Africa must tackle both the climate and coronavirus crises at the same time, according to a new paper published by the UN Economic Commission for Africa (UNECA), joining other regional agencies such as the European Commission and the World Health Organization in calling for a “green recovery” from COVID-19.

The paper, Climate Change and Development in Africa Post COVID-19: Some Critical Reflections, came on the day temperatures potentially set a grim new record for the highest temperature recorded within the Arctic Circle, where a small town in Siberia surpassed 100.4 degrees Fahrenheit.

“Sustainability in a post COVID-19 world should be based on reducing greenhouse gas emissions and protecting the environment,” writes experts from UNECA’s Africa Climate Policy Centre. “Recovery plans must not reinvest in… polluting industries but promote meaningful employment, ensure just transitions, and be based on available science.” 

The coronavirus’ breach of the animal-human barrier shows that the pandemic and climate crises are intertwined, writes the authors. Solutions must therefore address both. 

“The origin of the novel coronavirus in wildlife points to the dangers of the disruption and destruction of natural ecosystems and biodiversity, which has brought us much closer to wild animals – and their viruses.

“This ecosystem destruction is brought about by growing global demand for crops and animal-based foods, combined with unsustainable production practices (particularly industrial agriculture), and has resulted in us breaching several planetary boundaries including land use, climate change and genetic diversity.” 

World Meteorological Organization Sends Team To Confirm Record High Arctic Temperature

While the Siberian town, Verkhoyansk, is located in an area of Eastern Siberia with extreme temperatures in both the winter and summer, passing 100 degrees Fahrenheit may still set a new record for the region.

The World Meteorological Organization’s atmospheric scientists are “formally reviewing” the reports, according to a press release. 

““It has been an unusually hot spring in Siberia, and the coinciding lack of underlying snow in the region combined with overall global temperature increases, undoubtedly helped play a critical role in causing this extreme temperature observation,” said Prof Cerveny, President’s Professor of Geographical Sciences, Arizona State University.

So far, the WMO has tentatively confirmed the reports, which they say are consistent with upper atmosphere measurements above Eastern Siberia. 

Image Credits: WHO/Mwebembezi.

A COVID-19 vaccine may be the only way to halt the coronavirus

24 June 2020 (Cape Town, South Africa) – From today, South Africans volunteers will join thousands of people in the UK, US and Brazil in testing a COVID-19 candidate vaccine developed by the Oxford Jenner Institute.

The South African Ox1Cov-19 Vaccine VIDA-Trial will involve 2,000 people, including 50 people living with HIV, in a collaboration between Wits University, the University of Oxford and the Oxford Jenner Institute.

The candidate vaccine is currently being tested for safety on 4,000 Britons, with another 10,000 people expected to join the trial by the end of July as it expands to test efficacy. Within the next few weeks, 7,000 Brazilians and 10,000 US citizens will also start testing the candidate vaccine.

“This is a landmark moment for South Africa and Africa at this stage of the COVID-19 pandemic. As we enter winter in South Africa and pressure increases on public hospitals, now more than ever we need a vaccine to prevent infection by COVID-19,” said trial leader Shabir Madhi, and Professor of Vaccinology at Wits University.

Madhi said that Johannesburg residents had responded with enthusiasm to the call for volunteers: “We sent messages out via community groups and within three days, over 1000 people had come to our clinics wanting to know more about how they could be involved.”

Shabir Madhi, Principal Investigator of the first Covid-19 vaccine trial in South Africa

The study is being undertaken in urban areas where the risk of SARS-CoV2 infection is high. South Africa accounts for over half of Africa’s COVID-19 cases and this week reached 100,000 cases.

The double-blinded randomised control trial is expected to last a year, but Madhi said that “once 42 people have tested positive for the virus, we will know whether it will work or not”, adding that the vaccine would need to show at least 60% efficacy to be viable.

Madhi added that genetic information, including blood type, would be collected from volunteers to see whether this had any impact on infection.

Participants will be given an E-diary to record any symptoms experienced for seven days after receiving the vaccine. They will also record if they feel unwell for the following three weeks.

Following vaccination, participants will attend a series of follow-up visits. During these visits, researchers will review the completed diaries and take blood samples to assess their immune response to the vaccine.

If participants develop COVID-19 symptoms during the study, a member of the clinical team will assess them for infection and, if they become particularly unwell, they will be helped to get hospital care.

The technical name of the vaccine is ChAdOx1 nCoV-19, as it is made from an adenovirus called ChAdOx1. The vaccine contains genetic material that codes for the spike glycoprotein expressed on the surface of the SARS-CoV-2 virus.

