Over fifty women in the Democratic Republic of Congo have accused aid workers from the World Health Organization and leading international NGOs of sexual abuse and exploitation, concluded a year-long investigation led by the New Humanitarian and the Thomson Reuter Foundation on Tuesday.

The report highlights how “common” sexual exploitation and abuse are in humanitarian settings like the DRC, where Ebola has killed over 11,000 people in its 10th and deadliest outbreak.

The investigation found “at least” 30 separate incidents of sexual abuse or exploitation from men that claimed they worked for the WHO, as well as UNICEF, Oxfam, Médecins Sans Frontières, World Vision, ALIMA, and the International Organization for Migration. The perpetrators were from Belgium, Burkina Faso, Canada, Côte d’Ivoire, France, and Guinea, among other countries, said the women.

Okapi Palace in Beni in the DRC was “favorite spot” for sexual misconduct

The report was based on more than fifty interviews with women in Beni, one of the epicentres of the DRC’s Ebola outbreak. The findings were corroborated by over a dozen aid agency drivers and NGO workers.

Many women were approached near supermarkets or job recruitment centres, and taken to hotels using official drivers hired by the aid agencies, said four chauffeurs, who wished to stay anonymous. Among the “favorite spots” for abuse included the Okapi Palace hotel and Hotel Beni, where aid groups frequently booked rooms and had offices.

One of the women interviewed said the man that abused her drove in a car bearing a World Health Organization logo, noted the report.

Sexual Exploitation “As Regular” As Buying Food In A Supermarket

Sexual exploitation in the region is a “consistent finding”, Nidhi Kapur, a consultant for aid group CARE International, said to The New Humanitarian.

“It [sexual exploitation] was so common,” added one driver. “It wasn’t just me; I’d say that the majority of us chauffeurs drove men or their victims to and from hotels for sexual arrangements like this. It was so regular, it was like buying food at the supermarket.”

But in the past two years, “most” of the three dozen international organisations and local NGOs in the area have received “no complaints” of sexual abuse or exploitation. They also emphasized that policies are in place to prevent and report sexual misconduct, through staff training, complaint boxes or reporting hotlines. 

However, most women interviewed said they did not know how to report sexual abuse or exploitation. Others never spoke up for fear of losing their jobs, acknowledging that sexual favors have become a “passport to employment”, especially given the lack of job opportunities for women in the region.

“In this response, they hired you with their eyeballs,” said one of the women that was interviewed. “They’d look you up and down before they’d make an offer [for a job].”

WHO, World Vision and Alima have pledged to investigate the allegations. WHO encouraged the survivors to reach out to the Organization. 

Dr Tedros Adhanon Ghebreyesus, the Organization’s Director-General, has begun a “thorough review” of the investigation’s allegations and into sexual abuse and exploitation more broadly in emergency response settings.

“The actions allegedly perpetrated by individuals identifying themselves as working for WHO are unacceptable and will be robustly investigated”, the WHO said on Tuesday in a press release. “Anyone identified as being involved will be held to account and face serious consequences, including immediate dismissal.”

–  See WHO’s press release on Tuesday.

Tobacco products kill half of its users and claim 2 million lives a year through heart disease.

As fresh data reveals that tobacco products kill over 2 million people a year through coronary heart disease, tobacco control advocates are more determined than ever to protect the world against a product that kills half its users, not only from heart attacks but stroke, lung cancer and other diseases as well.

Comprehensive, but simple tobacco control policies, such as tobacco taxation, combined with blanket bans on smoking in indoor public places, could prevent up to 25% of strokes and heart attacks in some cases, reported a meta-analysis by the World Health Organization, World Heart Federation and Australia’s University of Newcastle just a week ahead of World Heart Day, observed this Tuesday. 

And now more than ever, quitting tobacco use in the midst of the pandemic can help protect the population against severe coronavirus disease, said WHO’s Medical Officer for the Tobacco Free Initiative Kerstin Schotte, in an interview with Health Policy Watch. It could also free up space in hospitals, especially as the flu season begins. 

Heart disease is, in fact, the leading cause of death worldwide, and in some cases, the main reason for admissions to hospitals and nursing homes – and in the past two decades, CHD deaths from tobacco have increased by 10,000 every year, warned the WHO last week.

Second-hand smoke is three times as toxic as mainstream smoke

Policies that create smoke-free public spaces also curb hospital admissions for non-smokers, as they limit exposure to second-hand smoke – which is three times as toxic as the smoke that smokers inhale themselves, and has double the nicotine content. Smoke-free public spaces also prevent young people from taking up the habit, noted Schotte.

In one meta-analysis of over 30 studies, comprehensive smoke-free legislation in all public places reduced hospitalization for acute coronary events by 14%, or almost twice as much as partial smoking bans on their own – which only reduced acute coronary events by 8%.

“Smoke-free public spaces make sense not only to protect people from the dangers of secondhand smoke,” said Schotte. “They can also prevent young people from starting to smoke, because if kids go out at night to bars and nightclubs, and they can’t smoke, they’re really less likely to start.”

Most of the world still lacks comprehensive tobacco control policies.

Most Countries Have ‘Long Way To Go’ On Tobacco Control

Despite a wealth of encouraging evidence about the health benefits of tobacco control policies, most of the world’s countries have a long way to go to adopt the “full package” of tobacco control policies, warned Schotte. 

Currently, four fifths of the world’s population live in countries where smoking is still permitted in some indoor public spaces – and three quarters of the world’s population live in countries where tobacco taxation is lower than the WHO’s recommended levels, according to the Organization’s latest report on the global tobacco epidemic.

Eduardo Bianco, Chair of the World Heart Federation Tobacco Expert Group

Eduardo Bianco, Chair of the World Heart Federation Tobacco Expert Group, also noted that stand-alone tobacco control policies are insufficient. A comprehensive approach is needed, including mass media campaigns, tobacco cessation programmes, as well as taxes on tobacco and smoke-free zones, among other measures, he said in an interview with Health Policy Watch. 

“You cannot fight this huge and complicated problem with a single tobacco control measure,” warns Bianco. “You need the total combo to have a strong impact as they are not enough on their own.”

But comprehensive policy approaches on tobacco require high-level political commitment, which is often challenging to generate, he added.

Ministries Of Finance Need To Get On Board With Tobacco Control  

Adoption of comprehensive tobacco control policies often meets with resistance from the Ministries of Finance, which may be beholden to big tobacco interests. And it is Ministries of Finance, not Health, which usually approve tobacco taxation policy – as well as approving finance for anti-tobacco initiatives in the Ministry of Health or Ministry of Education.  

“It is often difficult to implement all tobacco control policies in one go because ministries don’t always work well with each other,” said Bianco. “Ministries of health cannot tackle the tobacco epidemic on its own, as they must convince ministries of finance for tobacco taxation, or other ministries to approve mass media campaigns.”

Kerstin Schotte, WHO Medical Officer for the Tobacco Free Initiative

And there is still “incredible interference” by the tobacco industry, with many tobacco giants like Japan Tobacco International (JTI) headquartered just a few kilometers from the WHO in Geneva, said Schotte.

“Big tobacco interferes with policymaking,” Schotte noted. “They scare governments, they overestimate the economic impact of business from tobacco, they make threats of illicit tobacco trade if taxes are increased, and continue to intimidate governments with litigation for implementing tobacco control measures.”

