir, appear to have fallen by the wayside, failing to show significant reductions in mortality among seriously ill patients. Interim results on Remdesivir and three other drug treatments being studied as part of the WHO Solidarity Therapeutics Trial, the world’s largest randomized controlled trial of COVID-19 drugs, were published Friday on the pre-print journal, medRxiv.org. 

The WHO-coordinated study, covering some 11,266 participants across 30 countries, found that the antiviral Remdesivir, as well as Interferon, had no effect on 28-day mortality among hospitalized COVID-19 patients and little or no effect in reducing the initiation of ventilation or the duration of hospital stay. While the news on Remdesivir was fresh, the study also reported results of treatments with two other drugs, the anti-malarial Hydroxychloroquine, and the HIV/AID drug combination Lopinavir/Ritonavir, which have already been largely disqualified as good treatment options, in light of findings from studies published over the spring and early summer.  

“These Remdesivir, Hydroxychloroquine, Lopinavir and Interferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay,” states the study. “The mortality findings contain most of the randomized evidence on Remdesivir and Interferon, and are consistent with meta-analyses of mortality in all major trials.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General announcing negative Remdesivir results

The study includes findings from drug trials covering some 11,266 participants across 30 countries, with 2750 participants administered Remdesivir, 954 Hydroxychloroquine, 1411 Lopinavir, 651 Interferon plus Lopinavir, 1412 Interferon, and 4088 receiving no treatment drug. 

In a sober announcement of the results at Friday’s WHO press conference, Director General Dr Tedros Adhanom Ghebreyesu made it even more plainly clear:

“Interim results from the trial now show that the other two drugs in the trial, Remdesivir and Interferon, have little or no effect in preventing death from COVID-19 or reducing time in hospital. 

“For the moment, the corticosteroid steroid dexamethasone is still the only therapeutic shown to be effective against COVID-19 for patients with severe disease,” Dr Tedros added. 

WHO Will Push On To Test Monoclonal Antibodies and Other Antivirals

Despite the dead-end reached with the drugs that only a few months ago had seemed to offer potential for improving COVID treatment, Dr Tedros also said that WHO Solidarity Trial would push ahead  in coordinating new research to “assess other treatments, including monoclonal antibodies and new antivirals.”

The potential of drugs containing controlled portions of anti-SARS-CoV2 monoclonal antibodies have catapulted into the spotlight recently, after US President Donald Trump claimed that such a cocktail by the pharma company Regeneron had virtually “cured’ him of COVID-19.  

Even so,  clinical trials on a similar treatment, under development by Eli Lilly, were halted just this week after an adverse reaction occurred in one trial participant. Despite the lack of evidence about either drug, both Eli Lilly and Regeneron have already filed requests with the United States Food and Drug Administration for Emergency Use Authorizations of their products.  Remdesivir had also been approved by the FDA as well as by the European Medicines Agency, under the same EUA process.

The WHO Director General said that the global Solidarity Trial also is considering for evaluation other, newer antiviral drugs and immunomodulators – the latter are being studied because of the role they may play in tempering over-reactions by the immune system.  

Mass Gatherings, Protests, Masks & Travel – WHO Offers Views But Says Decisions Up To Member States 

With no drugs, or a vaccine, yet in sight, WHO officials are also stressing the importance of using what they call “non-pharma” measures that have been demonstrated to be effective in controlling the virus spread.  

Key among those strategies are the management of mass gatherings, use of masks, and safety in travel, said WHO Health Emergencies Executive Director Mike Ryan.  But he hedged on providing firm advice to countries to mandate masks or ban mass gatherings – saying it is ultimately up to the governments themselves to set out policies based on the local context.  Some excerpts: 

Mike Ryan, Executive Director of WHO Health Emergencies Programme

Mass gatherings – Not only the United States, but leading countries around Africa and the Eastern Mediterranean are also entering election season. Ryan repeated comments made earlier this week, saying that the pandemic shouldn’t be used as an excuse to discourage people from coming out to vote – saying rather that mass gatherings can be “managed” to ensure that elections can proceed.  

Ryan: “In terms of people coming together and gathering, many countries, groups and communities have shown that it is possible for communities to come together to express their views, to vote and to do other things, and that can be done in a safe manner. And therefore we continue to offer advice to countries and to organizations who are planning gatherings, especially important gatherings and elections. They must be associated with good risk management measures.”

Protests – Civil disobedience and protests are common occurrences, particularly during the COVID-19 pandemic, which has exacerbated existing inequalities and has strained the relationship between individuals and public authorities and institutions, Ryan acknowledged, adding:

“We do call for calm. People are suffering and when people are tired and suffering, there can be a gap in trust that emerges between communities and the people that govern them. But governments don’t govern people, governments are there to serve the people first and foremost…Governments should always encourage the right to protest and express dissatisfaction and we will continue to provide support to countries to ensure that they support their communities in that way.”

“Many people in many countries have many issues they want to raise with governments, everything from climate, to social justice, to employment, to COVID-19. It’s an important part of our global approach to democracy to ensure that people always have the right to protest and express their views. But obviously, we hope that can be done safely and in a properly risk managed way and can be done peacefully.”

Masks – WHO only belatedly began supporting masks as a public health measure – after considerable evidence showed efficacy. Now that it has become enthusiastic about their use, some countries, such as Sweden, still refrain from mandating masks, even in confined and crowded spaces, like public transport. 

Ryan: “Each country has had to take a different approach in this response, and each country has had to determine what its social contract is, and what is possible within the context of the relationship that the government has with people.”

“We, as WHO, would say that masks are an important part of the strategic, comprehensive approach to stopping the spread of this disease, especially where you have widespread community transmission and where you do not understand fully the chains of transmission…We will continue to work in our European regional office with all countries in the region to optimize their strategies.” 

Maria Van Kerkhove, WHO Health Emergencies Technical Lead

Maria Van Kerkhove, Health Emergencies technical lead adds: “Masks must be used as part of a comprehensive package. It must not be masks alone, because you still need hand hygiene and to use alcohol based rub…When you enter the workplace, avoid crowded settings, enclosed spaces, especially with poor ventilation, open the windows, physical distancing. All of this needs to happen.”

Travel precautions  – WHO’s Tedros and Mike were adamantly opposed to any travel restrictions in the early months of the COVID-19 epidemic, even as international travel was clearly the vector carrying the infection across the world. After most countries ignored WHO’s advice and unilaterally slapped on their own travel restrictions, sometimes closing their air space altogether and at other times, applying more selective measures, WHO fell silent on the matter and has largely remained so, despite pleas by some member states, such as Austria at last week’s Executive Board meeting, for more targeted and nuanced advice.  

Says Ryan: “Great strides have been made in ensuring that international travel is safer…De-risking travel is one thing in the sense of ensuring people aren’t exposed to the virus while traveling. 

“It’s a very different issue when it comes to deciding who can travel from one country to the other. If we’re going to see international travel resume in a meaningful way, we can commend the travel industry for doing all they can to reduce the risk of exposure during travel, but there’s still a way to go to create the confidence and trust between countries, so that travel can be opened between countries.”