The virus that causes COVID-19 uses this spike protein to bind to ACE2 receptors on human cells. Researchers have already shown that antibodies produced against sections of the spike protein after natural infection are able to neutralize the virus when tested in the laboratory.

By vaccinating volunteers with ChAdOx1 nCoV-19, scientists hope to make the human body recognise and develop an immune response to the spike glycoprotein that will help stop the SARS-CoV-2 virus from entering human cells and causing COVID-19.

The South African study has been approved by the South African Health Products Regulatory Authority (SAHPRA) and the Human Research Ethics Committee of the University of the Witwatersrand.

Helen Rees, Chair of South African Health Products Regulatory Authority

“It is essential that vaccine studies are performed in southern hemisphere countries, including in the African region, concurrently with studies in northern hemisphere countries,” says Professor Helen Rees, Chair of SAHPRA.

“This allows evaluation of the efficacy and safety of candidate vaccines to be assessed in a global context to see whether they work across different populations.”

However, Rees warned that access to any vaccine would be highly competitive and a vaccine might have to be rationed initially with health workers possibly being the first to be vaccinated.

There are currently over 260 candidate COVID-19 vaccines in development around the world. The ChAdOx1-Cov19 vaccine is one of only five vaccines that are currently in the clinical development phase in humans, with the studies mainly being done in China, USA, UK, Australia and Europe.

Image Credits: Kerry Cullinan , University of the Witwatersrand, University of the Witwatersrand.

To mark Olympic Day, the International Olympic Committee (IOC) launched a partnership with the WHO and the UN to inspire healthy behavior around the world, announced a WHO statement on Tuesday.

As COVID-19 upends daily routines and lives around the world, we need to pay attention to our own mental and physical health and help others who may need extra support, said the statement.

In a global collaboration with athletes during the pandemic, the WHO will bring tailored health messages to people around the globe through digital platforms.

“We are pleased to partner with the International Olympic Committee to spread important health messages that will save lives”, said WHO’s Director-General Dr Tedros Adhanom Ghebreyesus. “Olympians will help us advocate for healthier populations to ensure that people are as resilient as our health systems must be to fight COVID-19.”

Said IOC President Thomas Bach: “Sport can save lives. We have seen over the last few months just how important sport and physical activity are for health and well-being. And working together with the WHO and the United Nations we can take another step together. We will ask our Olympic athletes to help share the information and best practice that the world needs now.”

Physical activity can boost physical and mental well-being

According to a WHO survey, people with chronic diseases (NCDs) like hypertension, diabetes or obesity are more likely to be critically ill with COVID-19.

In Italy, for instance, 98% of people that died from COVID-19 had pre-existing conditions, including cardiovascular issues (67%) and diabetes (31%). And diabetics are twice as likely to die from COVID-19 compared to people without diabetes.

Chronic diseases are triggered by unhealthy lifestyles like physical inactivity, tobacco use, unhealthy diets and harmful use of alcohol. 

Image Credits: Derek Jensen (Tysto), International Olympic Committee, WHO and United Nations.

New digital technologies such as smartphone apps and localization data have been used to model and monitor the COVID-19 pandemic. But along with hopes that these tools will help curb the pandemic, their use by both authoritarian and democratic governments can invoke images of dystopian surveillance.

These tensions and more will be discussed Wednesday at Will Digital Technologies Save Us from the Pandemic?, the third panel in the Global Pandemics in an Unequal World Series, co-hosted by The New School, The Independent Panel on Global Governance for Health, and Health Policy Watch. 

Cities in China and the Republic of Korea have implemented contact tracing apps that require citizens to input information on daily temperatures and coronavirus symptoms. Taiwan uses a quarantine app that monitors location data on COVID-19 patients, ensuring they remain in isolation. In the United States, anonymized cell phone data has been used to model the spread of the disease. 

“Smartphone apps dominate global discourses on managing the pandemic,” said Sakiko Fukuda-Parr, director of the Julien J. Studley Graduate Programs in International Affairs and professor of International Affairs at The New School. “But let’s not forget public health infrastructure and methods that resulted in 20th century advances in controlling contagious diseases.”  

In the absence of a vaccine or cure, countries have turned towards “classic public health measures” such as contact tracing to map and control the spread of the virus. 

In the United States, which hosts the most coronavirus cases in the world, New York City’s army of contact tracers is doing things the old fashioned way – calling patients who test positive to identify those most at risk of onwards transmission.

Concerns Around Privacy Slow Public Health Surveillance Efforts In NYC
NYC subway resumes normal operation as city shifts to Phase 1. As cities, rapidly identifying new clusters of disease is important to help prevent a resurgence.

