Improving vaccine uptake
The WHO report says the key areas for improving vaccine uptake are creating an enabling environment, harnessing social influences and increasing motivation.

As the first vaccination campaign for COVID-19 could begin as early as next week, following the UK’s approval Pfizer and BioNTech’s mRNA vaccine, the World Health Organisation (WHO) technical advisory group (TAG) has published a series of guidelines and behavioural insights to improve vaccine acceptance and uptake across all populations.

The report, published on Friday, details the recommendations made during a 15 October meeting between TAG members and WHO Department of Immunization, Vaccines and Biologicals.

TAG identified three categories of drivers of vaccine uptake, based on existing behavioural research: enabling environments, social influences and motivation.

Political decision-makers, health workers, media outlets and community leaders may all influence vaccine uptake, the report says.

Enabling Environment

Reducing barriers and making the process of getting vaccinated simple and straightforward – especially for large populations who are not deliberately avoiding vaccination – can improve uptake, the report says.

It cited that what appears to be reluctance, resistance or even opposition among a group might be a response to the inconvenience of getting a vaccine. Environmental factors include:

  • Location of the vaccination.
  • Costs: including for the vaccine, for travel, or by missing work.
  • Time: booking should be accessible, and vaccines should be delivered at convenient times of day.
  • Quality of care: health workers should be informed and able to answer questions.
  • Information: relevant details should be provided ahead of time, with benefits outlined.
  • Regulations: vaccination may be mandatory for employment, education or social activities.

The report says that making vaccines available from familiar and convenient locations, like drop-in services, can encourage uptake. It also noted, however, that fears of contracting COVID-19 in a health facility might impede immunization efforts, and so safety measures should be implemented visibily.

Social Influences

Social influences that affect vaccination decision-making include family members, friends, members of a broader community, and digital or media outlets. The TAG report notes that “[harnessing] social influences” can be used to “promote favourable behaviours”. This can be achieved by:

  • Improving communication efforts to promote the perception that “most people are getting vaccinated”. Making uptake visible, either via social media or by enabling ways for people to signal they have been vaccinated, can normalise vaccination.
  • Amplifying endorsements from community members.
  • Supporting health professionals to encourage engagement. Motivational interviewing, designed to explore the reasons behind an individual’s hesistancy, has ben found to facilitate vaccination.
Increasing Motivation

Motivation towards getting vaccinated is the results of risk perception and severity of illness or infection, the report says. Some groups may believe they are at low risk, and so are reluctant to be vaccinated, for example, while others may be wary of the safety of the vaccine. Key strategies to remove motivational barriers include:

  • Building trust in vaccines before vaccination. Evidence indicates that strategies designed to change attitudes towards vaccination are not always successful. Building up trust ahead of the decision to receive a vaccine is vital.
  • Emphasizing the social benefits. Communicating the benefits of vaccination, such as restored engagement with the community and family members, has been found to increase vaccination intention.
  • Leveraging regret. Anticipated regret – the fear of regetting a future action – is a strong barrier. Highlighting the consequences of inaction – for instance, by asking people how they would feel if they do not get vaccinated and end up contracting COVID-19 or transmitting it to loved ones – may encourage vaccination.

Image Credits: Keystone/ Hans Pennick.

The WHO calls on countries to commit to the ACT Accelerator, calling it a “global solution” with economic benefits.

The economic benefits to the economies of ten high income countries being asked to support the equitable, worldwide distribution of COVID-19 vaccines, treatments and tests would be 12 times the costs, a new report has found.

The study, undertaken by the global political risk research firm Eurasia Group, on behalf of the Bill and Melinda Gates Foundation, found that the world’s ten largest donors would reap some US$466 billion in an economic boon over the next five years, if they were to support the US$ 38 billion required by WHO’s Access to COVID-19 (ACT) Accelerator to fund more equitable distribution of emerging treatments, vaccines and tests.  The same ten countries would reap at least US$153 billion over the coming year – due to improvements in global trade, tourism and economic activity that would result.

The report examined the economic benefits that would accrue to ten leading donor countries – including Canada, France, Germany, Japan, Qatar, South Korea, Sweden, the United Arab Emirates, the United Kingdom and the United States.