COVID-19 Soaring, but Restrictions May also Help Reduce Flu in Northern Hemisphere

Although COVID cases are rising sharply in 8 out of 10 countries of WHO’s European region after a reprieve over the summer, the spread remains uneven and posing various levels of threat, WHO officials also noted at the briefing.

Active cases of COVID-19 around the world and COVID-19 deaths globally (top right) as of 8:00PM CET 16 October 2020.

“Within Europe there are about 37 areas in 13 countries that have an increasing incidence and increasing hospitalizations that we’re looking at,” said Van Kerkhove.

Meanwhile, Dr Tedros expressed hopes this year’s flu season in the northern hemisphere might at least be lighter as a result of the wave of restrictions and preventive measures that are now being adopted by European countries to combat COVID-19.  

“Many of the same measures that are effective in preventing COVID-19 are also effective for preventing influenza, including physical distancing, hand hygiene, covering coughs, ventilation, and masks,” said Dr Tedros. “But we cannot assume the same will be true in the Northern Hemisphere flu season,” warned Tedros. 

Every year there are approximately 3.5 million cases of severe seasonal influenza worldwide, however, during this year’s influenza season in the Southern hemisphere, there were far fewer cases than usual, said Dr Tedros. 

Influenza coupled with COVID-19 has the potential to overwhelm health systems and facilities. Although vaccines exist for influenza, high demands would stretch supplies, particularly in low-income countries.  

However, it is hoped that the northern hemisphere countries can replicate the experience in the southern hemisphere, where the flu season was light, presumably because of precautionary COVID-19 measures taken there. 

Influenza Vaccination May Also Help Protect Against COVID-19 – New Study Finds

Meanwhile, several recent epidemiological studies also have suggested that there may be cross-protection between influenza vaccination and COVID-19 during the pandemic. Another preprint  study published Friday by a group of Dutch researchers on medriXiv.org even suggested the possibility of using an influenza vaccine against both influenza and COVID-19 for the 2020-2021 influenza season. 

The study found that the quadrivalent inactivated influenza vaccine used in the 2019-2020 influenza season in the Netherlands induced a trained immune response against SARS-CoV2, in laboratory blood samples, suggesting a possible relative protection against COVID-19. In addition, observational study of 10,000 Dutch health workers found somewhat lower levels of COVID-19 infection among people who had received their flu vaccine for the 2019-20 flu season. In the study group, 1.3% of vaccinated workers came down with test-positive cases of COVID-19, as compared to  2% of those who did not get the vaccine.

Image Credits: European Medicines Agency, WHO, Johns Hopkins.

TB screening activities in rural Cambodia.

The world must take urgent action to end the global tuberculosis epidemic by 2030, especially as the pandemic threatens to unwind hard-won progress made in past decades, concluded the WHO’s 2020 Global Tuberculosis Report on Wednesday. 

While the WHO European region is on track to achieve key 2020 targets, the rest of the world has fallen short of the milestones set for this year. Those targets included a 20% reduction in tuberculosis incidence and a 35% reduction in deaths between 2015 and 2020. 

As of 2019, global TB incidence had only dropped by 9% and TB deaths only dropped by 14%, warned the report. And progress is likely to lag even further due to the severe interruptions seen this year in TB diagnosis and treatment activities. 

“The report is sobering [and shows] that we were not on track, even before COVID hit,” warned Peter Sands, Executive Director of the Global Fund at Wednesday’s launch of the report. “Far too many people die of TB [1.4 million]…and the gap between those that fall ill and those that are diagnosed and treated is far too great.”

The report comes just two years after the world gathered at the United Nations high-level meeting on Tuberculosis (TB) to set bold targets to bring the world’s most deadly infectious disease to a halt. 

Although TB is largely preventable and treatable, it kills 4,000 people a day. That is as compared to just over 5,000 deaths from the coronavirus in past weeks. Since 2000, scientific and health systems innovations leading to much more effective and rapid TB diagnosis and treatment have averted 60 million deaths, according to the WHO.

The world is off track to reach TB targets for 2020.

TB Funding “Major Issue”; TB Testing “Critical”

Funding, however, remains a “major issue” for TB prevention, diagnosis, treatment and care, added Sands. In 2020, funding for TB prevention, diagnosis, treatment and care was only half of the US$ 13 billion target agreed by world leaders in 2018 – a “tiny fraction” compared to the world’s spending on COVID. 

Similarly to previous years, 85% of TB funding is domestic, which is problematic given recent reallocations in funding towards COVID by member states, said panelists on Wednesday.

TB testing in high-burden countries since January 2020

Although TB testing is critical to save lives, countries have struggled to maintain pre-pandemic levels of testing, especially in high burden countries like India, Indonesia, the Philippines and South Africa, according to data collated from over 200 countries. In these countries, testing has dropped by up to a third between January and June 2020, in comparison to the same 6-month period in 2019, said WHO’s Global TB Programme Director Tereza Kasaeva on Wednesday.

“A clear focus [is needed] on identifying missing cases and getting these people treatment. If you don’t find them, you can’t treat them, you can’t save their lives,” warned Sands.

In light of limited COVID-19 testing infrastructure, existing TB diagnosis platforms have been repurposed to test for COVID-19, such as the molecular GeneXpert platform, said Sands. And while these machines are “very effective” to detect COVID-19, countries should explore how to screen for both diseases, potentially by running GeneXpert machines for longer periods, buying more machines, and most importantly, investing in low-cost rapid diagnostic tests for TB.

“One of the biggest things that could transform the effectiveness of the fight against TB would be access at scale to cheap high quality rapid diagnostic tests, because that would make finding missing people with TB significantly more effective.” 

According to the WHO’s predictions, a 50% drop in TB case detection could result in up to 400,000 additional TB deaths this year alone – although other estimates suggest an additional 1.4 million TB deaths in the next five years.

Peter Sands, Executive Director of Global Fund

Image Credits: Yoshi Shimizu/WHO, WHO , WHO, The Global Fund.

 Illustration of the AdVac® adenovirus technology, being tested by  Johnson & Johnson, (Credit: J&J)

Johnson & Johnson, the only pharma firm currently developing a one-dose COVID-19 vaccine candidate, has “paused” its Phase 3 clinical trial due to an unexplained illness in one of the participants. A press release issued on Monday confirmed reports that a safety monitoring board had been convened to review the event and related data, but gave no further details about the nature of the illness.

Meanwhile the New York Times reported that Eli Lilly had also paused its clinical trial testing an antibody cocktail treatment for COVID-19 on hundreds of hospitalized people, due to a safety concern. The drug is simlar another antibody cocktail given to President Trump after he was diagnosed with Covid-19 earlier this month. Trump had pronounced the cocktail that he received, developed by the pharma company Regeneron, as a “cure,” and said he wanted to make it widely available for free to hospitalized COVID patients.  A few days later, Regeneron as well as Eli Lilly applied for Food and Drug Administration Emergency Use authorizations, even though the trials of the treatments were still underway.