But as widespread protests against police brutality grip the United States, old concerns about the ethical use of public health surveillance have resurfaced in New York City, the original epicentre of the US’ COVID-19 epidemic. 

Contact tracing requires asking people for personal information about coworkers, friends, and family members they have been in contact with – and some are hesitant to divulge personal information in the current political climate. Some protestors have been concerned that information used for contact tracing could be repurposed by law enforcement or immigration officers, Naiya*, a community organizer from NYC told Health Policy Watch. 

“While contact tracing may provide critical data to inform policy, it’s use in a racist and carceral society can transform contact tracing into a weapon for state surveillance and for the policing and control of vulnerable people,” they said. “We have to envision community-led, resource oriented, and consensual efforts to contain the pandemic.” 

New York City’s contact tracing team doesn’t ask people about their histories attending protests, according to Sarah*, a contact tracer in Manhattan. Nor does the team ask about immigration status, or divulge patients’ COVID-19 test information to employers or law enforcement. 

Regardless, “some folks are skeptical to share info about their contacts,” said Sarah. “I think privacy is the big concern. For example, home health aides have been hesitant to divulge information about their patients.” 

“If people are hesitant to share, we give them a number to call back after they have done more research on us, and if they feel comfortable sharing their contacts at a later date.”  

Who Creates and Accesses Data in the Smartphone Age?

Some experts are worried that new technologies amplify existing concerns around the ethical use of public health surveillance. In one widely reported case, authorities used information from rideshare company Uber to track down potential contacts of a COVID-19 patient, leading to the suspension of over 240 accounts and two drivers from the platform. 

“Viewed superficially, that’s responsible — but what’s actually happening here is that a private company suspended the livelihood of two drivers and a number of others’ mobility, based on suspicion of exposure, without a whole lot of science,”  writes Sean McDonald, a senior fellow at the Center for International Governance Innovation.

“Concerns surrounding corporate and political interests converge in the contexts of this current global pandemic,”  writes Stephen Roberts, a Global Health Policy fellow at the London School of Economics, noting a growing unease with the increasing role of large, private tech corporations in assisting governments with managing emergencies.

The United Kingdom, for example, recently partnered with Google, Amazon, and data processing firm Palantir on a COVID-19 surveillance project. Google had previously sparked controversy by breaching patient privacy laws when transferring billions of identifiable patient records without consent for a clinical alert app, according to Roberts. Palantir infamously supplied data to United States immigration authorities to inform deportations and family separations. 

 “Public health technologies must be considered within their sociopolitical and economic contexts; and histories,” said Naiya. “In pursuing such measures, we must ask ourselves: Who is this tool benefiting? How do we protect Black, brown, indigenous, undocumented, and disabled communities from violence and retaliation?”

For more on this topic, tune in Thursday to the Will Digital Technologies Save Us from the Pandemic? webinar at 10AM EST/4PM CET.

*Names changed by request of sources

Image Credits: Marc A. Hermann / MTA New York City Transit, NHS England.

Rwanda uses robots to deliver food, drugs & other necessities to quarantined patients, reducing healthcare workers’ exposure to COVID-19.

19 June 2020 (Ibadan, Nigeria) – We are at war with COVID-19, a war we must win to survive, said Dr John Nkengasong, Director of the Africa Centres for Disease Control, on Friday at a workshop on “Home-Grown Solutions to the COVID-19 Health Crisis,” hosted by the United Nations Development Programme.

Since the continent’s first confirmed case of COVID-19 was reported in Egypt in February 2020, the virus has spread across Africa to every country on the continent. However, initial grim predictions about the pandemic in Africa have yet to pass – a development that Nkengasong attributed to early measures that were taken to minimise the pandemic’s impact.

But four months into the pandemic, the Africa CDC Director noted that current measures including social distancing, wearing face masks, handwashing and movement restrictions will be inadequate in curbing the virus on the continent.

“We have to innovate ourselves out of the war,” Nkengasong said.

John Nkengasong, Africa CDC Director

From the outset of the pandemic, African countries have been scaling up cooperation; Africa CDC has also been coordinating response efforts including procuring diagnostic kits, drugs PPEs for African countries. Nkengasong noted that ongoing collaboration and communication among member states of the African Union will help in accelerating the continent’s journey to recovery from the impact of the pandemic on Africa economies. 

“We cannot unlock economies safely without expanding COVID-19 testing, contact tracing and getting effective treatment,” he said. He also identified diagnostics, vaccines and therapies as important components that must be in place to put the end of the pandemic within reach.