So far, the 10 countries featured in the report have contributed $2.4 billion to the work of the ACT Accelerator. The UK committed just more than US$1 billion, and Germany, Canada, France, committed US$618 million, US$290 million, US$229 million, and US$147 million respectively.

The ACT Accelerator is a unique global collaboration that supports the development and equitable distribution of tests, treatments, and vaccines the world needs to fight COVID-19. However, the ACT Accelerator, which published its Urgent Priorities and Financing Requirements last month, still has a significant funding gap of US$28.2 billion, and needs US$4.3 billion immediately for critical areas of work.

If that shortfall isn’t met, low- and middle-income countries (LMICs) risk delayed access to vital tools including vaccines in 2021. This would result in a prolonged pandemic with severe economic consequences – not just for LMICs, but for the wider global economy. The benefit to supporting LMICs with access to treatments and vaccines far outweigh the cost, the report, which was commissioned by the Bill & Melinda Gates Foundation, emphasizes.

 

Ratio of economic benefits (2020-25) to current US$5B billion funding gap for COVAX-AMC.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, called on countries to commit to the work of the ACT Accelerator, stating that, “The ACT Accelerator is the global solution to ending the acute phase of the pandemic as quickly as possible by ensuring equitable access to COVID-19 tools. Contributing to the ACT Accelerator is not just the right thing to do – it’s the smart thing for all countries – socially, economically and politically.” 

ACT Accelerator: Economic Gains to Low and Middle-Income Countries and High-Income Countries

Over just seven months, the ACT Accelerator’s progress has evaluated over 50 diagnostic tests and ensured the development of new rapid antigen diagnostics for LMICs. In addition, it has rolled out life-saving Dexamethasone treatments, research into monoclonal antibody treatments and has mapped out the health system requirements for delivery of COVID-19 tools have been mapped in 4 out of the 6 world regions. 

COVAX, the vaccines pillar of the ACT Accelerator, aims to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for participating countries.

According to the International Monetary Fund, if medical solutions can be made available faster and more widely, there could be a reduction of income divergence in all countries. Rapid, widespread, and equitable vaccinations, tests, and treatments have the potential to save countless lives in LMICs, allowing policymakers’ focus to return to the core development goals of raising living standards, empowering women, and marginalized communities, and strengthening institutions. 

 

Level of access to COVID-19 tools as of November 2020 in high-income compared to low-income countries.

WHO has stated that it is in every economy’s interests to finance a global solution, as all economies are interdependent through mobility and global trade. 

“There is a clear humanitarian and ethical case for supporting the ACT Accelerator and the COVAX facility, along with the obvious economic gains it would bring to developing countries. Doing nothing risks reversing years if not decades of economic progress. But our analysis shows that the program is likely to yield economic and other returns for major donor countries as well,” said Alexander Kazan, Managing Director for Global Strategy at Eurasia Group and one of the authors of the report. 

Kazan added: “The ACT Accelerator is a unique opportunity to save lives, repair the global economy, and build diplomatic capital that will last a generation.”

Image Credits: Marco Verch/Flickr, Eurasia Group, WHO.

A man struggles with smoke from the Silverado Fire in California, October 2020

As the world’s eyes are fixed on the pending roll-out of new Covid-19 vaccines, a team of 120 leading health and climate experts have called on global leaders to use the momentum of the pandemic response to accelerate climate action, just ahead of the five-year anniversary of the landmark Paris Agreement to limit global warming to “well below 2°C.”

The expert assessments were summarised in the 2020 Lancet Countdown on Health and Climate Change, released Thursday. The report finds that record heat waves and wildfires in Australia, North America and Europe, deadly dengue expansion across Latin America; and undernutrition, floods, and droughts in China, South East Asia and Africa, are creating unprecedented threats to health and wellbeing around the globe.

Still Time For Global Reset

Despite their gloomy assessment, other climate news suggests that there is still time for a global reset. Should China, Japan, South Korea and others deliver on recently-announced net zero emission targets, the 2015 Paris Agreement’s ambitious climate goals could be “within reach”, according to an analysis by the Berlin-based Climate Action Tracker, published on Tuesday.

“The Climate Action Tracker (CAT) has calculated that global warming by 2100 could be as low as 2.1°C as a result of all the net zero pledges announced as of November 2020,” stated the independent scientific group, which measures and models governments’ climate pledges and actions against the goals of the 2015 Paris Agreement.