In terms of the vaccine trial, J &J said that its pause in the vaccine clinical trial was “temporary”, not unusual when unexplained illnesses occur, and represented the high degree of concern with safety.

“We have temporarily paused further dosing in all our COVID-19 vaccine candidate clinical trials, including the Phase 3 ENSEMBLE trial, due to an unexplained illness in a study participant. Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians,” said the statement.

The announcement is significant, however, because the J&J vaccine is the only candidate being tested  that would presumably confer immunity with just one vaccine dose. The three other leading vaccine candidates now in Phase 3 trials by AstraZeneca, Pfizer and Moderna, all require two doses.

Along with the ease of distribution offered by a one-dose vaccine, the other advantage of the J&J canadidate is that the vaccine can be stored for at least three months at t 2-8° C – meaning that the vaccine would not require the special cold storage infrastructure that other vaccine candidates would need.

Like the AstraZeneca vaccine, the J&J candidate works by using an adenovirus as a vector (a carrier) of an antigen’s genetic code, to mimic components of the SARS-CoV-2 virus without causing severe disease, in a patented  AdVac® technology. The technology  also being tested in a J&J clinical trial of a vaccine against Ebola. The Astra-Zeneca vaccine was also been paused in the United States after two trial participants developed side effects, reported to be a rare form of spinal inflammation, myelitis.

https://youtu.be/tVdO5mzH1qU

In contrast, neither the Pfizer nor the Moderna vaccines so far have suffered significant interruptions.  Both companies are using a different, mRNA technology that uses an RNA fragment of the COVID-19’s characteristic spike to teach the body to mount an immune response. And in fact both companies recently said that they are on track to present the results of their Phase 3 clinical trial to the US Food and Drug Administration this fall,  later this month, in the case of Pfizer, while Moderna has said that it would present its results in late November.

The J&J Phase 3 trial started only on 23 September, late in comparison with other front-runner candidates where trials started over the summer.  But with an enrollment goal of 60,000 people on three continents, it was by far the largest trial of a vaccine candidate so far, and the one-dose regime appeared to give it a shot at rapidly yielding results.  Now those hopes appear to have been suspended, along with the trial.

 

Image Credits: Johnson&Johnson.

Human Brain

Cognitive symptoms are being reported by thousands of COVID-19 survivors, even those with mild symptoms and no previous medical conditions. The symptoms often include memory loss, confusion, difficulty focusing, and dizziness. 

A study published just last week covering more than 500 hospitalized patients in Chicago, found that some 82% had experienced neurological symptoms at some point during the course of their disease. The most frequent manifestations were myalgias or muscle pain, (44.8%); headaches (37.7%); encephalopathy, or altered brain function  (31.8%); dizziness (29.7%), dysgeusia, or distorted sense of taste (15.9%); and anosmia, or a loss of small (11.4%). Overall, neurologic pathologies were associated with increased morbidity and mortality, according to the study published in the journal of the American Neurological Association. 

Other studies of post-discharge patients hospitalized with COVID-19, found a wide range of common persistent symptoms, including fatigue, dyspnoea, loss of memory, concentration, and sleep disorders. 55 percent of patients experienced fatigue and 34 percent had loss of memory even 110 days after being discharged.

A report published in the CDC’s Morbidity and Mortality Weekly Report, surveyed 274 symptomatic adults with mild COVID-19 symptoms and found that 35 percent of interviewees had not returned to their usual state of health 2-3 weeks after their initial positive test result. For individuals aged 18-34, 26 percent experienced prolonged illness. 

Some researchers suspect that COVID-19 infections can cause long-lasting changes in the immune system, but further research and long term follow-ups are needed to understand the processes at play. 

WHO – We Are Only Beginning To Understand Long-Term Health Impacts

“We are only beginning to understand the long-term health impacts among people with ‘long-COVID’ so we can advance research and rehabilitation,” said WHO’s Dr Tedros Adhanom Ghebreyesus, speaking at a WHO press conference on Monday, where he warned about the dangers of letting the virus to run free with the hope that the global population might reach some kind of herd immunity.

These persistent symptoms are having serious consequences for patients’ jobs and their ability to return to their daily lives. Speaking to the New York Times, Rick Sullivan, a COVID-19 survivor who has had cognitive symptoms since his recovery in July, said “It is debilitating. I’ve become almost catatonic. It feels as though I am under anesthesia.”

“There’s no question that there are a considerable number of individuals who have a post viral syndrome that really, in many respects, can incapacitate them for weeks and weeks following so-called recovery and clearing of the virus,” said Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, in a review article of the issue published by the JAMA network in late September, entitled “As Their Numbers Grow, COVID-19 ‘Long Haulers’ Stump Experts.”  

Fauci noted that in some individuals, the symptoms are suggestive of myalgic encephalomyelitis/chronic fatigue syndrome, however the causes of persistent COVID-19 cognitive symptoms are currently unknown. 

Mady Hornig, a faculty member of Columbia University Medical Center’s epidemiology department, was quoted in the same review saying, “because of the large number of COVID-19 cases occurring simultaneously, we have a unique scientific window and a huge responsibility to investigate any long term consequences and disabilities that COVID-19 survivors may face.”

Both WHO as well as other experts and researchers have thus underlined the importance of telling the public about the risks of prolonged COVID-19 symptoms and illness. Even if individuals are not considered high risk, precautionary measures need to be taken to avoid infection with SARS-CoV2 and the potential post-viral syndrome after COVID-19, Dr Tedros emphasized in his press conference, using “every tool in the toolbox.”  

-Raisa Santos contributed to this story.

Image Credits: DigitalRalph.

Mother practices breast feeding her baby in the hospital maternity room in Ethiopia.

One stillbirth occurs every 16 seconds worldwide with approximately 2 million stillborn babies a year, says the first UN-wide report to document the global scale of the issue.

And COVID-19 related interruptions in maternal and child care services, particularly emergency obstetric care, could lead to an additional 60,000 to 200,000 stillbirths over the next 12 months, warns the report that was jointly produced by UNICEF, the World Health Organization, the World Bank and the Population Division of the United Nations Department of Economic and Social Affairs.  

“COVID will have an increase, reversing the gains that we have made,” said Anshu Banerjee, Director of the Department of Maternal, New born, Child and Adolescent Health and Ageing at the WHO, speaking at a press briefing on the report, which was released today. “However, we have seen that it is possible to make progress,” by strengthening health systems, improving the quality of care, and increasing the skills of birth attendants.” 

The WHO defines a stillbirth as babies born with no signs of life at 28 weeks of pregnancy. Approximately 2 million babies are stillborn every year. Often, these are deaths that lead to long-lasting psychological and financial consequences for women and their families.

In the majority of cases, stillbirths could have been avoided with high-quality care antenatally and during birth. The global issue of stillbirths is largely neglected in terms of research, data collection, and funding for interventions – although there is increasing recognition of the issue as a critical global health problem. 

“Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Executive Director of UNICEF Henrietta Fore. 

The report finds several reasons for these preventable deaths, including: absence of or poor quality of care during pregnancy and birth, lack of investment in preventable interventions, absence of global and national leadership on the issue, and few established global targets. 