“From the rooftop of the WHO building, we can see the JTI building, one of our biggest enemies,” she added. “In our department [Tobacco Free Initiative], it’s a little bit different than in other departments. We don’t fight germs or viruses, but we fight a very powerful and resourceful tobacco industry.”

In fact, tobacco taxation makes economic sense because of the revenues taxes bring to governments. However, there is a lot of resistance, added Bianco, mainly due to unfounded claims by the tobacco industry that tobacco taxation could increase illicit trade. He also noted that, in the early 2000s, when Canada bowed to political pressure to reduce taxes on tobacco, it was a “terrible failure”. Not only did illicit trade remain unsolved, tobacco consumption also increased.

Countries Should Implement FCTC & MPOWER  

Countries around the world should take advantage of the historic WHO Framework Convention on Tobacco Control (WHO FCTC) to slash tobacco consumption and save lives, emphasized Schotte. The FCTC has been ratified by over 180 Member States since it was adopted almost two decades ago, and is hailed as one of the biggest successes of the WHO ever.

WHO’s MPOWER tool lays out six key tobacco control measures to implement the WHO FCTC as fast as possible.

However, the FCTC is complex, and sometimes difficult to translate into policy action, especially for low- and middle-income countries with limited legal and regulatory capacity, said experts familiar with the FCTC.

They recommended the MPOWER policy package is a “good place to start” to implement the WHO’s FCTC on the ground, referring to six highly effective measures to reduce tobacco use as fast as possible. 

On the bright side, over five billion people are covered by at least one MPOWER measure, according to last year’s report  – more than four times as many compared to 2007. And in 2019, two-thirds of countries had robust monitoring systems to track tobacco usage and the impact of tobacco control interventions, compared to only one third of countries in 2017. 

Many Healthcare Professionals Still Ignorant or Indifferent to Deadly Link Between Tobacco & CHD

Another barrier is the attitude of healthcare professionals themselves, including cardiologists that remain unaware or indifferent to tobacco as a driver in heart disease – and cardiology associations have largely avoided the tobacco issue.

“Except for the World Health Federation and the Interamerican Heart Foundation, most cardiologists have not stepped up to encourage their patients to stop using tobacco products,” he noted. “This is malpractice, and equivalent to a pulmonologist failing to encourage his patients to quit smoking.”

“Cardiologists are a highly influential group, and they should lead and support tobacco control coalitions and policies,” he said.

In addition, CHD is perceived less seriously among members of the public than other diseases like cancer, added Schotte. Many people imagine that CHD is a  “painless” and “ideal way” to die – even though people with heart disease face repeated hospital stays, many years of disability and a poor quality of life.

But only one year of abstinence can halve the risk of heart disease for a smoker, although up to 15 years are required to further reduce the risk of CHD to that of a non-smoker. 

Based on such evidence, “All healthcare professionals should encourage their patients to quit smoking tobacco and avoid exposure to second-hand smoke,” she said. “Because there’s the amazing fact that if you quit smoking, one year later, your risk of heart disease is only half that of a smoker. So that is really something encouraging for people.”

Generating Political Commitment – The Story of Uruguay 

A whole-of-society approach is the “only way” to generate the necessary level of political commitment to tackle the tobacco epidemic, especially against the backdrop of tobacco industry interference, noted Bianco.

Tobacco control advocates can generate political commitment by setting up formal structures that support their efforts, he explained. 

“Tobacco control advocates can set up formal structures to foster and sustain their efforts, such as advisory committees within ministries of health, special funds to help pay off costly litigations, or research centers to demonstrate the beneficial impact of policies,” said Bianco. “In the past two decades, all of those have helped Uruguay fight tobacco, even to this day.”

In the early 2000’s, Uruguay’s highly respected National Medical Association created the National Tobacco Control Alliance, with representatives from various medical groups, civil society, smoking rights associations, as well as officials at Uruguay’s Ministry of Health.

A few years later, the National Tobacco Control Alliance put in place a special advisory commission on tobacco control within the ministry of health, with representatives from academia and civil society.

Tabaré Ramón Vázquez, former President of Uruguay, slowly gained the trust of tobacco control advocates.

The Alliance contacted the leading presidential candidate at the time, Tabaré Ramón Vázquez, who is an oncologist by training, to gain his support on the WHO FCTC that was being debated at the time. When Vázquez entered office in 2004, the advisory commission presented him with concrete policy advice on tobacco control. 

A few years later in 2007, the national Epidemic Research Center was set up to generate evidence that Uruguay’s tobacco control policies were cost-effective and that they could save lives.

As the years passed, Vázquez developed trust with the advisory commission’s policy advice, which helped tighten tobacco control in Uruguay, added Bianco. 

But in 2010, Philip Morris International (PMI) interfered through an international lawsuit, claiming the country’s tobacco policies violated the Bilateral Investment Treaty (BIT) between Uruguay and Switzerland.

Although Uruguay eventually won, without the support of Bloomberg Philanthropies with an initial $ 500,000 USD to kickstart the law case, Uruguay would have been unable to defend itself against PMI in court. The litigation cost $ 7 million in total, which PMI eventually paid back to Uruguay.

“These lawsuits cost millions and sometimes tens of millions of dollars, and we need to make sure that middle- and low-income countries can financially stand up against them through special funds, like the current Anti-Tobacco Trade Litigation Fund led by Bloomberg and Mill and Melinda Gates Foundation,” said Bianco. 

30-day tobacco consumption in Uruguay in teenagers aged 13-17

Presidents As Scientists – Helpful But Insufficient 

Although Uruguay’s former president Vázquez was “definitely” more receptive to tobacco control policies because of his training as an oncologist, having scientists at the helm of countries is insufficient to bring about health-related political change, emphasized Bianco. 

He referred to Chile’s tobacco control policy, which stagnated under the leadership of Michelle Bachelet in 2006-2010 and 2014-2018, even though she is a medical doctor by training. 

“Chile lacked the formal structures that Uruguay had to help generate evidence, trust, and high-level political commitment on tobacco control.”

“Having a scientist as president does not guarantee political will. What’s needed is a supportive environment and sustained action by civil society, academics, national medical associations, with the support of the international community and international treaties like the WHO’s FCTC.

Image Credits: WHO , Dennis Skley, WHO, Eduardo Bianco, Kerstin Schotte, Bloomberg Philanthropies, World Heart Federation / WHO, Presidencia de la República Mexicana, The World Bank.

Closing plenary at the European Health Forum Gastein,  2019. This year’s forum will meet in virtual format.

Billions of dollars in vaccine investments are needed to beat back Covid-19. But on the bright side, Europe is playing a more active global health leadership role. Geneva’s ‘dean’ of global health speaks to Geneva Solutions ahead of Wednesday’s opening of the European Health Forum (Gastein), which brings together key policymakers and experts from across the region.  

Health Policy Watch: The World Health Organization (WHO) says the world needs $35bn to fund the manufacture and equitable, worldwide distribution of two billion Covid-19 vaccines, as well as tests and treatments. But so far, only $3bn has been raised. Can we raise that kind of funding – and how?

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

llona Kickbusch: Stepping back, I think it shows us that the whole system of funding for these initiatives is totally insufficient. We are moving in global health from a situation where we were looking for millions to looking for billions and in some cases even trillions. And that means we need other sources. That is why there has been so much talk about linking up with various development banks and finding other types of funding from governments.