A recent wave of “net zero” emissions pledges announced this autumn by China, South Africa, Japan, the Republic of Korea and Canada have even “put the Paris Agreement’s 1.5°C temperature limit within striking distance,” states the latest report of the Climate Action Tracker (CAT).

As of November 2020, 127 countries “are considering or have adopted” net zero targets, the group said. Together, those account for some 63 per cent of global emissions. In addition, the incoming US administration of president-elect Joe Biden has pledged to rejoin the Paris Agreement and act more aggressively on climate change. Emissions are, nonetheless, still projected to increase until 2030, despite a small dip this year due to the COVID-19 pandemic.

“The year 2020 can be a global leap year for climate neutrality, so that we can reduce global emissions by 45 per cent by 2030, said UN Secretary General Antonio Guterres, speaking at a major address at Columbia University on the state of the planet. He recalled the vital link between climate, environmental stability and human health, saying, “Nature feeds us clothes us, quenches our thirst”, noting that health impacts from degradation come through multiple pathways, urban, air pollution, and environmental degradation: “Sound chemicals management could prevent some 2.6 million deaths per year.”

Lancet – Forty Global Indicators Still Show Worsening Impacts On Health

Even so, the 2020 Lancet report underscores how global warming that is already occurring is exacerbating the health impacts of the COVID-19 pandemic and vice versa.  The report, which involved 120 experts from 35 institutions like University College London, the World Health Organization and the World Meteorological Organization, found consistently worsening trends in all 40 global indicators that measured the health, social and economic impacts of climate change, revealing that health systems are still ill-prepared to deal with its deadly repercussions.

Maria Neira, WHO Director of Environment, Climate Change and Health

“The pandemic has shown us that when health is threatened on a global scale, our economies and ways of life can come to a standstill,” warned Ian Hamilton, executive director of the Lancet Countdown. “The threats to human health are multiplying and intensifying due to climate change, and unless we change course, our healthcare systems are at risk of being overwhelmed in the future.

“With trillions being invested globally in economic support and stimulus there is a genuine opportunity to align the responses to the pandemic and climate change to deliver a triple win – one that improves public health, creates a sustainable economy and protects the environment,” said the World Health Organization’s Maria Neira, who is at the helm of the Organization’s climate change and health efforts.

”But time is short. Failure to tackle these converging crises in tandem will [end up] moving the world’s 1.5C target out of reach and condemning the world to a future of climate-induced health shocks.”

A Comprehensive Report

This year’s report is more comprehensive than ever, featuring new indicators to measure the extent of heat-related mortality and its devastating economic costs, among other indicators on migration, urban green spaces and low-carb diets.

The authors show that climate change is knocking on Europe’s doorstep as well, triggering thousands of deaths a year from heat-related shock waves, damaging crop yields of staple grains, and facilitating the spread of mosquito-borne infections like dengue, with devastating costs to societies, healthcare systems and economies that are already strained.

The incentives to tackle climate change together with Covid-19 seem more enticing than ever, as limiting global warming to 1.5°C by 2100 could generate a net global benefit of US$264–610 trillion, which is at least triple the size of the global economy in 2018.

Higher temperatures are driving dengue spread to new regions

The World Doesn’t Have The Luxury Of Dealing With One Crisis At A Time 

Tackling climate change also bodes well with pandemic preparedness and prevention plans, since human encroachment into wildlife habitats, intensive farming, and deforestation promote both climate change and the emergence of “zoonotic” diseases like COVID-19. In fact, the world doesn’t have the luxury of dealing with one crisis at a time, added Hamilton in a press release on Wednesday night.

To reach the Paris Agreement’s targets by 2030, the world must reduce carbon dioxide emissions by 7.6% every year, which is more than five times higher than current government ambition, found the report. And although such changes seem out of reach, climate change is becoming more expensive to treat every year, given that a five-year delay in action would require a 15·4% reduction in carbon dioxide emissions every year to reach the set targets, representing a ten-fold increase in current government ambition. 