Access to Emergency Obstetric Care Could Reduce Scale Of Problem

With over 40 percent of stillbirths occurring during labour, access to emergency obstetric care and improved monitoring could reduce their scale, the report finds.  

“The tragedy of stillbirth shows how vital it is to reinforce and maintain essential health services, and how critical it is to increase investment in nurses and midwives,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. 

84 percent of stillbirths occur in low- and middle-income countries, with 3 in 4 stillbirths taking place in sub-Saharan Africa or Southern Asia, according to the report. In sub-Saharan Africa, 1 in 46 babies are stillborn, compared to the global average of 1 in 72 or the European and Northern American average of 1 in 321. 

Stillbirth rates globally per 1,000 births in 2019.

There are substantial disparities in stillbirths between income groups. And strikingly, one-half of all stillbirths occur across six countries – India, Pakistan, Nigeria, Democratic Republic of the Congo, China, and Ethiopia. The risk of a stillbirth is 23 times higher in the worst affected countries compared to countries with the lowest stillbirth rates. 

Access to health care, maternal education, socioeconomic status, and ethnicity are other factors that contribute to the variations in stillbirth rates. Notably, higher rates are observed in rural areas, among women without post-secondary education, in groups on the lower end of the socioeconomic spectrum, and among ethnic minorities. 

Over the past two decades there has been slow progress on preventing stillbirths. Although the global stillbirth rate declined by 35 percent since 2000, progress has lagged in comparison to achievements in reducing maternal and under-five mortality rates. 

The Every Newborn Action Plan (ENAP) was launched in 2014 to provide evidence-based solutions to prevent newborn deaths and stillbirths. It established a target rate of 12 stillbirths per 1,000 total births to be achieved by 2030 and issued guidelines for national steps to achieve this goal, which includes investing in quality antenatal and delivery care. 

Projected number of stillbirths by different scenarios from 2020 to 2030.

Currently, 56 countries are at risk of missing the ENAP target by 2030, 34 countries are at risk of missing it by 2050, and eight countries will not meet the target by the end of the century, according to the report. 

Projections for the next decade estimate that 20 million babies will be stillborn by 2030, of which 2.9 million could be prevented. In order to curtail the current trend, the new report calls for increased political will, smart policies, and targeted investment in antenatal and delivery care to accelerate progress towards the ENAP aims and Sustainable Development Goals. 

COVID-19 Exacerbates Existing Stillbirth Trends

The COVID-19 pandemic has disrupted health systems and services globally, including antenatal and labor care. The report projects that these disruptions could lead to 60,000 to 200,000 additional stillbirths over 12 months, increasing the global number of stillbirths by 3.2 to 11 percent. The impact is expected to be greatest in Armenia, the Dominican Republic, Jamaica, Egypt, Iraq, Pakistan, and South Africa, among others. 

“COVID-19 has triggered a devastating secondary health crisis for women, children and adolescents due to disruptions in life-saving health services,” said Muhammad Ali Pate, Global Health Director for Health, Nutrition and Population at the World Bank. 

The collective action plan provided by the report emphasizes the importance of reducing stigma, supporting bereaved families, strengthening health systems, nationalizing and localizing stillbirth targets, prioritizing equity through investment, and improving the measurement of stillbirth data. 

 

Image Credits: Flickr – UNICEF Ethiopia, UNICEF.

Punjab, India – Crop burning reduces crop yield and worsens air pollution.

With fires from crop stubble burning spreading across northern India heralding the beginning of Delhi’s winter air pollution season, Delhi’s Chief Minister Arvind Kejriwal has pledged to take pre-emptive action – announcing a ‘war on pollution,’ led from a ‘war room’ that he will personally command. His arsenal includes a seven-point action plan that will include:  tracking the city’s hotspots; launching a ‘green Delhi’ mobile app to address open air burning complaints; and repairing the city’s potholed roads to control dust.  But his most powerful weapon for now could be a cheap and simple rapid compost brew, Pusa Decomposer that he hopes will inspire farmers in surrounding rural states to turn their crop waste into valuable fertilizer rather than burning it.

If Kerjiwal’s initiative succeeds, that could mark a turning point in decades of inaction contributing to northern India’s bleak air pollution situation – as well as climate change.

If not, Delhi and neighboring areas are headed for what Indians are now calling an ‘Airpocalypse’, or toxic pollutant-laced air that is poised to exacerbate COVID-19 respiratory disease in a country that has the second highest coronavirus case toll in the world.

In particular, cases are surging in the very regions facing potential air pollution emergencies. While Punjab is about to cross one 100,000 positive cases, Haryana has reported 118,000 cases so far. Delhi, one of the worst affected states of the country, has 260,000 infections so far. And the evidence that air pollution puts people at an increased risk of COVID-19 is strong.

But the war on air pollution has only been declared. And time for Delhi is quickly running out, as the seasonal crop burning in neighbouring rural regions of Punjab, Haryana and Uttar Pradesh, which fuel Delhi’s air pollution, has aleady begun, while the city’s Air Quality Index already crossed the 200 mark yesterday after months of double digit levels. 

In addition, it’s so far unclear how much backing Kerjriwal will receive for his war from Prime Minister Narendra Modi – a political rival who 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. His ruling Bharatiya Janata Party is already grappling with farmers already agitating against the passage of three agriculture bills in Parliament last month.

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

Crop waste fires contribute to nearly half of Delhi’s Pollution in Peak Season

Due to an unfortunate convergence of weather and geography, the impact of rural crop burning on Delhi and other parts of northern India’s plains is huge. Particularly in the autumn months, preveailing winds bring the smoke emitted by crop burning into the city. Low wind speeds, dry weather, and temperature inversions combine to keep pollutants trapped in and around the metropolis and the wider region. The Himalayas form an additional barrier to the north, preventing toxic pollutants from dissipating. Past year’s have seen record air pollution events, with levels reaching hundred of times higher than the WHO’s recommended limits, and urban average are among the highest in the world. 

Altogether, it is estimated that crop burning in the States of Punjab and Haryana last winter accounted for up to 44% of Delhi’s air pollution during peak burning periods in autumn 2019, Central Pollution Control Board Member Secretary Prashant Gargava stated.  The burning of crop stubble by farmers in Punjab and Haryana cause fires so large that they can be seen from outer space.

This year, again, Nasa satellite data tracking PM2.5, the most health-harmful particulate pollutants, has already begun showing small spikes caused by farm fires, although the worst is yet to come. Fires usually peak to around 4,000 per day by late October and smoke from these add to the existing urban pollution load of vehicles, construction, road dust and other sources. So any measures to deal with crop stubble, if successful, would be significant.

True colour image and aerosol optical thickness (AOT) showing smoke depth from open agricultural burning in India in fall 2016 spreading across the northern plains, NPP VIIRS satellite data, NOAA View

At the same time, to really turn the corner on air pollution year round, the Delhi leader also needs to update plans on existing solutions like increasing electric buses for public transport; enacing stricter waste management measures; stricter enforcement and penalties for emissions from coal power plants; and better controls on upcoming government construction projects that could have a large pollution footprint. 