Efforts around these key issues have been advancing globally. Health Policy Watch recently reported the emergence of dexamethasone as an effective treatment in reducing mortality in patients with severe COVID-19 by up to one-third. 

Still, Nkengasong noted, relying on international cooperation alone to develop potent tools for the disease is ineffective.

Opportunities for Innovation Across Africa

Workers manufacture PPE in a Kenyan factory

When Rwanda deployed anti-epidemic robots to aid its response against COVID-19, it became a major example of opportunities for innovation. Clare Akamanzi, Executive Director and Chief Executive Officer of the Rwanda Development Board, noted that the robots have reduced the risks of exposure of the country’s health workers to COVID-19 by taking over routine activities such as temperature checks, food and drug delivery to individuals that tested positive and have been quarantined.

Global shortages of surgical masks and personal protective equipment compelled the country to look inwards for solutions; including importing machines from China to enable local production of much needed health consumables.

“76 local companies are now manufacturing face masks in Rwanda, three are making surgical masks while one is making PPEs – all have been certified by the Rwanda Food and Drugs Authority,” Akamanzi said.

She also mentioned the utilisation of 3D printing technology to make face shields for healthcare workers and the deployment of drones to enforce lockdown and social distancing rules by taking pictures of areas where public gatherings are being held.

Dr Julie Makani, Tanzanian medical researcher, noted that the multi-sectoral deployment of innovations during the COVID-19 pandemic would provide African countries with tools that can be converted for other health services.

For example, she pointed to a number of African countries, including Nigeria and Ghana, that are also deploying telemedicine to ensure that individuals living with sickle cell disease have access to professionals. 

Home Grown Solutions for the Continent

Bience Gawanas, Under-Secretary-General of the United Nations

While Rwanda’s pandemic robots were donated by UNDP, Bience Gawanas, Under-Secretary-General of the United Nations, argued that Africa can also play a more central role in developing the tools that the continent will use to combat the pandemic beyond simply mobilising already existing innovations.

She noted that limited capacities made it difficult for many hospitals in Africa to make use of donated equipment – a problem that could be addressed if Africa were the one that is providing the innovations. Moreover, she noted that Africa is in a better position to define its own priorities – which could differ from one country to another in the middle of the same pandemic.

“This is not just a health issue, it is also a social issue. Necessity is the mother of all invention and Africa’s economic independence will only happen when it changes from relying on foreign products to a continent that can produce,” Gawanas said.

As just one example, several African youths are repairing ventilators, and local innovators in Nigeria and other African countries have also presented prototypes of cheaper ventilators that could save lives, potentially providing easier access to the lifesaving devices that are in short supply globally.

However, controversies surrounding Madagascar’s COVID-19 cure claim brought attention to the continent’s scientific research ecosystem and existing gaps in clinical trials protocol. Author and researcher, Dr. Chika Ezeanya-Esiobu, noted that such developments may be due to the inability of African researchers to afford a conventional clinical trial. 

She noted that COVID-19 has confirmed that Western countries alone can no longer be relied upon to solve all of the world’s health problems and Africa should maximise the opportunity presented by COVID-19 to revamp, improve and localise its drug research strategies – putting the continent’s priorities and peculiarities into consideration. 

“Africa might hold the key to the solution of health challenges that face the whole of humanity which is why we need clinical trial processes that the continent can afford. Current approaches can only be funded by pharmaceutical giants that are driven by profits,” Esiobu noted.

The Enemy from Within

Pharmacy technician working on production of herbal medicines

Before the continent will be able to convince the rest of the world that its drugs and other innovations can be trusted, Ssali Rose, Managing Director of Ssali Publishing House, noted that Africans need to get over negative perceptions about locally developed medicines, especially one that equates local medicines to witchcraft (an esoteric practice).

“We need to decolonize our minds and accept that we must craft our own solutions so that we can quickly get ourselves out of the situation that we’ve found ourselves in. African governments also need to relax barriers so that it would be easier for one innovation from one part of Africa to be adopted by other African countries,” Rose said.

While agreeing that Africa needs to take a more central role in the development of tools for its healthcare sector, Nkengasong noted that the continent’s innovators, governments and other stakeholders must ensure that Africa’s innovations go through the rigor of scientific testing so that the rest of the world will begin to take solutions from Africa more seriously.

“Victory will be continental but the battle will be won locally,” Nkengasong said.

Image Credits: Twitter: Rwanda Ministry of ICT and Innovation, APO/MOH Kenya , AMR Industry Alliance.

A refugee filling an application at the UNHCR registration center in Tripoli, Lebanon.

As the world hit a sober new milestone of reporting more than 150,000 new COVID-19 cases in one day, another slow burning crisis has also reached new heights.