Very clearly, $35bn is actually peanuts, if you look at the trillions being discussed by the finance ministers of the G20. Many of the rich countries, if they got their act together, plus some of the middle-income countries could actually contribute, together with the development banks, and maybe even some of the philanthropists. If you look at the amount of money Mark Zuckerberg made during the Covid-19 pandemic, some of these sums pale in comparison. It shows that our whole system of financing is wrong- and bankrupt.

HPW: Ursula von der Leyen, European Commission President, also proposed that there should be a  European version of BARDA, the US agency in the Department of Health and Human Services, that has invested billions in vaccine research and development. Do you agree?

IK: Absolutely. That would be another mechanism.  It is clear the European Union has defined itself as a geopolitical actor in the global health conversation. And that has two dimensions – stronger cooperation between the European countries so they act as one, and then acting jointly in terms of global responsibility. That is reflected in the EU joining Covax [the WHO-led Covid-19 vaccine pool], supporting the World Health Organization, and making European institutions more fit for purpose for a global role.  And the EU moves have also been made towards other regions, like the African Union, which I think is important.

HPW: Why?

IK: Because you could say the global north is telling everyone else what to do. And this is not what the European Union wants to do. It wants to move away from an old-fashioned “leadership” model in global health to a “partnership-and-responsibility” model.

HPW: So can these regional initiatives help fill the gap that’s been left by the US withdrawal from the global health arena?

IK: The old model of multilateralism is one that always had this notion of countries like the United States or the United Kingdom showing leadership. The new notion of multilateralism is particularly important for smaller countries. That is why Germany and France created this alliance for multilateralism. And there are regional organisations, the African Union being a really important one. But there are also Asian groupings, all kinds of different constellations. And we are finding that regional organisations are going to be even more important in global health. And that also means stronger WHO regional offices.

HPW: So you see some hopeful signs in terms of regional actors stepping in to fill the gap – or reshape the paradigm?

IK: It has to change. The US has to change in its approach and the rest of WHO member states need to change. This is an organization of 194 countries, and that cannot be driven by three or four major donor countries. So I don’t want to even talk about a gap, I want to say we need a different kind of partnership based on common goods, based on multilateralism and not one or two countries thinking they should call the shots and tell everyone else what to do.

HPW: And WHO?  We’ve seen countries reaffirming WHO’s leadership role in the recent UN General Assembly resolution on the pandemic. But we also know that WHO is a big bureaucracy with lots of warts.  So what can WHO do to reform from the inside?

IK: I am a political scientist and I just do not understand why being a bureaucracy, per se, is considered a negative element. Bureaucracy is a form of organization, and if you have 196 member states…you need rules. And those rules are described as a bureaucracy. Obviously, I think digitalization will contribute to greater democratisation of WHO.  Tedros has also been working on a transformation. He has tried to streamline processes and be much more in direct touch with his staff, to have better cooperation between regions and headquarters, and have better staff in the country offices.  So I think there is a lot happening.

HPW: But if you are supposed to make use of digitalization, do you have the resources? And can you ensure continuity of work if you do not have the resources to hire staff for years, but only for months. So, as per the German and French initiative, you have to increase the assessed contributions of the WHO.  You have to address the budget to make it a well-functioning organisation.

Ilona Kickbusch (bottom right) in a webinar 11 September with other health policy experts from industry and the public sector, leading up to the 30 September event.

HPW: You have put up a strong defence of WHO, but at key moments in the pandemic, it moved very slowly. Why was WHO often behind rather than out front?

IK: What we need now is to strengthen the science part of the emergency response. There needs to be a good interface between the Health Emergencies programme and all of the science. Remember, many years ago, WHO had all kinds of research committees and they were closed down. Expanding that work, working together with key science organizations around the world is one of the things that needs to be a lesson from this pandemic. But it needs resources. I hope the WHO independent review panel would provide recommendations, just like we did after the Ebola.

HPW: Returning to the European Health Forum, Gastein, where you will be a keynote speaker next week, what role can this forum play now in regional health diplomacy?

IK: I think Gastein has an enormous opportunity this year to shape the agenda for the European Union. And through that for global health. The fact that the President of the European Commission has said very clearly we need a European health union – this is an issue that has been raised in Gastein very frequently. There are always high-level policymakers meeting linked to Gastein, and we have had discussions about how we would like to focus that meeting on what, beyond the slogan, is a European Health Union, and what is it in very concrete terms?

What are additional health competencies that the Commission should have? How can one strengthen the European Centre for Disease Prevention and Control? What should the European Medicines Agency look like?   What about social protection throughout the union? There are also many issues that relate to the social determinants of health – such as trade agreements that the European Union enters, European agriculture policy, and are they health proof? And now there is an opportunity for these to come together in a clear agenda. There is a closing panel which I am going to moderate, which will say ‘okay if we are to go to Ursula von der Leyen and the European Parliament and the Council, what should a European health union look like?’ So I think that is an extraordinary opportunity which must be used.

HPW: You have talked about a new sense of European solidarity but you also see the UK leaving the EU, and eastern European countries not as enthusiastic about multilateralism as France or Germany?

IK: Well, call it health diplomacy but if you have 26-27 countries, you have to reach agreements along the way.  And I think it’s been quite intriguing how with very hard negotiations, around the budget and everything else, in the end, there is a consensus. That is what the European Union is about. I would also urge us not to think you know there is one eastern Bloc and they are not interested. It is diverse and complex. And then there are the questions about positions the UK is going to take on global health and what alliances it will enter, as well as other non-EU countries like Switzerland and Norway.  Even here [in Switzerland], there are many common global health agendas and, sometimes agendas that you know the global south would be critical of, like around [access to] medicines.

HPW; As for Switzerland, where you have lived and worked for many years, what would be your single piece of advice to the Swiss Government about how it could position itself?

IK; Switzerland is the host country of a whole range of international health organisations. I would like to see Switzerland very active in ensuring the financial base of all these organisations, particularly the World Health Organization.

‘Leadership’ from a host country that is both a middle-sized power and a country committed to multilateralism should be important for Switzerland. It’s also important in terms of all the related economic issues and being the centre for multilateralism in Geneva. And we know that quite regularly there are issues around whether all of these organisations should really stay in Geneva. There are all kinds of support; I’m not trying to minimize that. But I think coming out very strongly politically for multilateralism is something that can be strengthened. I think that this is at the forefront for me. Because as a host country, while these are not necessarily your adopted children, you also have a kind of caretaker function for the organizations.

HPW: You have served in many high-level roles, but are still perhaps best known as the founder of the Geneva Graduate Institute’s Global Health Centre. What was your single biggest accomplishment there, and what is your biggest priority now that you have left the director’s post?

IK:  We created a centre that brings political science and international relations dimension to the global health governance debate. We gave that the term ‘global health diplomacy’. After ten years, I am delighted that I have been able to hand it over to such committed new co-chairs who are strengthening that political dimension, as well as focusing also on new issues, like access to medicines.

Now I’m involved in trying to shape the global health agenda in the European Union. I also work with the German presidency. I am involved with the World Health Summit in Berlin; that has become you know a major forum for debate. I have been part of the Swiss national health report. What I always try and do is to work at three levels, national, regional, and global and then see how those levels interface.

HPW: The UN Global Preparedness Monitoring Board, of which you are also a member, projected last year that the world could soon face a pandemic? What can you say now?

IK: Tedros has repeatedly said “health is a political choice,” we’ve seen very clearly in this year’s GPMB report, that political choices were either made too late, or the wrong political choices were made. There is a sort of negative extreme politicization – what is happening right now between the US and China. But one mustn’t fool oneself that global health is not political. Global health and global health diplomacy are always political. I hope that the [WHO] independent review panel with Helen Clark and Ellen Johnson Sirleaf will be able to take up the political decisions that were not taken, or were wrong, as well as show us those decisions that helped us move ahead –and keep the people secure.