Europe, The World’s Most Vulnerable Region To Heat-Related Shock Waves

Perhaps surprisingly, the authors found that in 2018, Europe was the world’s worst affected region by heat-related shock waves, triggering over a 100,000 deaths that year, mostly in older people, people with disabilities or pre-existing medical conditions, as well as those working outdoors or in non-cooled environments. The costs, say the authors, are equal to a whopping 1.2% of regional gross national income. 

A rise in temperatures in Europe, even by seemingly small amounts, is also facilitating the spread of infectious diseases like dengue to the region. The global climate suitability for the two main mosquitoes that carry dengue – the Asian tiger and yellow fever mosquitoes – have in fact increased by 41% and 25% since the 1950s, found the report.

Meanwhile, rising temperatures have made Africa’s highlands 40% more suitable for malaria transmission, and 150% more suitable in the Western Pacific region, in comparison with the 1950 baseline.

The outlook for food security is rather bleak as well, with consistently dwindling crop yields for staples like maize, winter wheat, soybean, and rice across the world. In Europe, for instance,  the crop growing season for maize was reduced by 20 days in 2019, a 14% reduction compared to the global averages between 1981–2010.

Maize growth duration has decreased since 1981–2010

Huge Losses

Increasingly warm temperatures are also triggering huge economic losses. Just last year the world lost 302 billion work hours due to climate change, or 103 billion hours more than two decades ago. These effects are more strongly felt in the construction sector in high-income countries, in comparison to low- and middle-income countries where extreme heats are most deeply felt in agriculture. In 2018, India and Indonesia lost 3.9 to 5.9% of their GDP because of lost outdoor labour. In India alone, this amounts to 100 billion hours of potential work lost to rising temperatures in 2019, compared with those lost in 2000.

If the world fails to intervene, up to 565 million people living in coastal areas, about three quarters of the total European population, may be forced to leave their homes due to rising sea levels. 

Progress Welcome, But Only 9% of Countries Have The Funds To Implement Health & Climate Adaptation Plans

Fortunately, there is some good news. Coverage of health and climate change in the media has increased by 96% worldwide between 2018 and 2019, and research in the field has increased by a factor of eight. Government engagement in climate change has also increased, especially for small island states and lower-income countries that have led the trend. And in 2019, government spending on health system adaptation rose by almost 13% to $18·4 billion. 

However, governments have a lot of work to do to implement effective multi sectoral strategies, warned the report, noting that governments “remain unable” to fully implement their plans for national health adaptation – even though two thirds of global cities surveyed anticipate climate change to seriously compromise public health infrastructure.

In fact, only half of governments surveyed have drawn up national health and climate change adaptation plans, and only 9% have the necessary funds to fully implement them.

An earlier version of this story was published on Thursday morning in collaboration with Geneva Solutions, a new non-profit Geneva platform for constructive journalism covering International Geneva.

Image Credits: AP, Climate Action Tracker, Maria Neira, The Lancet.

Special Representative for Global Health Diplomacy, Ambassador Deborah Birx.

Ibadan. While this year’s media coverage of the HIV epidemic has largely focused on COVID-related disruptions of services, deeper running trends and attitudes that stigmatize people found to be HIV-positive need greater attention, said US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, Ambassador Deborah Birx, in a special media briefing on the occasion of World AIDS Day. 

Stigma and discrimination are not specific to HIV/AIDS, she emphasized, but they are particularly insidious in the case of people living with HIV. Stigmatization deters people from seeking life-saving testing and treatment on the one hand, and on the other can lead to the transmission of infections to others.

“We have to create an environment where individuals do not see that there are barriers to their ability to access either prevention, or treatment service. This is the work that we have to still do,” Birx told Health Policy Watch at a briefing organized by the South Africa-based Africa regional Media hub of the US Government.

The year 2020 marks nearly 40 years since the discovery of the AIDS virus in 1983, and 32 years since the first World AIDS Day in 1988. In contrast to the 1990s, when the first available anti-retroviral treatments were expensive and out of reach to most people in parts of Africa and the developing world where the AIDS pandemic was raging, some 26 million people living with HIV/AIDS today are now regularly using ARV therapies. But that still falls short of the 30 million target for 2020, that was set before the COVID pandemic began.

Overall, it’s estimated that some 12.5 million people worldwide still don’t have access to lifesaving ARVs.