On the plus side, critics see it as a good sign that the Delhi Chief Minister’s initiative addresses multiple sources of pollution – instead of only focusing on the politically-charged crop residue burning by farmers from neighboring states. He has, in fact, reiterated his commitment to strengthen the newly-announced electric vehicle policy and denounced coal power plants that aren’t meeting their emission norms, while also announcing a renewed focus on transplanting mature trees rather than saplings to replace those sacrificed to new construction.

Serious implementation of a mix of these initiatives, including the composting technology, will be key to any significant reduction in air pollution, especially as the economy gears up to recover from the Covid-induced lockdown.

India had the world’s highest outdoor air pollution rate in 2017

Composting crop waste to save Delhi’s air 

In the states of Haryana, Punjab, Rajasthan and Uttar Pradesh, farmers produce almost 50 million tons of straw a year, four fifths of which are burnt, concluded a joint industry-government report in Bloomberg. CIMMYT’s more conservative estimates say farmers in northern India burn an estimated 23 million tons of straw from their rice harvests. That enormous mass of straw, if packed into 20-kilogram 38-centimeter-high bales and piled on top of each other, would reach a height of over 430,000 kilometers — about 1.1 times the distance to the moon.

Burning of crop residue not only releases toxic gases into the air, it also burns precious nutrients away from soil, reduces crop yields, and promotes excessive use of fertilizers, according to the International Wheat and Maize Improvement Center. Use of fertilizers is not only more expensive for governments, which provides massive fertilizer subsidies, it also increases costs for farmers.

In mid-September, a task force led by PK Mishra, principal secretary to Prime Minister Narendra Modi met with the states of Punjab, Haryana and Uttar Pradesh to brainstorm how farmers can limit stubble burning and reduce pollution.

Of all the measures that are being discussed, the Pusa Decomposer seems to be the most promising.  The technology includes four ‘bio-decomposer’ capsules that can be dissolved into a liquid formulation, sprayed on shredded paddy straw, turning it into manure, said Dr YV Singh, principal scientist at the Indian Agricultural Research Institute. 

“The four capsules in a pouch can be used to make 25 litre solution which can then be used on one hectare or 2.5 acres of field,” he told India Today last week. “This capsule will help in curbing the practice of crop burning. This can be used in all forms and on any farm.”

Whereas rice paddy straw from the summer’s harvest normally takes 45 days to compose even if it is shredded, the Pusa Decomposer speeds up the process to  25 days, according to Singh. Shortening the process would give farmers time needed to prepare fields for their winter wheat crop – without harming having to burn their fields.  

Delhi officials are now trying to promote the idea amore widely: ‘This will end stubble burning and pollution to a huge extent,” said Delhi State’s Environment minister Gopal Rai. “We are planning to provide all sorts of help to farmers so that Delhi is safe from stubble burning,” he added. 

Growing the wrong crop at wrong time in wrong state

Wheat field in Punjab, Pakistan – sown after the rice harvest is finished.

Crop-stubble burning isn’t new. But it has become much more common in the past decade, after a government order in 2009 compelled farmers to begin sowing their rice seeds in June at the beginning of the monsoon season, rather than in April, when the weather is still hot and dry. The new policy was intended to ensure that the first monsoon rains recharge groundwater reservoirs before the rice planting began, but it backfired.

As a result of delaying the time of the harvest to early autumn, farmers have struggled to clear their fields in time for the next planting season, leaving them no other choice but to burn their fields – the quickest option they had.

Winds also change direction by October, so if paddy fields are on fire due to the later harvest, toxic smoke from the north blows directly towards urban areas with dense populations such as Delhi, as well as satellite towns known as the National Capital Region –  choking roughly 46 million residents in the area.

More fundamentally, rice is one of the most water-hungry crops in the world, and Punjab isn’t the ideal location to grow rice at all, as its groundwater levels are chronically low; rice also requires standing water in its early stages of growth.  Traditionally the area grew wheat and other nutrient-rich legumes and grains, which were more in tune with local conditions – and also healthier diets. 

However, over the past few decades, government rice subsidies encouraged farmers to grow so much rice that India has now become one of its largest exporters, at 12 million tonnes a year. Even the government’s own stocks are now more than twice the required level. By growing so much rice, environmentalists, the country is effectively exporting its most precious resource – water – out of the country. Some have theorized that Punjab’s shifts in crop sowing and production patterns have also been encouraged by the government and industry promotion of genetically modified Bt rice seeds.  The agrochemical conglomerate Monsanto has been promoting the seeds, which include genetic material from the Bacillus thuringiensis to ward off pests across Asia, although so far China has resisted, India was more accomodating. 

Monsanto seeds are less nutritious than traditional varieties, and result in high levels of silica in soil

An analysis by the NGO Ecologise Network explains that the government subsidies, along with the industry promotion of GM seed varieties has, over time, undercut production of  more nutritious, traditional varieties of legumes, grains and seeds. These were not only less water-hungry but also easier to manage after harvests because they did not require widespread burning. Some of the new varieties of rice also leave high silica levels in paddy stalks, making them unusable for use as animal fodder.   

The network also charges that other Monsanto GMO maize and wheat products are contributing to the destruction of bee colonies that pollinate 90% of the world’s food supply, including plants vital to Indian food production, also replacing human food stocks with ones destined for animals.  

“Monsanto’s GMO maize is also not fit for human consumption and is primarily used as chicken feed. Likewise, most of Monsanto’s wheat is used to feed animals because it is unfit for human consumption,” charges the NGO.  

Getting more with less: the power of ancient grains  

Merely by shifting its subsidy policies and food support, the government could easily persuade farmers – and consumers – to switch back to traditional Indian coarse grains that are more nutritious, use less water, and don’t need to be burned at  the end of the season, critics say. These include pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize – all of which are traditionally grown in India. These grains have a high iron content and are perfect for a country that harbors one quarter of the world’s cases of anaemia. 

These traditional crops would also give farmers a longer window of time to clear their fields so they don’t have to slash and burn so hurriedly. Furthermore, with India’s ethanol policy 2018, any ethanol produced as a by-product can help farmers augment their income. For the country as a whole, investing in ethanol would also help create new employment opportunities and to save on oil imports.  

Until recently, the government’s main alternative to crop burning involved the promotion of tractors such as the ”Happy Seeder”, that mechanically cut stubble and sow seeds, and which have become popular in Punjab. However, critics say that the diesel-run machines are not only polluting but expensive to operate.  And they have not gained widespread acceptance either. Farmers in the neighboring state of Uttar Pradesh, for instance, have instead opted for more traditional farming techniques, as well as seed varieties that produce less stubble and silica than their counterparts in Punjab.

India could halt subsidies for the Happy Seeder – a dirty diesel-run machine to cut stubble and sow seeds

Improving Appetite For Stubble – IKEA Leads Way

At the same time, whether or not stalk waste is  processed by big tractors or more traditional methods, farmers will stop burning crop stubble if they can cut it and sell it. So solutions that reuse farm waste, and preferably monetize it, also  incentivize farmers not to burn it. Some advocates have proposed that the government directly pay farmers to deposit crop waste at collection centres or link it to their support price payments. 