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

This article was first published by Geneva Solutions, a new Geneva-based platform for news about health, climate, peace & humanitarian affairs, technology and sustainable business& finance, with which Health Policy Watch is partnering.

Image Credits: European Health Forum Gastein.

Speakers at the WHO Press Briefing 27 September

Some 120 million COVID-19 rapid diagnostic tests will be made available to low and middle-income countries through the World Health Organization-hosted ACT Accelerator, an initiative to scale up COVID-19 drugs, diagnostics, and vaccines.

The WHO Director-General Dr Tedros Adhanom Ghebreyesus made the announcement just before the world crossed the 1 million mark for deaths from the novel coronavirus, saying in a statement Tuesday, “It is never too late to turn things around.”.

The rollout of the rapid tests follows on WHO’s first listing of a rapid COVID-19 diagnostic antigen test last week for emergency use by global health procurement agencies. The test can offer reliable results in approximately 15 to 17 minutes, as compared to the hours or days required to process a traditional PCR test for COVID-19.

And the tool will help rapidly scale up testing in low-resource or rural settings, which often do not have access to labs that are required to process traditional COVID-19 tests. The new rapid test is produced by the Republic of Korean company SD Biosensor, and allows the diagnosis of COVID-19 on the spot, without the need to wait for a laboratory analysis.  A second test, by the United States-based firm, Abbott Laboratories, is due to be added to the list, said a WHO press release that accompanied the announcement.

“This will enable the expansion of testing, particularly in hard to reach areas that do not have lab facilities or enough trained health workers to carry out [traditional COVID-19] PCR tests. This is a vital addition to their testing capacity and especially important in areas of high transmission,”  Dr Tedros said at a WHO press briefing Monday.

High-income countries are conducting 292 tests per day per 100,000 people, according to Peter Sands, CEO of the Global Fund, a partner of the ACT Accelerator’s diagnostics pillar. However, testing is lagging in middle- and low-income countries, which are testing at less than half the rate, if that.  In low-income countries, the average testing rate is merely 14 tests per day per 100,000 people.

“Testing is a critical cornerstone of the COVID-19 response, enabling countries to trace and contain the virus now, and to prepare for the roll-out of vaccines once available,” said the WHO press release. “Effective testing strategies rely on a portfolio of test types that can be used in different settings and situations. While molecular tests started to be rolled out within a month of the virus being sequenced, these tests are mainly laboratory based, relying on infrastructure and trained personnel to conduct them. Rapid tests to detect the presence of the virus at the point of care, which are faster and cheaper, are a vital addition to the testing arsenal needed to contain and fight COVID-19.”

World crosses 1 million mark for COVID-19 deaths

The ACT Accelerator has agreed to purchase 220 million tests from manufacturers whose tests have been listed by WHO as reliable, for distribution in low and middle income countries. The Bill and Melinda Gates Foundation has agreed to help finance the procurement of 120 million tests, but more money is required to fund the procurement of the remaining 100 million. The tests are currently priced at US $5, which is already significantly lower than the price of a traditional PCR test.  The Global Fund to Fight Tuberculosis, HIV/AIDS and Malaria announced it would be contributing US$ 50 million to kickstart test procurement already this week.

However, US $1.7 billion in funding is still required to before the end of the year to ensure that all tests can be distributed to countries in need, according to Catharina Boehme, CEO of the Geneva-based Foundation for Innovative New Diagnostics (FIND), a non-profit agency that is a co-convener of the ACT Accelerator’s diagnostics pillar. Some US $650 million of the required funds will be used help finance the roll-out and distribution of tests in countries.

The first tests will be ordered as early as this week, and will be rolled out in up to 20 African countries by the Africa Centres for Disease Control (CDC) and its partners in October, WHO said.

World Crosses Somber Milestone of 1 million COVID-19 Deaths 

Commenting Tuesday on the milestone 1 million deaths from the SARS-CoV-2 virus that have now occurred, the WHO Director General cast a hopeful gaze across  those countries that have outperformed in terms of containment, setting examples for others.

Countries that applied an “all-of-government and all-of-society approach”  have succeeded to contain virus outbreaks before they got out of hand, he added, citing Thailand, Uruguay, Pakistan, New Zealand and others as among the success stories – along with countries such as Italy that were hit hard in the first wave, but eventually fought the virus back.

“Learning from the Wuhan experience, Italy put strong measures in place and was able to reduce transmission and save many thousands of lives,” he said. “National unity and solidarity, combined with the dedication and sacrifice of health workers, and the engagement of the Italian people helped bring the outbreak under control.

“Uruguay has reported the lowest number of cases and deaths in Latin America, both in total and on a per capita basis. This is not an accident. Uruguay has one of the most robust and resilient health systems in Latin America, with sustainable investment based on political consensus on the importance of investing in public health.

“Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children against polio have been redeployed and utilized for surveillance, contact tracing and care. This has both suppressed the virus and, as the country stabilizes, the economy is also now picking up once again. Reinforcing the lesson that the choice is not between controlling the virus or saving the economy; the two go hand-in-hand.

“Informed by the best available scientific advice, and a trained and committed community health workforce, Thai authorities acted decisively to suppress the virus, to build trust and to increase public confidence.

“There are many other examples including Cambodia, Mongolia, Japan, New Zealand, the Republic of Korea, Rwanda, Senegal, Spain, Vietnam and more. Many of these countries learnt lessons from previous disease outbreaks of SARS, MERS, measles, polio, Ebola and flu to hone their health system and respond to this new pathogen,” he said. “No matter where there is an outbreak it is never too late to turn things around.”

He underlined that the four essential steps to containing the virus, include:

  • Preventing amplifying events;
  • Reducing deaths by protecting vulnerable groups, such as older people, those with underlying conditions and health workers;
  • Public compliance with mask etiquette, hand hygiene and social distancing, while avoidance of the “three Cs” – closed spaces, crowded places and close-contact settings.
  • Government actions to find, isolate, test and care for cases, as well as tracing and quarantining contacts.
Scientifc Collaboration ‘Unprecedented’; But Money Needed Along with ‘Words Of Solidarity’, Says Wellcome Trust

Dr Tedros also lauded the unprecedented scientific “Just nine months on from the virus first being identified, some of the best scientists in the world have collectively developed tests to diagnose cases, identified treatments like corticosteroids to reduce mortality in the most severe cases of COVID-19, and produced vaccine candidates that are now in final phase three trials,” Dr Tedros said.

At the same time, Wellcome Trust Director Jeremy Farrar cast a more sober note, saying that the world remains far short of the US$ 35 billion needed to finance desperately needed tests, treatments and vaccines.

“Today, the world has passed a devastating milestone: 1 million recorded deaths from covid-19. In reality, the unrecorded total is much higher,” said Farrar in a statement.  “We must not forget that this pandemic is still accelerating and shows no signs of slowing down.

“The ACT-Accelerator urgently needs $35 billion to develop and provide tests, treatments and vaccines for the world and to have the health systems to deliver them. In the last week, the UK & Canadian Governments have stepped up and committed significant amounts. We urge global leaders to delay no longer and join them. Every day matters.

“This needs more than warm words of solidarity. This needs a moment of visionary, historic, political and financial leadership. Only when we have tools to detect, treat and prevent it everywhere, will we be able to stop this pandemic and therefore save lives, give children the education they deserve and restart all our economies.”