There are now nearly 80 million refugees around the world, making more than 1% of the world’s population forcibly displaced by the end of 2019, according to the United Nations High Commissioner for Refugees (UNHCR) annual report, released just days ahead of World Refugee Day on 20 June.

The number of new refugees shot up by nearly 10 million people from 2018 to 2019, compared to a 3 million rise in the number of refugees between 2017 to 2018. 

“We reported a dramatic increase in displacement figures last year compared to the year before,” said UNHCR Commissioner Filippo Grandi, speaking at the World Health Organization’s regular Friday COVID-19 press briefing. “This means that the opportunities for solving force displacement are receding. We are living in a world in which making peace is very difficult.”

“Refugees are particularly at risk of COVID-19 because they often have limited access to adequate shelter water, nutrition, sanitation and health services,” said WHO director-General Dr Tedros Adhanom Ghebreyesus.

The pandemic is exposing those forcibly displaced to even “more hardship,” added the DG, noting that in some places like Turkey, up to 70% of refugees have lost their jobs since the pandemic began.

“Contrary to the political rhetoric, almost 85% of refugees live in low- and middle- income countries,” said Grandi. “This means [they are in] countries that not only have fragile institutions and fragile economies, but also often fragile health systems.

“And remember, the majority of refugees and displaced are actually not in refugee camps, they live in communities. And those communities in some places have already been devastated by the pandemic.”

In those communities, it’s “extremely” important that the same services for refugees are being provided for the hosting community, said Grandi and WHO Health Emergencies Director Mike Ryan.

“We can’t create differentials because another risk that a pandemic might generate is further stigmatization of people that are not mainstream in that [host] community,” said Grandi.

Image Credits: Mohamed Azakir / World Bank.

Electron microscope photograph of a dying cell (green) heavily infected with SARS-CoV-2 (purple)

A standardized set of more than 80 compounds with known or predicted activity against SARS-CoV-2, the virus that causes COVID-19, has been compiled by the Medicines for Malaria Venture in an effort to catalyze the discovery of drugs for the disease.

The announcement comes amidst rapid shifts in the research around potential COVID-19 treatments. Just this week, the much-hyped antimalarial hydroxychloroquine lost favor as a potential treatment when preliminary data from the two large clinical trials showed it did not decrease mortality in COVID-19 patients. Fresh hope was pinned on the anti-inflammatory drug dexamethasone, a relatively new player, after results from the United Kingdom’s Recovery Trial found it was associated with a dramatic reduction in mortality in patients suffering from severe COVID-19.

“”Recent reports of the efficacy of dexamethasone for treatment of COVID-19 highlight the value of exploring all options for new treatments,” Dr Timothy Wells, MMV’s Chief Scientific Officer, told Health Policy Watch. “With MMV’s COVID Box we have combed through the scientific data to identify a collection of compounds with claimed or predicted activity against the virus – to our knowledge this is the only attempt to prepare and distribute such a compound set.”

The COVID Box contains some 80 marketed drugs and compounds in development that could potentially be used to treat the virus, and will be available free-of-charge by request to any scientists seeking to research potential treatments for the disease.

In return, researchers using the box are asked to publish their findings in open-access domains, thus making it faster to share relevant information on any of the candidate compounds.

The Box is ‘complementary’ to other initiatives to accelerate new tools for combatting the COVID pandemic, added an MMV spokesperson. Pooling all compounds with activity against the virus in one place gives scientists a base to start narrowing down potential treatment candidates.

Launch of the COVID Box launch follows on from an earlier initiative, the Pandemic Response Box launched by MMV and the Drugs for Neglected Diseases Initiative (DNDi) in 2019. That set contained over 400 compounds with antibacterial, antiviral, or antifungal properties that could potentially be used to combat the next pandemic threat. The advent of the COVID-19 pandemic prompted MMV’s scientists to begin combing through the data on compounds with specific activity against SARS-CoV-2 and 30 related viruses. This led to the selection of the initial 80 compounds in the box. Another 80 compounds will soon be added to the Box, according to an MMV press release.

‘Open Science’ Model Helps Accelerate Research By Narrowing Down Compounds

Dr Sara Cherry’s Virology lab at the University of Pennsylvania has been screening many of the compounds in the original Pandemic Response Box to test for those that may block entry of the SARS-CoV-2 virus into human lung cells.

“Pretty early in the game, we began screening [compounds] using an assay that we developed where we basically take cells, we add drugs, and then we add the virus. And then we look at the viral infection in the cells to see if there are compounds that block infection,” explained Dr Cherry.