Still other solutions would involve subsidies to entrepreneurs that create solutions to tackle crop stubble burning, such as green refrigeration systems powered by farm waste or ecologically-based crockery or textiles, which also reduces plastic use.

The Swedish home furnishings company IKEA, for instance, recently launched its Forandring collection of home accessories like baskets and mats, textiles,  made  in collaboration with local industries, and which are using rice stubble pulp.  The collection is part of IKEA’s  Better Air Now initiative which is collaborating with the UN Environment Programme’s  Climate and Clean Air Coalition.

“No-till” farming can improve soil quality and crop yields

There is yet another way to reduce the air pollution and greenhouse gas emissions from crop burning by almost 80%  – and it can also 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 Science study.

Image Credits: Neil Palmer, Sumitmpsd , Our World In Data, AishaSaleemkhan100, Karen Eliott, Science Direct, Maggilautaro .

President Donald Trump, still ill with coronavirus, waves to his supporters in a drive-by outside of Walter Reed National Military Medical Center on Oct. 4.

A hail of criticism has followed US President Donald Trump’s drive-by to wave at supporters outside of the Walter Reed National Military Medical Center, including by a doctor at Walter Reed who said the president put the Secret Service at great risk.

President Trump was hospitalized on Friday, after testing positive for SARS-CoV2 hours earlier. Trump was moved to Walter Reed after the White House reported that he was experiencing “mild symptoms”, including a low-grade fever, nasal congestion and a cough. 

On Sunday, the White House physician Sean P. Conley corrected previous reports, announcing that Trump had a high fever on Friday and his blood oxygen levels dropped below 95 percent on two occasions, on Friday and again on Sunday. 

The president received an antibody cocktail from Regeneron, a biotech company that has developed a treatment to lower the level of the virus. Later on Friday Trump began taking the experimental drug Remdesivir, developed by Gilead. And the following day, he was given dexamethasone, a drug reserved for use in “severe and critical COVID-19” cases, according to WHO guidelines. He was also reportedly given oxygen on a couple of occasions. 

The White House has been widely criticized for the incomplete and sometimes contradictory information regarding Trump’s health. Infectious disease experts have begun questioning if Trump’s condition is more serious than implied by his doctors due to the combination of drugs he has been given. 

Trump has attempted to quell concerns by posting a video on Twitter, praising his doctors at Walter Reed and saying, “I learned a lot about COVID…I get it and I understand it.” Moments after releasing the video, Trump left the hospital in a vehicle with his Secret Service detail to wave to his supporters – who he referred to as “the great patriots” – gathered outside. Trump was wearing a mask and the Secret Service agents were wearing respirators and eye protection.

Trump’s actions have been harshly criticized by doctors and experts for putting the Secret Service agents at risk. James Phillips, an attending physician at Walter Reed, said Trump’s drive-by was “political theater” and “insanity.” 

“The risk of COVID-19 transmission inside [the vehicle] is as high as it gets outside of medical procedures. The irresponsibility is astounding,” said Phillips. 

According to the White House spokesperson, Judd Deere, the drive was “cleared by the medical team as safe.” However, Secret Service agents told the Washington Post that Trump’s behavior was reckless. 

“By taking a joy ride outside Walter Reed the president is placing his Secret Service detail at grave risk,” said Jonathan Reiner, professor of medicine and surgery at George Washington School of medicine and health services. 

Trump’s Medical Team Report That He Will Be Discharged
White House Physician, Sean Conley, and President Trump’s medical team hold press conference on Oct. 4.

Meanwhile, Conley announced on Monday that the president will be discharged from the hospital and return to the White House on Monday evening. Trump has received a third dose of remdesivir and continues to take dexamethasone, according to his doctors at Walter Reed. 

Trump affirmed that his health has drastically improved, saying on Twitter, “I feel better than I did 20 years ago!” These feelings, however, could be attributed to the dexamethasone that the president has been taking. The steroid dampens the body’s immune response and can cause some patients to develop “insomnia, mania, agitation and grandiosity,” said Céline Gounder, a clinical assistant professor of medicine and infectious diseases at the NYU Grossman School of Medicine. 

Several medical experts have raised concerns about the decision to discharge Trump. “I think it would be disastrous to be in a situation where he gets really sick at the White House, and you’re having to emergency transfer him,” said Gounder. 

However, in the absence of more detailed, and transparent, reports about the President’s health by his doctors, the speculation remained just that.  

As the US COVID-19 deaths reached 210,000 on Monday, President Trump tweeted ,defiantly, “Don’t be afraid of COVID. Don’t let it dominate your life.”

Image Credits: Flickr – White House, Flickr – White House.

The COVID-19 pandemic has disrupted mental health services in 93% of countries at a time when they are most needed, concludes a new WHO survey, released Monday. The survey is based on data from 130 WHO countries gathered between June and August 2020.

Despite rising awareness of the enormous strain that the pandemic has placed on the mental health of people in rich and poor countries alike – as well as mounting research evidence that the SARS-CoV-2 virus can also cause or exacerbate neurological conditions – most of the world’s countries are facing massive shortfalls in funding for mental, neurological and substance use services.

WHO’s director of the Mental Health and Substance Use department Dévora Kestel

And these are exactly the kinds of services that are most needed now – as people face huge economic losses, disruption in school and social plans, and increased isolation as a result of the measures taken to contain the virus spread.  

“We want to make sure that people in need of attention receive the care they deserve and need,” aid WHO’s director of the Mental Health and Substance Use, Dévora Kestel, at a WHO press briefing. “And so we want to make sure that there is better, [and] more investment on essential services for mental, neurological, and substance use [disorders].” 

While nine out of 10 countries surveyed have included mental health and psychosocial support within their national COVID-19 response plans, less than one-fifth have allocated enough funding to implement those plans, according to the report, published just days before World Mental Health is observed on 10 October, including WHO’s Big Event for Mental Health.

“The problem is that only 17% of countries have the funding for the implementation of [mental health and psychosocial] plans,” added Kestel.

Even though evidence-based interventions in mental health are highly cost-effective, mental health funding has stagnated at less than 2% of national health budgets, according to WHO.

The data were collected by WHO through a web-based survey completed by mental health focal points at ministries of health between June and August 2020. 

Children And Adolescents Most Affected By Mental Health Service Disruption

Children and adolescents are the most severely affected by mental health service disruptions

Children, adolescents and older people were the most severely affected groups, said the report. Disruptions in services for these groups were reported by 70% of countries, especially mental health promotion and prevention services in schools. 

Almost two-thirds of mental health services in schools or workplaces were wholly or partially disrupted, warned the report. Only 30% of mental health services for children and adolescents or for older adults were fully available without disruption.

Community-based and outpatient mental health services were also deeply affected, including the closure of, or restrictions on residential, home and day-care services.

Disruptions in mental health services are often a result of travel restrictions that have prevented patients from reaching clinics, especially in low-income countries, which have had trouble responding to COVID-19 through digital healthcare services like telemedicine, teletherapy or hotlines. 