–Updated 29.09.2020

Members of Nigerian civil society speak at an accountability forum

When donor dollars go missing, the guilty must be held to account. But when past transgressions hold country-ownership of global health programs to ransom with no clear end in sight, everyone loses.

Today, almost two million people are living with HIV in Nigeria yet the latest UNAIDS figures show that only about one out of every two HIV-positive people are on life-saving treatment. In 2018 alone, 53 000 people died from an AIDS-related illness.

Nigeria’s HIV response is heavily reliant on international donors, which provide more than 80% of all HIV funding in the country, according to the United Nations HIV body. The Global Fund to Fight AIDS, TB and Malaria alone has pumped more than US$1.4 billion into combatting its namesake three diseases in Nigeria since 2003.

The Global Fund works by moving money from its coffers to government ministries and non-governmental organizations that have been designated as “principal recipients.” Principal recipients are selected by national councils, which are also called Country Coordinating Mechanisms (CCM). These bodies oversee grants on behalf of their countries and are comprised of government officials, civil society, and people affected by the three diseases, development partners, among others.

Recently, Nigeria’s country coordinating mechanism was asked by the Global Fund Secretariat to choose between two principal recipients to help administer a new Global Fund grant for HIV: One, an indigenous non-governmental organization and the second, an international non-governmental organization.

Although the local organization delivered services to a smaller number of more challenging to reach patients, it outperformed the international non-governmental organization in at least nine performance areas, according to a country coordinating mechanism evaluation using Global Fund approved performance frameworks for both organizations.

In fact, a value-for-money analysis presented to the national council found that only about half of the donor funds channeled into the international non-governmental organization would go towards actual service delivery to target beneficiaries.

Two out of three dollars directed to the local non-governmental organization, meanwhile, would have gone to service provision to target beneficiaries.

To many Nigerian civil society organizations and those on the country coordinating mechanism, the choice seemed clear: The local organization performed better and would stretch donor dollars further.

The international organization was ultimately chosen by the Global Fund, simply because it can on the basis of the powers conferred to the Fund by what’s called an Additional Safeguard Policy.

Members of Nigerian civil society attend a CSO accountability forum
Fight the Rot in Countries, Not the Choice

In 2015, the Fund’s Office of the Inspector General uncovered what the Fund called “evidence of systematic embezzlement, fraudulent practices and collusion”to the tune of US$3.8 million. In response, the Global Fund Secretariat invoked the Additional Safeguard Policy to reduce the risks to its investments.

The policy can be applied to an entire country or a single disease portfolio in response to not only financial mismanagement but also political instability or a lack of transparency when choosing implementing partners. Countries who fall under the Additional Safeguard Policy may be subject to certain financial management procedures and, as in Nigeria, forfeit the right to select their own principal recipients and other implementing partners.

Global Fund managers can request that the policy be invoked but must outline specific actions that a country must undertake to qualify to be released from the policy. The final decision to revoke the policy falls to Fund’s executive director

In a 2016 letter from then-Global Fund Executive Director Mark Dybul to Nigerian President Muhammadu Buhari. Dybul informed Buhari of the decision to invoke the policy in Nigeria and suspend two grants – HIV and malaria. The lifting of this, Dybul wrote, would be “at the sole discretion of the Global Fund and the satisfaction” of three conditions: That Nigeria investigates the graft, reimburse the funds and demonstrate — following a Global Fund assessment — principle recipients’ capacity to manage grants.

Today, Nigeria has fulfilled these conditions. The nation has put those guilty of offenses on trial and repaid the money. The Fund itself had re-instated the government principal recipients it had de-listed when it evoked the Additional Safeguard Policy.

When Countries Own Their HIV Responses, Donor Dollars are Better Spent

And yet Nigeria remains under the policy, which means the Fund continues to impose, for instance, its choice of principal recipients upon the country. Meanwhile, there is no concrete clarity from the Fund on how Nigeria might ever release itself from the conditionalities that erode the kind of national ownership of its HIV, TB and malaria responses that Executive Director Peter Sands has touted as one of the Fund’s keys to success.

The Global Fund has long been a proponent of country-ownership — the idea that even though projects to prevent and treat HIV, TB and malaria are internationally funded, it is countries that must decide how money is used and what programs look like. Why? Because, as Sands wrote in a 2019 paper in the journal Health Systems & Reform, “experience shows that fighting HIV, tuberculosis (TB), and malaria is most effective where programs are designed and implemented by local experts, not by outsiders.”

He continued: “Second[ly], health programs work best when a broad range of stakeholders — especially civil society and people affected by the diseases — are involved in key decisions.”

The Fund’s prolonged use of the Additional Safeguard Policy without clear conditions for its termination undermines both national ownership and broad-based participation.

Let us be clear: There can be zero tolerance for corruption that strips people of life-saving medication and when that happens, donors and countries must act.

And we acknowledge that since the Fund’s 2015 audit, more fraud has been uncovered in Nigeria. In 2019, the Fund similarly found that an additional US$166,930 in Global Fund money has been misappropriated in Nigeria.

We are not saying that the Fund is wrong to implement measures to curb fraud. But we are saying that, as a country, Nigeria deserves to know where it stands with regard to taking ownership of its grants.

A Nigerian Civil Society Accountability Forum in 2019
Countries Cannot be Held to Conditionalities in Perpetuity

If the nation has met conditions previously set in writing to its head of state, the Additional Safeguard Policy should be revoked. If new corruption necessitates the policy’s re-invocation, then this must be communicated anew alongside clear terms for the policy’s end because the policy itself is meant to be a temporary measure, according to Global Fund. This must happen both for the sake of transparency and accountability in Nigeria, but also to set a clear precedent for many other countries currently operating under the Additional Safeguard Policy.

When we wrote to the Fund to express our concern over its insistence on installing an international principal recipient against the country’s wishes rooted in objective analysis, Sands wrote that the international non-governmental organization’s inclusion as a principal recipient had been “one of the key mitigation measures” that has allowed the Fund to continue supporting Nigeria. He did not go into further detail.

This international non-governmental organization has been and will continue sending millions back to its headquarters in America in order to provide services in Nigeria.

Without any clear indication from the Fund about Nigeria’s status under the Additional Safeguard Policy, we have put together our own proposed roadmap, which lays out various conditions for the country’s eventual exit and the parties responsible.

In the next three months, we call on the Global Fund Board or a designated committee to conduct an independent assessment of Nigeria progress. Again, if the conditions of the original Additional Safeguard Policy invocation have been fulfilled, then it must be revoked.

Countries cannot be held to conditionalities in perpetuity, especially on terms that remain obscured in their entirety from local civil society. Corruption shouldn’t go unpunished but neither should it be held as an excuse for donors to tout their own commitments to transparency, accountability and partnership.

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Ize Adava is the Chairperson of the Peer Review Forum (PRF) based in Nigeria. The Peer Review Forum is a non-service implementing, advocacy platform for the HIV response in Nigeria and works to ensure accountability in the HIV response.

Image Credits: Ize Adava.

Mike Ryan, Executive Director of WHO’s Health Emergencies Program, speaks at UNGA Infodemics webinar

The ‘infodemic’ is one of the “most concerning” governance challenges of our time, undermining trust in science in the midst of the pandemic, and threatening people’s physical and mental health, warned United Nations Development Program (UNDP) Administrator Achim Steimer. 