But compounds that show activity against the virus in a lab studies may not be effective against the virus in a human body.

And even in lab experiments, compounds can react differently to the virus based on the type of cell model used, according to Dr Cherry.

“Because the [COVID box] narrows the list of compounds down to a smaller set, more people can test them in more relevant models, rather than creating unnecessarily large libraries where it’s hard to screen in more relevant models like lung cells,” said Cherry, welcoming the more targeted set of compounds the box contains.

An Important Finding from Targeted Screening Studies: Chloroquine & Chloroquine Derivatives Can’t Block Virus Entry into Lung Cells

Colorized electron microscope photograph of SARS-CoV-2 (yellow) heavily infecting a dying cell (blue)

For example, earlier studies of compounds with potential activity against SARS-CoV-2 used a cell line derived from the kidneys of African green monkeys, called Vero, which can easily be infected by novel viruses, thus making it easier to reproduce in large quantities for large studies screening many different compounds.

But Cherry said that while the Vero cell may be simpler to set up as a cell model, it does not most accurately mimic how SARS-CoV-2 attacks the human lungs.

“We found that very few of the drugs that people reported are antiviral in Vero cells are active in [our lung cell model],” said Dr Cherry. Many of the molecules in the same family of drugs as hydroxychloroquine for example, can help block the virus from entering the Vero cell line, but do not block the virus from entering a lung cell, which may partially explain hydroxychloroquine’s lackluster performance in recent clinical trials.

“What this tells you is that the virus can enter cells in different ways, and we should really be focusing on [how it enters] lung cells, because that’s where the problem is during human infection,” said Cherry. A promising candidate compound is camostat mesylate, which blocks  the TMPRSS2 protease, a key protein that helps SARS-CoV-2 enter lung cells.

“With this move towards open science, I think it’s been really helpful for everyone to learn about what drugs might be active against the virus,” said Dr Cherry. “That level of data sharing could move everything faster to potentially help people. So I think MMV, by collating this all together and providing a resource is really very valuable for everyone.”

Image Credits: NIAID, NIAID, MMV.

Unhealthy food habits drive obesity

In the past forty years, the world has done “really well” on improving food availability.  But  meanwhile, diets have shifted in “very bad”, unhealthy directions. Even people who can afford nutritious food are opting for junk food instead, said Steve Godfrey, of the Geneva-based food and nutrition NGO, GAIN, at a conference on food systems hosted by Geneva’s Graduate Institute on Tuesday.

Improving food systems is essential because diet is the “single biggest cause” of disease burden worldwide, added Lina Mahy, WHO’s Technical Officer for Nutrition and Food Safety, who also spoke at Tuesday’s event.

Unhealthy diets claim 11 million lives a year. They also lead to stunting in 20% of children worldwide, and contribute to malnutrition in a third of the population.

“Sugar now is more dangerous than gunpowder”, said Githinji Gitahi, CEO, of the Nairobi-based NGO Amref Health Africa. “More people are dying of sugar than from terrorism and violence…Three times as many people are overweight and obese than those that are hungry.”

At the same time, accessing sufficient food has become an even bigger challenge for many people living on subsistence incomes and diets, particularly in COVID-challenged times. 

School feeding programmes – an important component of nutrition support for children and adolescents  – have shut down completely in some communities, said Igbeka. Products that would have been used by schools remained in producer’s warehouses, where their storage capacity is “very limited” and technologies for long-term preservation are minimal.

After Ebola, “nothing was done” to build resilient health and food systems, said Gitahi, and we are facing the same challenges now. 

“Food is about dignity,” he added, describing food security as a foundation of health.   

Government Lockdowns Have Far-reaching Impacts On Frail Food Systems

COVID-19 had ‘minor impact’ on 3% of businesses surveyed

In Africa, government-imposed lockdowns have had ‘far-reaching’ impacts on already-frail food systems because workers have not been able to get to production sites or access their farms, said Uduak Igbeka, Country Support Manager for the SUN Business Network, a global movement of 61 countries to end malnutrition.

And closed borders have limited exports of foods like avocados or eggs from Nigeria, Kenya and Ghana.

In West Africa, restrictions on movement have “seriously” impacted the planting season – and have slashed production volumes and sales, while also destabilizing food prices in the whole of Africa:

In one study of some 340 small- and medium- sized enterprises (SMEs), 80% reported decreased food sales, and only 3% said that the coronavirus had ‘little impact’ on their business, she added. Over 50% of businesses said the impact was ‘considerable’ and ‘difficult to manage’, with almost one fifth risking closure.