While over 80% of high-income countries said they used digital healthcare to replace in-person consultations, only 50% of low-income countries have been able to do so, revealed the report.

Lower-income countries have found it harder to adopt digital health solutions during the pandemic

Countries Must Ramp Up Mental Health Surveillance And Research

Countries must ramp up mental health surveillance and research, especially as the coronavirus exacerbates existing mental, neurological and substance use issues and triggers new ones – including delirium, strokes or psychoses, said Kestel.  She added that only half of  130 surveyed countries have collected data on mental, neurological and substance use disorders – and fewer than one-tenth are researching how the COVID-19 virus attacks the brain.

People with pre-existing mental, neurological and substance use disorders are also more vulnerable to COVID-19 disease, according to the latest research.

In one cohort study of almost 1,700 patients with COVID-19, those with psychiatric disorders were about 1.5 times more likely to die from COVID-19, even after adjusting for differences in age, underlying conditions or hospital locations, reported researchers from Yale University’s School of Public Health less than a week ago.

Even if people with mental health disorders are safe from the coronavirus, inadequate access to services can be life-threatening. Together, suicides, alcohol and drug overdoses kill over 4 million people a year – or four times more than the coronavirus has killed thus far.

“The impact of the pandemic on people’s mental health is already extremely concerning,” said Director-General of the World Health Organization Dr Tedros Adhanom Ghebreyesus in mid-May. “Social isolation, fear of contagion, and loss of family members is compounded by the distress caused by loss of income and often employment.”

Image Credits: WHO/NOOR/Sebastian Liste, WHO, WHO.

Every year, tobacco consumption claims 8 million lives and costs economies $1.4 trillion

For the second year in a row, Geneva’s International Chamber of Commerce has hosted a dialogue bringing local tobacco industry leaders together with a major Geneva-based UN Agency – in this case to discuss the ‘role of multinationals in economic recovery following the coronavirus’. 

The ICC’s 6th Business Dialogue, involving Teresa Moreira, Head Competition and Consumer Policies Branch of UNCTAD, the UN’s main body for trade, investment and development issues, and Vice President External Affairs of Philip Morris International Gabriela WURCEL, took place on Wednesday evening at the Four Seasons Hotel in Geneva. 

Face-to-face meetings in such fora are supposed to be taboo in the UN system, according to the model policy for agencies of the United Nations system on preventing tobacco industry interference, which was developed out of the WHO Framework Convention on Tobacco Control (FCTC), a WHO official told Health Policy Watch.

“The policy runs across all UN, ‘to ensure that efforts to protect tobacco control from commercial and other vested interests of the tobacco industry are comprehensive, effective and consistent,’” said the official who asked not to be named. 

Thomas Pletscher, the ICC’s Secretary General, said UNCTAD did not express any reservations about participating in the event with PMI, in the same format as it did last year, to Health Policy Watch.

UNCTAD’s Teresa Moreira did not respond to queries from Health Policy Watch regarding her appearance. The UNCTAD media team also declined to respond. 

UNCTAD headquarters in Geneva

Event is Example of Way Tobacco Industry Exerts Political Influence 

The participation of big tobacco in a dialogue focusing on coronavirus recovery was all the more ironic, in light of the fact that tobacco use increases vulnerability to serious cases of COVID-19:

A WHO review of studies by public health experts published in April found that smokers are more likely to develop severe disease with COVID-19, compared to non-smokers.  

And only last week, WHO, released a major brief detailing how most countries in the world are still failing to enact robust policies to increase tobacco taxation, limit advertising and expand smoke-free public spaces — and that is often due to the industry’s outsize political influence. 

Asked about the meeting, happening in WHO’s own Geneva backyard, a WHO spokesperson declined to comment publicly. 

Anti-tobacco campaigners have  frequently called out the ways in which industry exerts its political influence, interferring in the development of stronger national control measures.   

“Interference by the tobacco industry remains one of the greatest obstacles to implementing the WHO FCTC,” one expert source told Health Policy Watch.

“Tobacco industry interference takes many forms…. exaggerating the economic importance of the industry while ignoring the social, environmental and health costs caused by tobacco and tobacco products; manipulating public opinion to gain the appearance of respectability, this is part of efforts to look “socially responsible”. The corporate social responsibility of the tobacco industry is an inherent contradiction since the tobacco industry’s core functions are in conflict with the goals of public health. “

In Switzerland alone, where the tobacco industry still thrives, tobacco products account for 15% of total deaths every year – or four times as many as the coronavirus. The current coronavirus death toll has almost reached 2100 deaths, compared to some 9,500 yearly deaths from tobacco, reports the Federal Office of Public Health.

ICC Calls PMI’s Invitation “Mere Coincidence”

Thomas Pletscher, ICC Secretary General

When asked why the ICC chose to invite PMI, for the second year in a row to its annual dialogue event, Pletscher told Health Policy Watch the choice was “mere coincidence”.

Asked why the ICC didn’t invite one of the many other Swiss-based multinationals, such as Nestlé or Procter & Gamble, Pletscher acknowledged that locally, the ICC’s contacts with P&G were not as close as those with PMI.

“We choose panelists according to familiarity with the topic, mixture of the panel and notably availability,” Pletscher said. “Nestlé was not available for speaking and we do have less close contacts to P&G in Switzerland. There is no priority for PMI, it is mere coincidence.”

Asked why the ICC could justify an invitation to the world’s largest tobacco company for meeting on economic recovery from COVID, Pletscher argued that PMI’s “challenges and opportunities” are “similar” to other multinationals that may be in the same boat as PMI.

PMI headquarters in Lausanne, Switzerland

“In fact, PMI employs more than 70,000 people at 38 production facilities worldwide and is a typical global manufacturer including close links to primary sector, logistics and distribution,” said Pletscher. “We expect contributions on the panel [to] how PMI reacts to such and other challenges [including] organisation of work, protection of workers, working from home and ensuring the supply chain.”

The ICC, headquartered in Paris with 45 million members in 100 countries worldwide, is a well-known vehicle for big tobacco’s interests for over two decades, civil society critics say.

Even so, the policy of the Geneva ICC branch is particularly regrettable, given the plethora of other multinationals headquartered in Switzerland- some of which can “genuinely” contribute to economic recovery, said Mary Assunta, of the Bangkok-based Global Center for Good Governance in Tobacco Control (GGTC). 

“The tobacco industry cannot be involved in economic recovery,” said Assunta, “Its traditional products kill 8 million people a year and cause poverty and human suffering. Its new products [smokeless tobacco and electronic nicotine delivery systems] result in youth addiction and cause health harms.” 

Tobacco Industry Put Workers at Risk In COVID-19 Pandemic  

Louis Laurence, Researcher for University of Bath’s Tobacco Control Research Group

In its rush to maintain supply chains and sales, PMI also put factory workers at risk during the pandemic – especially in Indonesia, Argentina and Pakistan, charged Louis Laurence, Investigative Researcher for the Tobacco Control Research Group at the University of Bath.