While the overabundance of misinformation – or ‘infodemic – is not new, it has blown out of proportion since the coronavirus erupted, especially through social media platforms like Facebook and Twitter, added misinformation expert Claire Wardle, at a side-event of this week’s 75th session of the United Nations General Assembly.

In recent months, Facebook and Twitter have fueled misinformation, rumours, and conspiracy theories that have undermined COVID-19 responses at the local, national, and global level, said panelists at the event. As a result, many citizens have failed to comply with national coronavirus policies like mask wearing, physical distancing and regular hand hygiene. 

Some have even begun self-medicating themselves with unproven treatments for COVID-19, like the antimalarial drug hydroxychloroquine. Meanwhile, others have injected themselves with the detergent “Lysol” after US President Donald Trump recommended it for COVID-19 in April.  

And more recently, unfounded claims that consumption of highly concentrated alcohol can neutralize the coronavirus are directly responsible for 800 people’s deaths, almost 6,000 hospitalizations, and 60 cases of blindness, according to a recent study. Most of these were reported in Turkey, Qatar, Iran, India, and the US, among other countries.

“Just as COVID-19 has spread around the world, so too have rumors and truths and disinformation, and they can be just as dangerous,” said World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus. “Too many people have done themselves harm based on falsehoods, self-medicating with toxic chemicals or dangerous medications. Others have not taken the precautions they should have.” 

The distribution of rumor, stigma, and conspiracy theories related to COVID-19 globally

Misinformation can also erode trust in health institutions and lead to social and political polarization, as well as hate speech and discrimination, warned panelists. For example, as a result of widespread politicization of the coronavirus as the “Chinese virus,” discrimination against Asian communities skyrocketed during the first several months of the pandemic.

Fighting The Infodemic 

Health professionals must learn to communicate the science in a way that is understandable by communities, and empower them to implement their own solutions to the infodemic, suggested Mike Ryan, Executive Director of WHO’s Health Emergencies Program.

 “The community is the single most important pillar for fighting epidemics,” said Ryan. “They are owed by us our best service and the highest quality of information.” 

Ryan had suggested at previous briefings that health promotion messages should be written at the 8th grade comprehension level and translated into multiple local languages, to make them as accessible as possible.

Communication in an era of a networked internet audience also requires new strategies to hold dialogues with the public and to convey scientific information. Storytelling, for instance, can be used to rebuild trust in science and public health, and help communities make sense of the world, added Wardle. 

States, media platforms and other stakeholders should develop and implement action plans to turn the tide on the infodemic, said UN organizations, as well as IFRC and ITU, in a joint statement. 

Citizens around the world must have access to accurate information, particularly as mistrust of big pharma and regulatory agencies grows, they said. The stakes are even higher in the midst of accelerated development for a COVID-19 vaccine. The politicization of the vaccine development timeline in the United States, with president Donald Trump quoting a much faster timeline than regulatory agencies or the vaccine companies themselves, has begun to erode public trust in a potential vaccine before it can even be approved.

Svet Lustig Vijay contributed to this story.

Image Credits: WHO, The American Journal of Tropical Medicine and Hygiene.

Edward Kelly, director of Integrated Health Services at the World Health Organization

The COVID-19 pandemic has not only disrupted access to basic healthcare services, but has also exposed the vulnerabilities the people working in the health care industry.

“About 14% of all infections reported to us are in healthcare workers, I think that’s… put the spotlight on the need for reforming [the healthcare system] and supporting health workers in all aspects,” said Edward Kelly, director of Integrated Health Services at the World Health Organization. “We’re not just talking about care providers, but also [everyone from] the people who clean the rooms, the people who work in the communities as outreach workers.”

The pandemic has also not only impacted healthcare industry workers in terms of infection rates, but “mental health” and “stress’ as well, added Kelly.

He also acknowledged that about half of all health services around the world were interrupted by the pandemic at some point.

“That’s everything from… dental services and rehab services down to acute emergency services,” said Kelly. “All countries right now are figuring out ways to make this work.”

Kelly’s comment’s come just a day after a new report by the Partnership for Evidence-Based COVID-19 Response highlighted the need to ensure protections for healthcare workers, and increase access to healthcare services in Africa.

According to a survey of more than 24,000 adults across 18 African Union states, some 44% of those who had required health care during the pandemic reported skipping or delaying seeking care. Of those that needed medicines, some 45% have reported facing more barriers in obtaining necessary drugs.

“As in past outbreaks, we are seeing a high cost from missed and delayed health care,” said Dr Zabulon Yoti, acting regional director of the Emergency Preparedness and Response Cluster at the World Health Organization, in a press release. “Even routine check-ups are critical for screening and treating people for both communicable and noncommunicable diseases. We must protect access to health care by making sure that facilities are equipped to handle COVID-19 infections, and that health workers are protected.”

Additionally, reports of lack of resources and lax protocols in some hospitals have left health industry workers at risk of infection by the virus.

According to the report, there were 288 reported health care worker protests across Africa between March and August 2020 related to COVID-19 working conditions. Most of the protests were focused around demanding proper compensation and personal protective equipment for those working in healthcare facilities.

Despite some difficulties the continent has faced, self-reported adherence to mask wearing, handwashing, and physical distancing has remained high across Africa.

 

Mariangela Simao speaks at a UNGA side event on the COVID-19 Technology Access Pool

While the COVAX Facility, a global initiative to pool procurement of a safe and effective COVID-19 vaccine, has been gaining momentum, another global initiative to pool intellectual property rights for tools to combat the pandemic has been moving at a much slower pace.

Only three more countries have signed on to support the COVID-19 Technology Access Pool (CTAP), an initiative to pool COVID-19-related intellectual property IP, including patent rights, since the pool was first launched in 29 May. That makes 40 countries now supporting the initiative, according to WHO Access to Medicines, Biologics, and Vaccines Director Mariangela Simão, speaking at a UNGA side event hosted by Costa Rica’s President Carlos Alvarado Quesada on Friday.

The high-level event also included WHO Director General Dr Tedros Adhanom Ghebreyesus and UN AIDS executive director Winnie Byanyima. Byanyima expressed concern about the lack of support the IP pool had received so far from countries as well as industry.

“A vaccine is our greatest hope of rising up from this crisis. But the only place where a COVID-19 vaccine is a global public good is in rhetoric, not reality,” Byanyima said. “We congratulate the hard work of scientists, and yes, of pharma corporations too. And yet despite that – all the knkowledge and technology to make them remains a secret. It is the private property of companies. They are deciding how many vaccines get made. They are deciding what price is charged. They are deciding who gets them.

“The implications are clear. Oxfam’s research shows that rich countries representing 13% of the world’s population have secured half the vaccine supplies belonging to the major candidates…Do I need to remind us of the 10 million lives needlessly lost to HIV and AIDS? That’s what happened the last time we relied on the good will of pharmaceutical corporations in a crisis….

“Together we believe that there must be safe and effective vaccines for everyone. Vaccines that are fairly and speedily distributed across the world – free of charge – according to need and not ability to pay. We need a people’s vaccine not a profit vaccine. To do this all pharma corporations must openly share their know-how and technology for producing their vaccines free of patent and monopoly. This know-how and technology can then be shared with as many producers as possible. Once we have more producers, we have more doses, and there will be no need for this self-defeating vaccine bidding war in which the most at-risk populations will always loose.