“We can see that there is high demand for technical support”, said Igbeka. “We are carrying out capacity building initiatives in different countries to see how we can bring the right knowledge [to SMEs] and [help] businesses adapt to the current situation [so that they can] survive it themselves.”

Fostering Food Resilience – Stronger Governance Critical

Bees are essential to pollinate food crops

The world has the tools to foster food system resilience for better health, said Gitahi. However, we need to use them “now” to build back better from the pandemic.

Good governance is part of the answer, he said.

Governments need to “make the link” between health, food and the environment said Mahy, because these systems don’t exist in a vacuum.

“Health and food are very intimately connected..the strength of our health systems depends on food [systems]” and on the environment, said Godfrey. 

Bees, for instance, are “essential for our food systems to work, but they’re dying”, said Mahy.

Protecting Health – Smart Investments, Legislation & Stakeholder Engagement 

Carefully-crafted policies also can nudge people to eat healthier food. They can make healthy food accessible to the most vulnerable, while shooing people away from toxic foods that are high in sugar, salt or unhealthy trans fats – principally by making them more expensive:

“We must bring legislation & regulation to the table, and civil society must force governments to improve regulation of unhealthy foods”, said Gitahi. “Countries need to regulate sugar imports, regulate unhealthy fats, and the time to do it is now.”

But such policies and rules also need public support – and that requires awareness-raising about the health benefits of balanced and varied diets:

“This is a time where dietary diversification needs to be emphasized… people need to know what to eat, there needs to be advice on what exactly is good.”

“Stakeholder engagement is very critical in gaining equity,” added Igbeka. “All players need to be able to understand what is in the best interest of each other.”

Data Is Vital To Identify Malnourished and Undernourished

Githinji Gitahi, CEO of Amref Health Africa.

Data is vital to identify groups that are suffering the most from poor access to food or lack of nutritious foods. 

While real-time data is plentiful for COVID-19, there is “very little clear data on food availability, pricing and differentials…that’s quite a big gap” that needs to be addressed, added Godfrey.

“In Africa, there is a lack of disaggregated data to determine who is vulnerable”, said Gitahi. ”Who do you give aid to if you don’t know who’s vulnerable? Data is extremely critical.” 

And even when there is data, it’s often not made publicly available, or it doesn’t target those that actually need help, mainly because of rigid eligibility criteria:

“We don’t know who to give [aid to], so you end up spreading [limited money] across everyone because you don’t know exactly [who needs help].”

According to Gitahi, the best way to improve access to food in Africa in the present health emergency is not going to be via the traditional aid paradigm of big conveys delivering sacks of flour, corn or basic necessities. Rather, data-driven approaches can identify households or communities in greatest need, and systems like mobile cash transfers can help ensure that aid reaches them for the purchase of basic necessities. 

Image Credits: Flip, photophilde.

Smiling schoolgirls get their pictures taken near Jinja, Uganda.

While children seem to largely escape the worst COVID-19 infections, lockdowns to curb the pandemic have increased exposure to a different threat to children’s health – abuse and violence.

In Eastern Uganda, where so far no child has been infected with COVID-19, lockdowns have led to an uptick in reports of child abuse, exploitation, and violence.

In Mayuge district, 59 cases of defilement – or the sexual abuse of a child – have been reported since the national lockdown began two months ago, according to a qualitative study led by local non-profit Community Concerns Uganda. Some 58 cases have been recorded in Jinja district.

“Many girls have entered cross-generational relationships to access basic supplies like pads and soap, which has contributed to early pregnancies,” Brenda Doreen Nakirya, managing director of Community Concerns Uganda, told Health Policy Watch.

Because parents, working as casual labourers or owners of small businesses, have lost their source of income since lockdowns began, many families are unable to feed their children regularly.

And essential menstrual products for girls, like sanitary pads, are “no longer a priority” for cash-strapped families, said Nakirya.

Additionally, the closure of schools, which act as safe havens for many children has increased the risk of experiencing violence.

“Generally, the pandemic has worsened the living conditions of children, putting them at an increased to gender-based violence at a time when reporting channels and referral pathways are severely affected,” said Nakirya.

“COVID-19 has greatly limited children’s access to basic needs including food and health care.”

Child Violence As A Global Problem
A young girl wearing a mask holds a laptop. Children are shifting to online learning as schools shut down during the COVID-19 pandemic.

The situation in Eastern Uganda is just a snapshot of a pervasive global problem. Approximately 1 billion children every year are affected by physical, emotional, sexual, or psychological violence, and COVID-19 lockdowns could be exacerbating abuse, according to a new report published Thursday by several UN agencies, including UNICEF, and the End Violence Partnership.