Since 2003, the US government has invested more than $85 billion in the global HIV/AIDS response through its PEPFAR initiative (President’s Emergency Plan for AIDS Relief), which extends across more than 50 countries today.

That has saved 20 million lives, preventing millions of HIV infections, and moved the HIV/AIDS pandemic from crisis toward control, Birx said. But it has not stopped the disease from being a source of stigma for people living with it.

“So it tells me that there’s still a stigma around keeping people healthy and prevention programming versus treatment programs, no matter where we work around the globe,” she observed.

She added that there remains great disparities in the means by which countries and policies address stigmas around HIV/AIDS. Great progress has been made in some countries, notably South Africa, where the epidemic raged two decades ago, but the situation has worsened elsewhere in Sub-Saharan Africa.

LGTBQ+ Groups At Particular Risk From Stigmatization- Freedom of Association Under Attack 
Winnie Byanyima, Executive Director UNAIDS.

While access to treatment has improved in many parts of the world, things have actually gotten worse in many parts of Sub-Saharan Africa, as a result of stigmatization against key at-risk groups, said Onyekachi Onumara, Nigerian-based senior program officer at the Rural Health Foundation, in a separate interview with Health Policy Watch.

“There is much more stigma around key populations in Sub-Saharan Africa than there was five or six years ago. We have to work on this comprehensively. We also have to remember that economic fragility also brings additional risk to women and children,” Onumara told Health Policy Watch.

Gay men and sex workers are among the groups most often targeted by legal as well as social pressures that prevent them getting acces to HIV services, noted UNAIDS Executive Director Winnie Bynaymia, during the launch of last week’s 2020 Global AIDS Update.

Byanyima cited her home country, Uganda, where both groups are targeted by serious stigmatisation, backed with state legislation, including the 2014, Anti-Homosexuality Act, making homosexual acts punishable by life in prison. Such laws are common in conservative cultures of Africa as well as the Middle East and Asia. And in some countries, a backlash by conservative cultural and religious groups has seen them reinforced only recently.

“For LGBTQI laws, that’s where our criminal laws are hardest, and are not being unwound. So we have to understand this conservative backlash and see how to address it. I think such forces can only be rolled back through movement building. We cannot hope to have an open space unless we mobilize people and change attitudes,” Byanyima said last week.

“Sometimes [we] think we can solve the problem of HIV AIDS through a biomedical approach. We can’t. There is no treatment, no pre-exposure prophylaxis, ARV or whatever, that will reach the hands of a gay man in my country Uganda where the criminal law is being enforced in a harsh way,” she said.

She said the world needs to push back against conservatism that is making it harder to move forward on women’s rights or the rights of all sexual identities.

“I say this really sincerely,” she said. “Free media, freedom of association, freedom of speech, these are also under attack. And I think that for us, if we want to fight AIDS, we do need to protect those core tenants of a liberal democracy.”

Invest in Peer-Led HIV/AIDS Services 

As one means of overcoming stigma, Birx said more money needs to be invested in supporting and protecting peer-led HIV/AIDS services.

“We need to overcome the structural barriers that really plague key population programs, particularly in Sub-Saharan Africa. In many places around the globe, peer-led service delivery is much more successful outside of the public sector for many reasons.

Peer led services are more able to cope with “Stigma discrimination – It’s how people are dressed and how people are seen and spoken to and spoken with,” Birx said.

Global AIDS Response Off Track Before COVID-19

While the global AIDS response was off track before the COVID-19 pandemic, the onset of lockdowns and travel restrictions created additional setbacks. While services have since “rebounded” in many countries, according to the World Health Organization, UNAIDS has warned that the the world may still see an estimated 123,000-293,000 more HIV infections and 69,000-148,000 more AIDS-related deaths between 2020 and 2022.

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

 

 

Image Credits: UNAIDS .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr Tedros Adhanom Ghebreyesus, WHO Dicrector General.

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

The 2020 G20 Riyadh summit, November 2020.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

________________________

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

Image Credits: G20, European Health Forum Gastein.

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

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

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

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

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

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

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

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

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

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

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

Image Credits: @WHO/Yoshi Shimizu, WHO.

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

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

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

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

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

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

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

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

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

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

How COVID-19 has impacted immunisation in Africa

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

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

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

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

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

Image Credits: WHO, United Nations Photo.