“To achieve this, we must push harder on CTAP. This is the most important multilateral solution we have on the table to unlock supply. The World Health Organization have shown us how access pools work, for example with the Medicines Patent Pool. We welcome COVAX, but we need its spirit of solidarity to extend to sharing technology and intellectual property for the global public good.

Public Subsidies in Vaccine R&D Strengthen Argument for IP Sharing

The case for IP sharing is particularly strong in the case of COVID-19 vaccines, where unprecedented amounts of public and government funds have been poured into  R&D and pre-purchaes agreements, argued  Jamie Love, head of the medicines access advocacy group, Knowledge Ecology International, at the event. He described the investements as “massive, effectively derisking the development of products.”

But public funders have not done enough to push for public ownership of IP rights to the innovations that they helped finance, he said.

“Talk about solidarity has not yet been given concrete action …  The funders of R&D, including primarily governments, but also foundations like the Gates Foundation, have not used their leverage to open source the know-how or rights in patents or data. This reinforces shortages and higher prices, and works against building more distributed capacity for manufacturing, not only today, for years to come and future pandemics.”

While the COVAX pool, to which 64 high-income countries as well as pharma have endorsed, strengthens global systems for vaccine procurement, an IP pool would address potential bottlenecks even more fundamentally:  “CTAP is about access to know-how, cell lines and rights inventions and data We have and will face shortages of supply, and inequality of access to products. But there is no legitimate basis for not sharing knowledge, and in particular, manufacturing know-how, access to cell lines and rights in inventions and data.”

In addition, Love added, “we also need more transparency of R&D costs and subsidies, prices, licenses and advance purchase agreements, and trial outcomes.”

CTAP IP Pool Has Not Received Pharma Support; Simão Says Medicines Patent Pool Could Be Way Forward

Unlike the COVAX pooled vaccine facility, which has received broad industry support, CTAP has been dismissed by the pharmaceutical industry, which holds most of the rights to the vaccine technologies, data, and research that the CTAP IP pool would aim to distribute freely. Director-General of the International Federation of Pharmaceutical Manufacturers and Associations Thomas Cueni has previously said that he did not understand the added benefit of the initiative, echoing comments from heads of large pharma companies.

Still, progress is inching along on the initiative, which was originally proposed by Costa Rica in March. And getting private industry on board is key, according to Simão. She noted that the C-TAP Pool would be built on existing expertise and strategies developed by the Medicines Patent Pool, an initiative founded by UNITAID that has experience negotiating voluntary agreements with industry for the pooling and distribution of generic licenses for the production of medicines for HIV/AIDS as well as other infectious diseases, such as Hepatitis C.

“I think we need our [potential] partners to understand that there is a mutual advantage in sharing prices, in sharing data and know-how. In ways, [it helps] accelerate product development and widespread manufacturing,” said Simão. “We are about to ask for a ‘light’ consultation, a strategy for private sector engagement, because without the private sector as partners we won’t go anywhere.”

-Updated 27.9.2020

 

 

 

“Social support, which is about ensuring that people have the material resources and necessities required to be able to ensure effective care is delivered, is a critical piece that has been under-invested in and focused on Europe in the US and the response to the pandemic.” – Katie Bollbach, director Of US Public Health Accompaniment Unit, PIH USA

New York City, USA – With no approved vaccines and cures on the market for COVID-19, countries everywhere have retreated back to the fundamental public health measures to control the pandemic – test, track, and isolate cases.

And many global health organizations, such as global health NGO, Partners In Health, that have helped manage outbreaks in low resource settings for years, could see the impending signs of an outbreak spiraling out of control in the rich countries that were first hit by the pandemic. It was the first time that these organizations had to set up emergency responses in the countries of their headquarters.

The steady disinvestment in local public health systems in rich countries like the United States, even before the pandemic, had left local authorities woefully underprepared for rapidly responding to an emerging infection.

“For those of us Americans who spend most of our career working outside of the US… it’s been incredibly eye-opening and humbling to see how COVID has absolutely overwhelmed the capacity of our system here in the US,” said Bollbach. “We simply have a deeply fragmented, underfunded, and misaligned health system not really focused on prevention and public health and primary care, but rather on a specific slice of for-profit, secondary and hospital based care.

“And so we’ve seen the result of that in terms of our inability to control the epidemic here in the US.

And from the get-go, it became clear that the same barriers to care that patients faced in low resource settings were replicated in the high income countries. In Massachusetts USA, where PIH first began to engage in the COVID-19 response, it quickly became clear that not everyone had the resources to safely isolate at home.

“We know that it’s simply insufficient to call someone and say, you’ve tested positive for COVID, please stay home for two weeks. Not everybody will be able to do that,” said Bollbach. “People’s ability to stay at home and isolate is linked to their material resources and the broader social determinants of health, such as their household dynamics.”

A panel of experts from PIH discussed local pandemic responses in the United States, Mexico, and Lesotho at a webinar discussing “Why Local Public Health Systems Play A Critical Role in Controlling the Spread of COVID-19” on Wednesday. The webinar is the fourth and final installment in the Global Pandemics in an Unequal World series hosted by the New School, Health Policy Watch, and the Independent Panel on Global Governance for Health. Panelists focused on each individual countries’ struggles, and noted what the various countries could learn from each other.

Implementing Social Support In Massachusetts, USA
Panelists and moderator at the “Why Local Public Health Systems Play A Critical Role in Controlling the Spread of COVID-19” webinar.

The large majority of people who get infected with COVID-19 will not require hospitalization, says Bollbach. Approximately 80% of cases will be moderate, mild, or asymptomatic, and people can stay at home to recover.

“We’ve been really focused on ensuring deeper investment in staffing and resourcing at a local community level to facilitate the coordination of care and safe isolation,”  said Bollbach. 

The Massachusetts contact tracing team, for example, refers patients to care resource coordinators, who work with the patient to help identify needs. 

“This ensures that there is referral and follow-up, to get home delivery of groceries, to get cash to make up for lost wages… We’ve found in our work in Massachusetts that 20% of cases require some form of care, referral, or social support,” said Bollbach. 

The care resource coordinator model has been implemented in contact tracing teams in other major US cities as well, including New York City, the original epicentre of the US’ COVID-19 epidemic.

Big Cities Have Resources, But What About Rural Regions? – A Case From Mexico

Mexico City has also instituted a social support program, in which those who are diagnosed with COVID-19 can receive a care package that contains food, medicine, and extra cash to help ease the burden of lost wages.

But in poorer, rural regions of Mexico, such as Chiapas where PIH’s Mexico team works, the state has little money and resources to help support those that require safe isolation, said Daniel Bernal, sub-regional coordinator for Companeros En Salud Mexico.

“Here, 85% of people live below the poverty line,” said Bernal. “In contrast with Mexico City, we in Chiapas are only doing 0.6 tests per 1000 people per day, less than 3% of the suspect cases and 0% of contacts have been tested, there’s no quarantine for contacts, and there is no money for state social support.

This is why local responses are critical. Communities know and care for themselves, and despite having limited resources, so community engagement is the best option…Communities decide and reinforce social distancing norms.”

In the beginning, Bernal noted that communities did not even want to get tested for COVID-19. But having a strong community engagement strategy, especially in engaging with local leaders, has been important in changing the public perception around testing.

“I think the key piece is the community health workers that have been working with us,” said Bernal. “Some of them have been with us for five years now. And the fact that the information comes from someone in the community that works with [a trusted] organization, that’s been really important.”

But ultimately, more “investment [is needed] to shape the response,” said Bernal. “The thing that they did in China was to set up spaces for isolation. And this is the ideal response, and is something that we are trying to fight to have in Mexico.