A staggering 40,105 children were victims of homicide in 2017, according to the report. The homicide rate in boys was almost twice that of the rate in girls worldwide. Boys in the Americas faced the highest risk, with a staggering rate of 9.3 homicides per 100,000 people in boys under 17. Some 120 million girls experienced unwanted sexual contact before the age of 20.

COVID-19 Closures Lead to Increase In Violence Against Children

School closures have forced almost 1.5 billion children to stay at home, with many engaging in online learning for the first time.

Amidst the COVID-19 lockdowns, cases of domestic abuse, as children and spouses are forced to shelter-in-place with their abusers, have spiked. According to the Global Status Report on Preventing Violence Against Children 2020, one in four children under 5 lives with a mother who suffers from intimate partner violence. Nearly 75% of toddlers age 2-4 regularly suffer physical punishment and or psychological violence at the hands of caregivers and parents.

There has been a rise in cyberbullying and online exploitation of children, according to Audrey Azoulay, UNESCO Director-General. A third of students between the ages of 11 to 15 were bullied in the past month, according to the report. Cyberbullying affects 1 in 10 children worldwide.

A young boy plays a video game at the Binational Border Assistance Center on the border of Peru and Ecuador.

And even as cases of violence rise, children are separated from normal sources of emotional support including friends, extended family, and mental health professionals. An increase in calls to domestic violence helplines has been observed, alongside a decrease in the number of abuse cases referred to child protection services.

“Violence against children has always been pervasive, and now things could be getting much worse,” said UNICEF Executive Director Henrietta Fore. “Lockdowns, school closures and movement restrictions have left far too many children stuck with their abusers, without the safe space that school would normally offer.

“It is urgent to scale up efforts to protect children during these times and beyond, including by designating social service workers as essential and strengthening child helplines.”

INSPIRE Framework Promotes Key Child Protection Strategies

Using the INSPIRE framework, which promotes seven key child protection strategies, countries can make progress against violence. However, the report, the first one to compare progress in 155 countries against the framework, found that countries are lagging behind in implementing all seven strategies, despite about 80% of countries having a national strategy to reduce violence against children. 

Among 155 countries, only about 20% of those national strategies were fully funded. Some 88% had laws protecting children against violence, but only 47% strongly enforced such laws.

Countries made the most progress in collecting data and school enrollment, with 54% of countries reporting that a sufficient amount of children in need were enrolled in school. Some 83% of countries reported having national data on violence against children.

However, only 21% used national data to set targets to prevent and respond to such violence. And only about a third of countries believed that victims of violence could adequately access support services, and some 26% of countries had programmes supporting parents and caregivers.

Even fewer countries reported enacting programmes to address norms and environments around child abuse. Some 21% of countries reported programmes to change harmful norms, while only 15% had programmes to provide safe physical community spaces for children.

Image Credits: UNICEF, Flickr: neiljs, UNICEF Ecuador.

Mwelecele Ntuli Malecela, director of NTD Control at WHO

As COVID-19 puts the world collectively on pause, essential programmes for neglected tropical diseases (NTDs) are also feeling the cut.

NTDs are estimated to impact up to 1.3 billion people around the world, mostly prevalent in poor, marginalized communities with low access to healthcare.

“One of the things that’s been severely affected is our neglected tropical disease programmes,” said Mwelecele Ntuli Malecela, director of NTD Control at WHO. “Particularly in Africa, as part of the focus on social distancing, we’ve had to stop most of the mass drug administration programmes.”

“NTDs are a group of 20 diseases, including elephantiasis, sleeping sickness, leprosy, trachoma, and intestinal worms that collectively wreak havoc on the poorest and most marginalized communities,” explained WHO Director-General Dr Tedros Adhanom Ghebreyesus. “These diseases disfigure, disable and can kill. And they strike hardest in place spaces of poverty. And in remote areas where access to quality health services is extremely limited.”

Mass drug administration (MDA), or the regular administration of safe anti-parasitic drugs to everyone living an NTD-prevalent area, is a cost-efficient intervention that helps control the most common NTDs, such as intestinal worms.

But in the wake of COVID-19, official WHO guidelines have urged countries to put a pause on MDA campaigns.

The focus now is on how to improve programmes as countries come out of lockdown, post-COVID-19, said Ntuli Malecela.

“Are there innovative ways that we can actually carry out these programs where people can be treated… while ensuring the safety of the people being treated and the safety of the community health workers who are treating them? That is the ongoing discussion,” she added.

A new, 10-year Roadmap for NTD control will be released in late August by the World Health Organization. The organization will be hosting a series of webinars in anticipation of the Roadmap launch.

For more on NTDs, see the draft Roadmap here.