“It is sickening that ICC thinks a tobacco company can contribute to economic recovery post COVID-19,” Anna Gilmore, Professor of Public Health at the University of Bath, and a partner of tobacco industry watchog STOP, told Health Policy Watch. 

Along with violating UN policy, UNCTAD’s repeated exchange with PMI at the ICC means that it is also contributing, at least indirectly, to tobacco interference within international fora, Gilmore added. 

Loss Of “Credibility” For Geneva ICC   

Overtures to PMI also reflect a “loss of credibility” for the ICC as an international face of the business community in Geneva, Gilmore said.  While it is member states, and not businesses, that are signatories to the WHO FCTC, the ICC should set the example by aligning to UN norms.

“Since ICC is ostensibly partnering with UN agencies, it should abide by the UN Norms and values that are reflected in the WHO FCTC [these include] WHO FENSA, UN Model Policy on Tobacco Industry Interference for the UN System, and UN human rights principles,” she said.

Anna Gilmore, Professor of Public Health at the University of Bath

Every year, tobacco consumption claims 8 million lives and costs the economy $1.4 trillion, she pointed out. “Even without the additional burden from COVID, most countries around the world already struggle to cope with the massive health care burden caused by smoking.

“Not only is there is clear evidence that smokers have worse outcomes from COVID-19, but tobacco companies have actively sought to undermine efforts to control the pandemic,” warned Gilmore, noting that recent tobacco advertising has also aimed to cast doubts about proven links between smoking and serious COVID-19 disease.

–Updated 2 October 2020

 

Image Credits: SimonDes, WHO FCTC, Mourad Ben Abdallah, ICC, Louis Laurence, Anna Gilmore.

Prime Minister Justin Trudeau announces US$440 million for the COVAX vaccine pool at today’s highl-level UN General Assembly event.

The World Bank will make available up to $12 billion in “fast-track financing” that low- and middle-income countries can access to procure vaccines against Covid-19 – as soon as one is approved, said the Bank’s president David Malpass, on Wednesday.

The announcement at a United Nations high-level panel on the pandemic that also included commitments from the big pharma firm Johnson&Johnson, Bill Gates and numerous heads of states – marks the first serious flow of finance into an ambitious global vaccine pool.  The “Covax” vaccine pool is part of a World Health Organization co-sponsored Act Accelerator initiative to raise some $35 billion to finance 2 billlion vaccine doses, as well as diagnostic tests and treatments, for low- and middle-income countries across the globe.

A handful of rich countries, including Canada, the United Kingdom, Germany and Sweden, also announced nearly $670 milllion in new pledges to the “Covax” pool, which is co-sponsored by the WHO and Gavi, the Vaccine Alliance. Some 168 rich and poor countries have joined the pool, in an unprecedented show of solidarity. But until today, the vaccine facility had only secured $3 billion in donations, far short of the billions that WHO and its partners have said they would need to roll out vaccines in 92 low- and middle-income countries that can’t afford to pay.

In another precedent for the fund-raising effort, Alex Gorsky, CEO of the pharma giant Johnson&Johnson also pledged to “allocate up to 500 million doses” of its Covid-19 vaccine to lower-income countries – should its candidate now under development pass Phase 3 trials with results showing it is safe and effective. Trials were launched just last week for company’s vaccine candidate, which is the only one that would require just one dose. Other vaccines in advanced R&D stages, by AstraZeneca, Pfizer and Moderna, would require two doses.

Gorsky did not elaborate on whether his offer meant that the company would donate the vaccines outright or offer them at a reduced price.  However he underlined that,  “having access to life saving COVID diagnostics therapeutics or vaccines… shouldn’t depend on where you live, whether you’re rich or poor, and whether you live in an industrialized country or in an emerging economy. The COVID-19 virus does not care about any of those things, and neither do we.

“Decisive collaborative action itnow will help us beat this pandemic and better prepare us for the future virus outbreaks.”

Also at the event, Bill Gates announed that his  Bill & Melinda Gates Foundation had signed an agreement with a coalition of 16 pharmaceutical companies and the to cooperate on vaccine manufacturing and to scale up production.

Funds Mark Step Towards Goals, But More Funding Still Needed
Bill Gates, chair of the Bill and Melinda Gates Foundation, at the UN General Assembly event

Altogether, WHO and Gavi have said that some $15 billion is needed immediately to began making the manufacturing orders and planning distribution networks that would allow for the massive rollout of a vaccine in 2021. The US$ 12 billion in World Bank finance goes a long way towards that, most immediate goal.

Among the individual countries making fresh pledges to the COVAX global pool, Canada made the largest outright commitment of $440 million, including $220 million as a donation to low-income countries. But the United Kingdom upped the ante, with Foreign Secretary Dominic Raab, pledging to donate up to £250 million ($322 million) more to match new pledges from other countries. That benchmark was met and then exceeded as Germany and Sweden also threw new cash into the pool, for €100 million and $10 milliion respectively.

Said World Bank President David Malpass: “I’ve proposed to our board to make available up to $12 billion of fast track financing to countries for the purchase and deployment of COVID-19 vaccines. Once the vaccines have been approved by several highly respected stringent regulatory agencies. This additional financing will be to low and middle income developing countries that don’t have adequate access and will help them alter the course of the pandemic for their people. “Our vaccine financing is additional to the COVID fast track health financing we announced in March, and it’s an important part of bank group’s intention to make available $160 billion in grants and financial support over a 15 month period to help developing countries respond to the health, social and economic impacts of COVID-19.”

The World Bank’s pledge, together with a total of nearly $US 3 billion in commitments secured from national and philanthropic donors, means that most of the funds required to get 92 low-income countries access to the vaccine pool have now been secured. High-income countries, on the other hand, will pay for their vaccines, with flexible pre-purchase agreements that will allow them to get the best vaccine options for their nation as well as to trade in their vaccine “shares”, in some cases, according to national needs. ,

However, according to the WHO’s investment case, another $22 billion more in funding would still be needed for the other two pillars of the so-called ACT Accelerator initiative, including hundreds of millions of units of COVID treatments and protective gear and 500 million rapid COVID tests – 120 milliion of which WHO is already planning to roll out in low- and middle-income countries that lack the equipment for expensive PCR laboratory tests.

The new funding for COVAX, largely closes the finance needs for vaccines. However, billions of dollars still need to be raised for tests and treatments.

Still, that is remarkable progrss for the ACT Initiative, which was launched by the WHO together with the European Commission, France and the Gates Foundation five months ago.

Said Gates, “One thing I’ve learned studying the history of pandemics is that they create a surprising dynamic when it comes to self-interest and altruism. Pandemics are rare cases where a country’s instinct to help itself is tightly aligned with its instinct to help others. The self-interested thing and the altruistic thing–making sure poor nations have access to vaccines–are one and the same.

“A number of countries, most recently the United Kingdom and Canada, are good models for what other wealthy nations should do. They have donated enough money for COVAX, the vaccine pillar of the ACT-Accelerator, to procure, probably, hundreds of millions of vaccine doses for poor countries. But more will be needed and I hope wealthy nations will continue to be generous.”

Image Credits: NIAID, UNGA, WHO .