“The fact that you don’t have the resources [does not mean] that you can just say, ‘well, it’s not going to happen and we won’t do anything.'”

Building On Existing Local Capacities In The COVID-19 Response in Lesotho

In Lesotho, where PIH has been involved in strengthening the country’s response to HIV/AIDS since 2006, the organization was well positioned to build on the existing HIV/AIDS infrastructure to help augment the COVID-19 response, said Melino Ndayizigiye, acting director of PIH Lesotho.

Over the years, PIH has helped support the training, deployment, and retainment of more staff at rural clinics and health centres, built up patient referral systems, and helped procure medical equipment and supplies for clinics.

But when COVID-19 hit, the country, which has one of the lowest life expectancies in the world had been struggling with multiple heath crises such as tuberculosis and HIV/AIDS, said Ndayizigiye. The COVID-19 response had to also consider patients co-infected with the novel coronavirus and disease like tuberculosis or HIV.

“We have also created a treatment center for multidrug resistant tuberculosis patients who are also co infected with COVID-19. We empowered staff and send them guidelines on managing medical conditions co-existent with COVID-19. And we have integrated medical health care and psychological insights, psychological support services,” said Ndayizigiye.

But ultimately, the system is currently still dependent on outside support.

On average, in PIH supported clinics, some 20 staff are paid by the organization, which receives funding from government grants from high-income countries, large private foundations, and private philanthropy. And the country, which is landlocked within South Africa, is still dependent on South Africa to supply medical oxygen, a key tool required for the treatment of more severe COVID-19 cases.

“We are establishing an oxygen plant that will produce oxygen for COVID-19, and for patients [with other diseases] who might need it across the country,” said Ndayizigiye. “We are thinking beyond COVID-19, because what we have seen what the country lacks.”

Image Credits: Partners in Health.

A lineup of global health leaders called upon high income countries to join the new global COVID-19 pool, saying that worldwide access to a safe and equitable vaccine is essential to beat the COVID-19 pandemic. 

Speaking at the virtual UN General Assembly (UNGA) side event on Wednesday, the leaders also said that maintaining essential vaccine services, during the pandemic, would help lay the groundwork for rollout of a COVID-19 vaccine. 

“The building back of the routine immunization program is the underlying fundamental that creates the infrastructure on which we will deliver [COVID] vaccines,” said Katherine O’Brien, of the World Health Organization. 

“Rebuilding trust in national immunization programs, maintaining essential vaccination services and ensuring safe and effective immunization campaigns will not only prevent countless deaths, but also lay the groundwork necessary for the deployment of a safe and effective COVID vaccine,” said Xavier Castellanos, under-secretary-general of the International Federation of Red Cross and Red Crescent Societies (IFRC).

Xavier Castellanos, Undersecretary General of the IFRC

The  appeals came days after some 64 high-income countries, including the 27 states of the European Union, Switzerland, Norway and Iceland, formally joined the vaccine pool – being rolled out by Gavi, The Vaccine Alliance along with the World Health Organization to bring down prices and ensure broad vaccine access. 

However, significant holdouts to the vaccine pool include countries such as the United States, Russia and China. 

And some $7.5 billion still needs to be recruited by the end of 2020 to finance the 2021 procurement  and distribution of 2 billion vaccine doses for 92 low-income countries that already participate in Gavi’s bulk vaccine procurement system, said Seth Berkley, CEO of Gavi. While that is still a huge sum, the $7.5 billion that Berkley cited as immediately needed, is still only about one-fifth of the $35 billion WHO said was the global “ask” for COVID-19 vaccines, tests and treatments.  

Keys to COVAX Success – Money & Solidarity 
Seth Berkley, CEO of Gavi, the Vaccine Alliance

“COVAX is a global insurance policy,” Berkley said. “We now have an exit plan that can help us avoid the indefensible outcome of only a few benefiting,” he said. “The probability of death from Covid-19 increases with increasing poverty, and we know if wealthy countries buy up the first two billion doses of Covid-19 vaccines instead of making sure they’re distributed in proportion to the global population, then almost twice as many people could ultimately die from Covid-19.”

Xavier Castellanos echoed Berkley’s remarks, saying that the COVAX pool represents an  opportunity “to ensure the Covid-19 vaccine will be allocated fairly and equitably,” not reserved for a privileged few.

“To end the acute phase of the pandemic, the vaccine must be available everywhere it is needed, not only where it can be afforded. None of us will be safe until we are all safe,” said Castellanos. “Ensuring fair allocation and timely delivery to all who need [a vaccine], especially the most vulnerable, is the greatest challenge that we are facing.”

Pharma needs to play role in ensuring wide global distribution 

“We need a commitment from [pharmaceutical companies] to make sure that we are able to supply globally and not just to the highest price payer,” Berkeley stressed. 

He was referring to unilateral plans by some countries, including the United States, to eschew the COVAX Facility initiative and pre-purchase large quantities of vaccines on their own. 

Participation of high- and middle-income countries in the pool is critical to increase the volume of vaccine orders and thus keep prices manageable. However, donor aid will still be required to finance the purchase of vaccines for some 92 low-income countries outright, or at greatly reduced prices.

Health Leaders Warn That Battling Stigmatization and Rebuilding Trust Also Key to Rollout 

Panelists also underlined the need to overcome the stigmatization and fear that arises from misinformation about the pandemic, and building trust in health systems.  

The calls also followed WHO/Europe warnings that the SARS-CoV-2 virus is resurging in the region, following the reopening of borders and several tourism hotspots. Countries have doubled back with even stricter quarantine and restriction measures for this second wave. Elsewhere in the world, many low and middle income countries across South East Asia, Latin America, the Middle East and Africa continue to battle against infection resurgence or steadily increasing rates.  

Questions were also raised about how COVAX would ensure that migrants, displaced persons and other non-citizens could be reached by a COVID vaccine. 

Dr. Asha Mohammed, secretary general of Kenya’s Red Cross Society, predicted that there would be big challenges in providing access to a COVID-19 vaccine to such groups; nomadic populations such as Kenya’s highly mobile pastoralists are also likely to be challenging. Cultural and religious beliefs also could pose a threat to the acceptance and access of immunization within these communities, and more broadly, she said.

Secretary General of Kenya Dr. Asha Mohammed

Berkley said, however, that many migrants and displaced populations are already counted among the vaccine-eligible population in countries that receive subsidized vaccines from Gavi, and would be “taken care of by the advanced market commitment mechanisms.” Plans are being made to ensure delivery to such groups, even if  they are excluded from national plans, he said.  

Joyce L. Kilikpo, Executive Director of the Public Health Initiative, Liberia,  highlighted the parallels between the Ebola response in Liberia and the current COVID-19 pandemic, which has left an enormous impact on the Liberian health system. Widespread misinformation has kept families from taking their children to healthcare facilities in the COVID period. Immunization campaigns such as the one for measles have been suspended, leaving children vulnerable. There has also been a disruption in other essential healthcare services for women and children, which was exactly what she witnessed on the frontlines of the Ebola outbreak.

“We need a robust and continuous investment in the healthcare system,” Kilikpo advised. This would require investment in the health workforce, primary health care infrastructures, planning and monitoring systems.

But strong community engagement is the underlying key, according to Kilikpo.

“After all is said and done, and we have the system working, we need the community to make use of it,” she said.

Image Credits: Flickr: Jernej Furman.